Retrospective survivorship and outcomes study of 320 consecutive Neer-type TSAs in 267 patients, performed 1974-1988. Examines implant survival, range of motion, strength, pain, and DASH scores at minimum 10-year follow-up. The largest long-term TSA cohort with the longest follow-up reported at the time of publication.
A patient asking 'how long will my shoulder replacement last?' deserves a specific answer: roughly 85% of Neer-type TSAs are still functioning at 20 years, a benchmark that holds up against hip and knee arthroplasty data.
When counseling before surgery, pair the survival data with realistic functional expectations: 92% will feel the shoulder is 'better,' but a mean DASH score near 50 (vs 3-6 in healthy adults) means meaningful overhead and high-demand limitations persist for most patients.
When a patient develops instability in the first 1-2 years after TSA, attempt closed reduction first. Half of dislocations in this series resolved without revision, and early presentation distinguishes instability from the loosening that dominates after year 7.
For patients with AVN considering TSA, the Cox regression hazard ratio of 6 for revision is worth flagging in the consent discussion. The authors caution the number is statistically fragile (only 8 AVN patients, 2 failures), but the mechanistic explanation is plausible: isolated joint disease leads to higher functional demands and accelerated mechanical loosening.
Retrospective survivorship and outcomes study of 320 consecutive Neer-type TSAs in 267 patients, performed 1974-1988. Examines implant survival, range of motion, strength, pain, and DASH scores at minimum 10-year follow-up. The largest long-term TSA cohort with the longest follow-up reported at the time of publication.
A patient asking 'how long will my shoulder replacement last?' deserves a specific answer: roughly 85% of Neer-type TSAs are still functioning at 20 years, a benchmark that holds up against hip and knee arthroplasty data.
When counseling before surgery, pair the survival data with realistic functional expectations: 92% will feel the shoulder is 'better,' but a mean DASH score near 50 (vs 3-6 in healthy adults) means meaningful overhead and high-demand limitations persist for most patients.
When a patient develops instability in the first 1-2 years after TSA, attempt closed reduction first. Half of dislocations in this series resolved without revision, and early presentation distinguishes instability from the loosening that dominates after year 7.
For patients with AVN considering TSA, the Cox regression hazard ratio of 6 for revision is worth flagging in the consent discussion. The authors caution the number is statistically fragile (only 8 AVN patients, 2 failures), but the mechanistic explanation is plausible: isolated joint disease leads to higher functional demands and accelerated mechanical loosening.