JSES - 2026-04-07 - Case Reports; Journal Article
Minimum Five-Year Outcomes of Anatomic Total Shoulder Arthroplasty with the Arthrosurface Aspherical Humerus and Inlay Glenoid.
Harkin W, Lew RM, Hornung A, Kurowicki J, Hussain ZB, Hummel A, Garrigues GE, Nicholson GP
Topics
Key Takeaway
At mean 82.2 months follow-up, zero of 45 shoulders required revision for symptomatic glenoid loosening after aTSA with an Arthrosurface inlay glenoid, with no significant radiolucency progression on radiographs in 30 patients with 5-year imaging.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective series evaluated minimum 5-year clinical and radiographic outcomes of aTSA using the Arthrosurface aspherical stemless humeral head and inlay glenoid in 45 predominantly male (91%), active patients with mean age 54.9 years. All four PROMs (ASES, VAS, SANE, SF-12 physical) improved significantly and exceeded MCID thresholds; forward elevation improved from 116.0° to 158.8° and external rotation from 26.0° to 53.3°. Five patients (11%) required revision—four to rTSA for soft-tissue failures and one for infection—with no revisions attributable to glenoid loosening and no significant radiolucency progression in the radiographic cohort.
Key Limitation
The single-surgeon, single-implant retrospective design with no comparator group (onlay glenoid or rTSA) prevents any conclusion about whether the inlay design specifically drives the low loosening rate versus patient selection or surgical volume effects.
Original Abstract
BACKGROUND
Aseptic glenoid loosening is the most common cause of revision after anatomic total shoulder arthroplasty (aTSA). Inlay glenoid components have been shown to reduce edge loading and opposite-edge lift-off forces compared with onlay glenoids. Early clinical results of inlay glenoids have been promising, although there is a paucity of literature detailing mid- to long-term follow-up. We report the minimum five-year clinical and radiographic outcomes after aTSA with the Arthrosurface inlay glenoid component and a stemless, aspherical humeral head in an active, young patient population.
METHODS
A retrospective review of aTSA with an inlay glenoid component and an aspherical humeral head component was performed for 45 shoulders. Patients were evaluated with patient-reported outcome measures, range of motion, and radiographs. Return to occupational and sporting activity, complications, and reoperations were analyzed.
RESULTS
A total of 45 patients were available for an average follow up of 82.2 ± 21.7 months. The average age of the cohort was 54.9 +/- 7.6 years and 41/45 (91.1%) were males. ASES, VAS, SANE, and SF-12 physical patient reported outcome measures (PROMs) were all significantly improved. Each of these improvements in PROMs also exceeded the established minimum clinically important difference (MCID). Active forward elevation significantly improved from 116.0 +/- 28.4 degrees pre-operatively to 158.8 +/- 20.6 degrees post-operatively. Active external rotation significantly improved from 26.0 +/- 14.5 degrees to 53.3 +/- 16.2 degrees. Five total patients underwent a revision shoulder arthroplasty during the study period. Four had revision to a reverse total shoulder arthroplasty (rTSA) for subscapularis failure (2), superior rotator cuff failure (1), and stiffness (1). No patient was revised for symptomatic glenoid loosening. Another patient had an antibiotic spacer placed for infection. Among the 30 patients with five-year radiographic follow-up, there was no significant progression of radiolucency around the glenoid component between initial post-operative films and final follow-up.
CONCLUSION
Anatomic total shoulder arthroplasty with the Arthrosurface inlay glenoid coupled with a stemless, aspherical humeral head in a young, active population results in durable improvements in function and range of motion with minimal evidence of glenoid loosening at mid-term follow-up.