Narrative review of what determines how long an anatomic total shoulder arthroplasty lasts. It organizes survivorship data around patient factors, glenoid pathoanatomy, implant design, surgeon volume, and the rotator cuff. The goal is to help surgeons counsel patients and plan around modifiable and nonmodifiable risks of revision.
When you counsel a patient for anatomic TSA, lead with etiology, not just age. Primary osteoarthritis does well (90% at 10 years), but posttraumatic arthritis falls to 33%, and osteonecrosis to 75%.
The glenoid is where these implants fail. Aseptic glenoid loosening drives roughly 30% of revisions, so version control is central. Keep retained retroversion under 15 degrees, and treat B2/B3 morphology with a lower threshold for advanced imaging and planning.
Implant choice follows a clear hierarchy: pegged all-poly cemented beats keeled, and both beat metal-backed glenoids, which revise at 3 to 5 times the rate. Do not forget the cuff. Late failure often reflects superior migration and edge loading (rocking-horse phenomenon), so a deficient cuff should push you toward reverse arthroplasty, as it did for patients with prior Latarjet.
Narrative review of what determines how long an anatomic total shoulder arthroplasty lasts. It organizes survivorship data around patient factors, glenoid pathoanatomy, implant design, surgeon volume, and the rotator cuff. The goal is to help surgeons counsel patients and plan around modifiable and nonmodifiable risks of revision.
When you counsel a patient for anatomic TSA, lead with etiology, not just age. Primary osteoarthritis does well (90% at 10 years), but posttraumatic arthritis falls to 33%, and osteonecrosis to 75%.
The glenoid is where these implants fail. Aseptic glenoid loosening drives roughly 30% of revisions, so version control is central. Keep retained retroversion under 15 degrees, and treat B2/B3 morphology with a lower threshold for advanced imaging and planning.
Implant choice follows a clear hierarchy: pegged all-poly cemented beats keeled, and both beat metal-backed glenoids, which revise at 3 to 5 times the rate. Do not forget the cuff. Late failure often reflects superior migration and edge loading (rocking-horse phenomenon), so a deficient cuff should push you toward reverse arthroplasty, as it did for patients with prior Latarjet.