Anatomic Total Shoulder Arthroplasty: Long-Term Clinical, Radiographic, and Patient-Reported Outcomes

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.