This national registry study compares survivorship of five shoulder arthroplasty types in patients under 55 with osteoarthritis. It asks which implant has the lowest revision rate and why each type fails. Data came from 1564 procedures in the Australian Orthopaedic Association National Joint Replacement Registry.
When you counsel a young patient with an arthritic shoulder, match the implant to how it fails, not just to a single survivorship number. Metal hemiarthroplasty and resurfacing erode the native glenoid over time, which is why glenoid erosion drives their revisions. TSA is durable but fails through glenoid loosening, instability, and eventual cuff wear.
RTSA had the lowest mid-term revision rate here, but read that with caution. Its failures cluster as early dislocation in the first 2 years, and a failed RTSA has few salvage options, which can artificially lower its apparent revision rate.
Watch the confounders: RTSA and pyrocarbon follow-up is short (RTSA mean 3.5 years, HSPH 2.6 years), so their low numbers may not hold up. Practical levers that improve survivorship include cross-linked polyethylene in TSA and correct glenosphere sizing in RTSA. Avoid pyrocarbon hemiarthroplasty in a B2 glenoid.
This national registry study compares survivorship of five shoulder arthroplasty types in patients under 55 with osteoarthritis. It asks which implant has the lowest revision rate and why each type fails. Data came from 1564 procedures in the Australian Orthopaedic Association National Joint Replacement Registry.
When you counsel a young patient with an arthritic shoulder, match the implant to how it fails, not just to a single survivorship number. Metal hemiarthroplasty and resurfacing erode the native glenoid over time, which is why glenoid erosion drives their revisions. TSA is durable but fails through glenoid loosening, instability, and eventual cuff wear.
RTSA had the lowest mid-term revision rate here, but read that with caution. Its failures cluster as early dislocation in the first 2 years, and a failed RTSA has few salvage options, which can artificially lower its apparent revision rate.
Watch the confounders: RTSA and pyrocarbon follow-up is short (RTSA mean 3.5 years, HSPH 2.6 years), so their low numbers may not hold up. Practical levers that improve survivorship include cross-linked polyethylene in TSA and correct glenosphere sizing in RTSA. Avoid pyrocarbon hemiarthroplasty in a B2 glenoid.