Rate of Shoulder Arthroplasty After Anterior Shoulder Instability Surgery: A Systematic Review.

Abstract

Background: Recurrent or persistent anterior shoulder instability (ASI), the most common form of shoulder instability, may progress over time to osteoarthritis (OA) necessitating shoulder arthroplasty. Anterior shoulder instability surgery (ASIS) techniques, including soft-tissue and bony augmentation procedures, have been shown to reduce the risk of recurrent dislocation.

Purpose: The purpose of this review is to evaluate the rates of progression to shoulder arthroplasty, time to conversion to shoulder arthroplasty, OA grades at time of conversion, and clinical outcomes of shoulder arthroplasty in patients with a history of ASI initially managed with ASIS, including glenoid labrum repair, Bankart repair, or coracoid transfer procedures.

Study design: Systematic review; Level of evidence, 4.

Methods: This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using combinations of keywords related to shoulder arthroplasty and ASIS. The search was performed on February 26, 2026, across the PubMed, Ovid, MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases. Outcomes analyzed included the rate of shoulder arthroplasty after ASIS, time to conversion to shoulder arthroplasty, age at each procedure, OA grade at the time of conversion, range of motion, infection rate, revision rate, failure rate, and clinical outcome scores.

Results: A total of 52 studies met preliminary inclusion criteria, and 19 studies met full inclusion criteria. Current studies suggest that the conversion rate from ASIS to shoulder arthroplasty is 1.25% and that shoulder arthroplasty was performed, on average, 25.3 years after initial ASIS. ASIS was performed at a mean age of 29 years, while shoulder arthroplasty was performed at a mean age of 61 years. Also, 55% of patients undergoing shoulder arthroplasty after ASIS had Walch grade A1 lesions.

Conclusion: ASIS was associated with a low long-term conversion rate to shoulder arthroplasty, occurring at a mean of 2.5 decades postoperatively. These findings suggest that ASIS provides durable joint preservation with conversion to shoulder arthroplasty remaining rare over long-term follow-up.