High-level bodybuilders and powerlifters are at risk to develop symptomatic glenohumeral arthritis (GHA) due to the excessive demands placed on their shoulders. Upon failure of conservative management, surgical treatment options are limited and pose clinical challenges due to a relatively young patient age combined with the desire of sport continuation. Arthroscopic management is limited, and stemmed arthroplasty remains controversial due to high glenohumeral stresses upon return to sport.
Hypothesis/Purpose: The purpose of this study was to assess inlay total shoulder arthroplasty (inlay TSA) utilizing a stemless non-spherical humeral head and inlay glenoid (IG) replacement for the treatment of advanced GHA in competitive and high-level recreational strength athletes.
Study Design: Prospective Case Series
18 shoulders in 14 male athletes with a mean age of 45.6 years (range 25-57) were included in this study. Pre- and postoperative evaluations included physical and radiographic assessment, patient reported outcomes (PRO) (ASES, WOOS, VAS-P), range of motion (ROM), patient satisfaction, and return to sport.
All procedures were performed on an outpatient basis. No intraoperative complications occurred, and no blood transfusions were required. The mean follow-up was 38 months (range: 25-51). The average ASES improved from 26-93, WOOS from 18-87, and VAS-P from 9-1. The mean ROM increased from 115-145 degrees (forward flexion), from 30-60 degrees (external rotation), and from the level of the sacrum to L3 (internal rotation).
Radiographic analysis at last follow-up showed no evidence of component loosening, glenoid migration, or signs of device failure. All patients were satisfied with the procedure and 12 / 14 returned to moderate or high level of weightlifting. One patient developed arthrofibrosis and required an arthroscopic capsular release and debridement which significantly improved function. Four patients decided to undergo inlay TSA on their symptomatic contralateral side within 6 months of their index procedure.
Stemless non-spherical humeral head and inlay glenoid replacement provide substantial pain relief and functional improvement and is a promising option for the management of symptomatic osteoarthritis in this challenging patient population. The procedure allows for a return to activities without restrictions and leaves multiple arthroplasty options if revision becomes necessary.