Patient survivorship after anatomic total shoulder arthroplasty: are patients failing before their prosthetics? a 10-year minimum follow-up analysis

Background

Since the development of shoulder replacement, focus has been placed on the timeline in which surgical complications occur, like glenoid loosening or rotator cuff insufficiency. What has been less researched is longer term patient survival following shoulder arthroplasty. This study aimed to evaluate patient and implant survivorship after anatomic total shoulder arthroplasty at a minimum 10-year follow-up and identify risk factors for mortality and revision surgery.

Methods

This was a single-institution, retrospective, cohort study of all patients who underwent primary anatomic total shoulder arthroplasty for glenohumeral osteoarthritis from 2005 to 2011. Patient characteristics including age, sex, body mass index, race, and Charleston comorbidity index (CCI) were recorded. A patient medical record query and a national obituary database query were performed to assess for revision surgery or patient mortality. Reason for revision surgery was recorded. Statistical analyses were performed to compare groups and assess for associated risk factors (P < .05 was significant).

Results

Three hundred and sixty two patients met inclusion criteria. Mean patient age was 65.4 ± 10.02 years and 242 (66.9%) patients were male. Mean body mass index was 29.73 ± 5.62 and the mean CCI was 3.28 ± 1.29. A total of 56 patients (15.5%) passed away within the study period prior to undergoing revision surgery, while 20 (5.5%) underwent revision surgery within the study period. Reason for revision included rotator cuff insufficiency (8), glenoid loosening (4), posterior instability (4), infection (3), and culture negative continued shoulder pain (1). On Analysis of Variance analysis, older age and higher CCI were associated with an increased risk of mortality (P < .001). Patients in the revision cohort were significantly younger than patients who did not undergo revision surgery (60.3 years vs. 64.3 years, P = .01).

Conclusion

Older patients (mean age 72.2 years) and patients with more medical comorbidities are more likely to retain their index procedure implants throughout their lifetime than to undergo revision surgery. This study provides data and an insight into preoperative patient guidance, shoulder implant selection, and shared medical decision-making.