2021 ISAKOS Biennial Congress Paper
Inlay Total Shoulder Arthroplasty For Primary Glenohumeral Arthritis
John W. Uribe, MD, Coral Gables, FL UNITED STATES
John E. Zvijac, MD, Coral Gables, FL UNITED STATES
Luis A Vargas, MD, PhD, Coral Gables, Florida UNITED STATES
David A. Porter, MD, Coral Gables, FL UNITED STATES
Anshul Saxena, BDS, PhD, Miami, FL UNITED STATES
Matthias Schurhoff, MD, Miami, Florida UNITED STATES
Andrew Payomo, MD student, MIAMI, FLORIDA UNITED STATES
MIAMI ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE, Coral Gables, Florida, UNITED STATES
FDA Status Cleared
Summary
Treatment with inlay total shoulder arthroplasty demonstrated meaningful functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid stages
Abstract
Background
Anatomic total shoulder arthroplasty (TSA) with a non-spherical humeral head and inlay glenoid replacement has been introduced in the past, however clinical evidence remains limited. We hypothesized that patients with advanced glenohumeral arthritis demonstrate meaningful improvements.
Methods
Prospective patient-reported outcomes (PRO) included the American Shoulder and Elbow Surgeons Score (ASES), a pain visual analog scale (VAS-Pain), and satisfaction. Range of motion was compared to the preoperative status. A sensitivity analysis examined responder rates (RR) to literature TSA thresholds for minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Glenohumeral staging and implant stability with zone-specific periprosthetic radiolucency were performed radiographically.
Results
Thirty-nine shoulders in 36 patients (3 bilateral) with a mean age of 65.9 years (26 males, 13 females) and a mean follow-up of 41.0 months, were included. 93% had Grade III osteoarthritis, 7% Grade II. Glenoid stages included A1 (25%), A2 (25%), B1 (22%), B2 (25%,) and C (3%). All PROs improved significantly (p<.001) with a mean ASES from 30.4 -77.1, a VAS-Pain from 8.1-1.5, and excellent (9.1/10) patient satisfaction. PRO related RRs for MCID and SCB were >85%. Forward elevation improved from 106.50-154.90, and external rotation from 21.90-50.80. One intraoperative glenoid rim fracture led to advanced radiolucency; no other clinically relevant radiolucency was observed.
Conclusion
Treatment with inlay total shoulder arthroplasty demonstrated meaningful functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid stages. Our initial evidence provides further support for this new option in primary shoulder replacement.