JAAOS - 2026-03-11 - Journal Article
Anatomic Total Shoulder Arthroplasty: Long-Term Clinical, Radiographic, and Patient-Reported Outcomes.
Patel AV, White CA, Schroen CA, Cirino CM, Ranson WA, Shukla DR, Galatz LM, Parsons BO, Flatow EL, Cagle PJ
Topics
Key Takeaway
Anatomic TSA achieves 97% implant survivorship at 10 years but drops to 72% at 20 years, with ASES scores improving from 34.8 to 72.6 at mean 15-year follow-up.
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Summary
This study evaluated long-term clinical, functional, and radiographic outcomes in 78 patients undergoing aTSA with minimum 10-year follow-up. All ROM parameters and PROs improved significantly: forward elevation +28.8°, external rotation +32.4°, ASES 34.8→72.6, VAS pain 6.4→2.3. Implant survivorship was 97% at 10 years, declining to 72% at 20 years.
Key Limitation
Single-institution retrospective design with no reporting of glenoid component design or fixation type limits generalizability and prevents identification of implant-specific failure modes driving the late survivorship decline.
Original Abstract
BACKGROUND
Short- to midterm outcomes following anatomic total shoulder arthroplasty (aTSA) are well documented. However, few studies to date have reported on long-term outcomes following aTSA. The purpose of this study was to investigate and report the long-term clinical, functional, and radiographic outcomes of patients who underwent anatomic aTSA at our institution.
METHODS
Patients who underwent aTSA with a minimum of 10.0 years of follow-up were included. Range of motion (ROM; forward elevation, external rotation, internal rotation), patient-reported outcomes (American Shoulder and Elbow Surgeons score, simple shoulder test, and visual analog scale scores), and radiographic variables (glenoid morphology, lateral humeral offset, acromiohumeral interval, and humeral lucency) were recorded. Implant failure-free survival was defined as shoulders requiring no revision surgeries following primary aTSA.
RESULTS
Seventy-eight patients (78 shoulders) were included with an average age at surgery of 63.2 ± 8.4 years and a mean follow-up of 15.0 ± 4.5 years. All measurements of ROM saw notable preoperative to postoperative improvements. Overall, forward elevation improved from 118.8° ± 23.9° preoperatively to 147.6° ± 22.6° postoperatively (P < 0.01). External rotation improved from 22.3° ± 25.8° to 54.7° ± 18.6° (P < 0.01); internal rotation improved from L4 to T12 (P < 0.01). American Shoulder and Elbow Surgeons scores improved from 34.8 ± 21.6 preoperatively to 72.6 ± 23.0 postoperatively (P < 0.01). Simple shoulder test scores improved from 3.5 ± 2.6 preoperatively to 8.1 ± 3.4 postoperatively (P < 0.01). Visual analog scale pain scores improved from a mean preoperative score of 6.4 ± 2.7 to a mean postoperative score of 2.3 ± 2.8 (P < 0.01). Implant survivorship was 97% at 10 years and 72% at 20 years.
CONCLUSION
aTSA provides long-term improvements in pain scores, ROM, and shoulder function. Implant survivorship was excellent and demonstrated aTSA results to be durable at 20 years postoperatively.
LEVEL OF EVIDENCE
IV.