JSES - 2026-08-01 - Journal Article
Long-term clinical and radiologic outcomes of primary reverse total shoulder arthroplasty at a minimum follow-up of 15 years.
Kriechling P, Scherer M, Hochreiter B, Düppers F, Willemsen E, Bouaicha S, Wieser K
Topics
Key Takeaway
At minimum 15-year follow-up, rTSA achieves a reoperation-free survival of 84% with maintained Constant score of 64 and SSV of 80%, but complication-free survival drops to 76% by 15 years.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study analyzed a prospectively maintained rTSA database from a tertiary center to determine clinical, radiographic, and survival outcomes at a minimum 15-year follow-up. Kaplan-Meier analysis of 258 shoulders showed 76% complication-free and 84% reoperation-free survival at 15 years, with younger age (HR 0.97), female sex (HR 2.04), and revision indication (HR 2.08) as independent risk factors for complications. In the 52 shoulders with complete long-term data, functional gains achieved at 2 years were maintained through 15 years across nearly all metrics, with the exception of forward flexion, which declined from 130° to 115°; radiographic changes plateaued after 10 years.
Key Limitation
Only 20% of the original cohort (52/258) completed full clinical and radiographic assessment at 15 years, making functional outcome data susceptible to survivorship bias and limiting generalizability of the reported scores.
Original Abstract
BACKGROUND
Long-term data at 15 years following implantation of reverse total shoulder arthroplasty (rTSA) are very limited. The aim of this study was to analyze patients at a minimum of 15 years following rTSA implantation.
METHODS
A prospectively followed database of rTSAs performed at a tertiary referral center was analyzed at a minimum follow-up of 15 years. Kaplan-Meier survival curves were used to estimate time to complication and reoperation/revision rates and to calculate predictive factors. Clinical outcomes included the absolute and relative Constant-Murley score (CSa and CSr), Subjective Shoulder Value (SSV), and range of motion including CS internal rotation (CS IR) and CS pain. The radiographic measurement included analysis of notching, radiolucent lines, heterotopic ossification, stress shielding, and tuberosity resorption.
RESULTS
A total of 258 shoulders (249 patients, median age 72 [75%; interquartile range (IQR), 66%-78%] years, 62% female) underwent rTSA implantation in the specified period. Kaplan-Meier survival analysis revealed a complication-free rate of 80% (IQR, 78%-83%) and 76% (IQR, 70%-81%) and a reoperation-free rate of 84% (IQR, 80%-89%) at 10 and 15 years, respectively. Risk factors for complications were younger age (hazard ratio [HR] 0.97), female gender (HR 2.04), and revision surgery as indication (HR 2.08). Of those 258 shoulders, 52 rTSAs (52 patients, median age 64 [IQR, 59-70] years, 46% female) were available for complete clinical and radiographic analysis at a minimum follow-up of 15 years (median 15.1 [IQR, 14.9-16.6] years). The initial improvements observed for most clinical parameters could be maintained from 2 years to mid- and long-term follow-up at 10 and 15 years, respectively, including a CSa of 64 (IQR, 46-71), CSr of 79% (IQR, 60%-86%), SSV of 80% (IQR, 60%-93%), CS pain of 15.0 (IQR, 10.0-15.0), abduction of 120° (IQR, 88°-145°), external rotation of 20° (IQR, 10°-40°), and CS IR of 4.0 (IQR, 2.0-8.0), as well as strength of 2.13 (IQR, 0.00-3.45) kg at the 15-year follow-up. Only flexion showed worsening over time from 130° (IQR, 100°-150°) at 2 years to 115° (IQR, 94°-130°) at 15 years postoperatively. All radiographic parameters progressed from preoperatively to 10 years postoperatively with no further progression.
CONCLUSION
rTSA provides a stable clinical and radiographic outcome at long-term follow-up of at least 15 years. However, complication and revision rates are still high.