JSES - 2026-06-17 - Journal Article
Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years.
Jomaa M, Ingoe H, Hollman F, Pareyón R, Whitehouse SL, Du P, Gill DRJ, Maharaj J, Gupta A, Cutbush K
Topics
Key Takeaway
At 6 years, stemless aTSA (7.0% CPR) and rTSA (6.5% CPR) had statistically equivalent revision rates in patients under 55, while stemmed aTSA carried a 2.04-fold higher revision hazard than rTSA.
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Summary
This AOANJRR registry study compared 6-year revision rates across five shoulder arthroplasty constructs performed for primary glenohumeral OA in patients under 55 between 2005 and 2022. Stemmed aTSA carried a significantly higher revision hazard than rTSA (HR 2.04, 95% CI 1.16–3.57, p=0.012), while stemless aTSA was statistically equivalent to rTSA (HR 1.05, 95% CI 0.51–2.19, p=0.889). Predominant revision diagnoses differed by construct: glenoid erosion drove hemiarthroplasty and resurfacing failures, instability drove stemmed aTSA and rTSA revisions, and loosening predominated in stemless aTSA.
Key Limitation
The registry does not capture rotator cuff integrity or glenoid morphology, making it impossible to determine whether rTSA was used appropriately for cuff-deficient cases or was applied to intact-cuff patients, which confounds the direct survivorship comparison with aTSA.
Original Abstract
BACKGROUND
Primary glenohumeral osteoarthritis in young patients poses challenging treatment decisions. Arthroplasty options have different failure profiles and implant survivorship patterns. This registry study aims to analyze the cumulative per cent revision (CPR) rate of different types of arthroplasties conducted for primary osteoarthritis in patients below 55 years of age.
METHODS
This comparative observational national registry study included all shoulder arthroplasty for osteoarthritis in patients below 55 years of age undertaken between January 1st, 2005, and December 31st, 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The CPR was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for gender. Reasons for revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed.
RESULTS
Two thousand one-hundred eleven primary shoulder arthroplasties were compared. Glenoid erosion is the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability is the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), while loosening is the predominant cause of revision for stemless aTSA. The 6-year CPR is 12.8% for humeral resurfacing, 14.1% for hemiarthroplasty, 12.4% for stemmed (aTSA), 7.0% for stemless aTSA, and 6.5% for rTSA. Stemmed aTSA had a higher revision rate than rTSA (entire period HR = 2.04 (95% confidence interval 1.16, 3.57), P = .012). In contrast, the revision rate of stemless aTSA was not different from rTSA (HR = 1.05 (95% confidence interval 0.51, 2.19), P = .889). Males outnumber females for all shoulder arthroplasty categories.
DISCUSSION
rTSA and stemless aTSA are viable options in young patients with primary osteoarthritis. Their short-to-medium term revision rates are comparable to those of older patients and lower than those associated with humeral resurfacing, hemiarthroplasty, and stemmed aTSA.
CONCLUSION
In the predominantly male patient population below the age of 55, reverse shoulder arthroplasty and stemless aTSA have a lower short-term revision risk than stemmed aTSA.