2025 ISAKOS Biennial Congress ePoster
Patients with Bilateral Shoulder Arthritis Choose Contralateral Inlay Total Shoulder Arthroplasty Nearly Three Times More Frequently
Nicolette Schurhoff, BS, Coral Gables, FL UNITED STATES
Andrew Barrett, MD, Coral Gables, FL UNITED STATES
Samuel Joseph Bauer, MD, Miami, FL UNITED STATES
Camila Torres-Caiaffa, BA, Coral Gables, FL UNITED STATES
Alexandra Diane Moutafis, BS, Miami, Florida UNITED STATES
Matthias Schurhoff, MD, Miami, Florida UNITED STATES
Luis A Vargas, MD, PhD, Coral Gables, Florida UNITED STATES
John E. Zvijac, MD, Coral Gables, FL UNITED STATES
John W. Uribe, MD, Coral Gables, FL UNITED STATES
Baptist Health Orthopedic Institute , Coral Gables, FL, UNITED STATES
FDA Status Cleared
Summary
Sentence summary: The incidence rate of bilateral shoulder arthroplasty in patients with bilateral shoulder arthritis is nearly 3-times higher for inlay total shoulder arthroplasty compared to national US averages in shoulder replacement.
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Abstract
Background
Previous claims data from national US databases with 27,962 total shoulder arthroplasties (TSA) reported an incidence of bilateral TSA of 6.3%. Over the past thirteen years, we observed a greater percentage of patients electing bilateral inlay total shoulder arthroplasty (iTSA) at our institution. The purpose of this study was to determine the incidence rate and examine patient-reported outcomes (PROs) after staged iTSA for advanced bilateral glenohumeral osteoarthritis.
Methods
We conducted a retrospective review of prospectively collected data from our institutional database. The study included patients with advanced glenohumeral arthritis treated with iTSA between 2011 and 2024. PROs included the American Shoulder and Elbow Surgeon’s (ASES) score and a visual analog scale for pain (VAS-Pain) and clinical outcomes included range of motion (ROM). The incidence was calculated based on bilateral procedures during the observation period. Improvements in PROs were assessed at last follow-up stratifying the results by procedure sequence, gender and two age groups (Group I: < 65, Group II: >65).
Results
432 patients (510 shoulders) were included in this study with a bilateral incidence rate of 18.1% (78 patients, 156 shoulders). The median time interval for the second shoulder replacement was 12.0 months (5-45). There were 29 females and 49 males with a mean age of 67.1 ±9.5 years. Group I included 55 shoulders, Group II 101. The mean follow-up was 41.6 ±36.1 months. All PROs improved significantly (p < .001) with a median ASES from 33.8 (21.2-46.7) to 80.0 (60.0-93.3) and VAS-Pain from 7.0 (5.0-8.0) to 1.0 (0.0-3.2). The median range of motion improved significantly (p < .001) from 100.0° (80.0-130.0) to 160.0° (147.5-170) in forward elevation (FE) and 20.0° (10.0-30.0) to 50.0° (40.0-60.0) on external rotation (ER). Gender, bilateral sequence, and age group did not impact ASES (p = 0.09). VAS-Pain (p = 0.08) FE (p = 0.35), or ER (p = 0.41). Forward elevation improved significantly more (p = 0.004) in males.
Conclusion
Staged bilateral inlay TSA showed significant pain relief and improvement in functional outcomes. Based on our results in this cohort, the patient decision making process for contralateral TSA showed a higher incidence than previously reported for TSA and adds a patient-centric validation for the treatment of advanced bilateral shoulder arthritis.