This systematic review and meta-analysis pooled 44 studies to determine why primary anatomic total shoulder arthroplasties fail today. It asks which failure modes dominate and how they shift by follow-up time and glenoid fixation type. The goal is to sharpen patient selection, surgical technique, and implant design.
When you counsel a patient before aTSA, the glenoid is the component most likely to fail them. Loosening drives 26.1% of failures and is almost entirely glenoid, not humeral, so glenoid preparation, version correction, and fixation choice matter most for longevity.
Timing shapes the differential. A shoulder failing within the first few years points toward cuff insufficiency or infection, while one failing after 5 years points toward glenoid loosening, which classically shows progressive radiolucency starting around year 5.
Fixation type reframes the risk. Metal-backed glenoids fail by loosening; all-polyethylene glenoids fail by cuff insufficiency. Know which implant your patient has before you work up a painful arthroplasty. When the cuff fails after aTSA, plan for reverse TSA conversion rather than attempted re-repair, which does poorly.
This systematic review and meta-analysis pooled 44 studies to determine why primary anatomic total shoulder arthroplasties fail today. It asks which failure modes dominate and how they shift by follow-up time and glenoid fixation type. The goal is to sharpen patient selection, surgical technique, and implant design.
When you counsel a patient before aTSA, the glenoid is the component most likely to fail them. Loosening drives 26.1% of failures and is almost entirely glenoid, not humeral, so glenoid preparation, version correction, and fixation choice matter most for longevity.
Timing shapes the differential. A shoulder failing within the first few years points toward cuff insufficiency or infection, while one failing after 5 years points toward glenoid loosening, which classically shows progressive radiolucency starting around year 5.
Fixation type reframes the risk. Metal-backed glenoids fail by loosening; all-polyethylene glenoids fail by cuff insufficiency. Know which implant your patient has before you work up a painful arthroplasty. When the cuff fails after aTSA, plan for reverse TSA conversion rather than attempted re-repair, which does poorly.