Shoulder
Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity

https://doi.org/10.1016/j.jse.2019.10.003Get rights and content

Background

Biomechanical studies show that inlay glenoid components in total shoulder arthroplasty (TSA) can reduce edge loading and opposite-edge lift-off forces with humeral translation compared with onlay glenoids. However, clinical data for these implants are lacking. We report clinical outcomes and return to activities after anatomic TSA with an inlay glenoid component and a stemless ovoid humeral head in an active, young patient population.

Methods

A retrospective review of TSA with an inlay glenoid component and an ovoid humeral head component was performed for 27 shoulders. Patients were evaluated with patient-reported outcome measures, range of motion, and radiographs. Return to occupational and sporting activity, complications, and reoperations were analyzed.

Results

A total of 27 shoulders were available for minimum 2-year follow-up. Age averaged 52.1 years, and 92.6% of shoulders were in male patients. The preoperative Walch grade was A1 or A2 in 15 shoulders (55%), B1 in 8 (30%), and B2 in 4 (15%). Patients showed significant improvements in patient-reported outcome measures, active forward flexion, and external rotation (P < .001) with no reoperations. At an average of 3.7 months, the rate of return to work was 92.6%, with 76.0% of those patients returning to their preoperative occupational demand level. At an average of 9.1 months, 75% of patients who responded to our custom survey returned to sport, with 50% achieving the same level or a higher level of sporting activity. Annual postoperative radiographs revealed no inlay component loosening.

Conclusion

Anatomic TSA with an inlay glenoid coupled with a stemless ovoid humeral head in an active population resulted in improved clinical outcomes, no reoperations or radiographic loosening, and a high rate of return to activity at shorter-term follow-up.

Section snippets

Patient selection

A retrospective review was conducted in a consecutive series of patients undergoing anatomic TSA with an inlay glenoid component and a stemless ovoid humeral head component (Arthrosurface, Franklin, MA, USA), for a diagnosis of primary or post-traumatic glenohumeral osteoarthritis, performed by a single surgeon between February 1, 2014, and March 1, 2017. Prior to TSA, patients underwent nonoperative management including modification of activity and oral anti-inflammatories in all cases. In

Patient demographic characteristics

During the study period, TSA with an inlay glenoid component was performed in 27 shoulders in 24 patients and, in all cases, with a stemless humeral component. All 27 shoulders were available for 2-year follow-up (average, 40.4 ± 12.1 months; range, 24-60 months). Patients' average age was 52.1 ± 6.0 years (range, 42-63 years), 92.6% of shoulders (25 of 27) were in male patients, and worker's compensation claimants comprised 11.1% (3 of 27) (Table I). The preoperative diagnosis was glenohumeral

Discussion

Anatomic TSA with an inlay glenoid and stemless ovoid humeral head in a young, active population resulted in improved clinical outcomes at an average of 40.4 months' follow-up. The majority of patients were satisfied with their shoulder; however, only 55% returned to sporting activity at the same level or a higher level. There were no reoperations, and annual postoperative radiographs revealed no inlay component loosening.

Treatment of the young, active patient with advanced glenohumeral

Conclusion

Anatomic TSA with an inlay glenoid and a stemless ovoid humeral head in a young, active population resulted in excellent range of motion, improved clinical outcomes, no reoperations or radiographic loosening, and a high rate of return to occupational and sporting activity at shorter-term follow-up.

Disclaimer

This study received departmental funding.

Brian R. Waterman is an American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America board or committee member; is an editorial board member of the American Journal of Orthopedics and Arthroscopy; receives publishing royalties and financial or material support from Arthroscopy and Elsevier; and is a paid presenter or speaker for Genzyme.

Gregory P. Nicholson receives royalties

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This study was approved by the Rush University Medical Center Institutional Review Board on January 23, 2017, under ORA no. 16121601-IRB01.

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