2025 ISAKOS Biennial Congress Paper
Five-Year Outcomes Analysis of Anatomic and Reverse Shoulder Arthroplasty in Patients Under 55 Years of Age with Primary Glenohumeral Osteoarthritis
Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Mohammad Jomaa LEBANON
Helen Ingoe, MBBS, FRCS (Tr+Orth), MD, MSc, PGCert, Dunedin NEW ZEALAND
Freek Hollman, MD, PhD, Venlo NETHERLANDS
Roberto Pareyon MEXICO
Sarah L Whitehouse, PhD, Brisbane, Queensland AUSTRALIA
Peiyao Du, BMathsCS, Adelaide, SA AUSTRALIA
David Gill, MBChB, FRACS, Perth, WA AUSTRALIA
Tristan Shuker, BSc, Brisbane, QLD AUSTRALIA
Jashint Maharaj, MBBS, FRSPH, Brisbane, QLD AUSTRALIA
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, QLD, AUSTRALIA
FDA Status Not Applicable
Summary
The purpose of this population level registry study is to analyze the cumulative percent revision rate (CPR) of different types of arthroplasties conducted for primary osteoarthritis in patients under 55 years of age.
Abstract
Introduction
Primary glenohumeral osteoarthritis in young patients pose challenging treatment decisions. Shoulder arthroplasty options have varying failure profiles and implant survivorship patterns. The purpose of this population level registry study is to analyze the cumulative percent revision rate (CPR) of different types of arthroplasties conducted for primary osteoarthritis in patients under 55 years of age.
Methods
This is a comparative observational national registry study from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of all shoulder arthroplasty for osteoarthritis in patients under 55 years of age undertaken between 1 Jan 2005 and 31 December 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The CPR was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for gender. Revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed.
Results
2149 primary shoulder arthroplasties were compared. Males outnumbered females for all shoulder arthroplasty categories. Glenoid erosion was the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability was the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA), while loosening was the predominant cause of revision for stemless ATSA. The 6-year CPR was 12.8% for humeral resurfacing (HRA), 14.1% for hemiarthroplasty (HA), 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% CI = 1.16-3.57, p=0.012). The revision rate of stemless ATSA was not different from RTSA (HR=1.05, 95% CI 0.51-2.19, p=0.889).
Conclusion
There is a lower short-term revision risk with RTSA and stemless ATSA compared to stemmed ATSA in a patient population under the age of 55 who were predominately male. RTSA and stemless ATSA are viable options in young patients with primary osteoarthritis, with short- to medium-term revision rates comparable to those of older patients and lower than the rates associated with HRA, HA, and stemmed ATSA.