Inlay total shoulder arthroplasty for primary glenohumeral arthritis

Abstract

Background Anatomic total shoulder arthroplasty with a nonspherical 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 significant improvements in pain and function. Methods Prospective patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons score, a pain visual analog scale, and satisfaction. Range of motion was compared to the preoperative status. A sensitivity analysis examined responder rates and compared them to literature thresholds using the minimal clinically important difference and substantial clinical benefit. The preoperative glenoid morphology was determined using the Walsh classification. Zone-specific periprosthetic radiolucent lines were quantified at the last follow-up. 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. Ninety-three percent had grade III osteoarthritis, and 7% grade II. The glenoid Walsh classification included A1 (25%), A2 (25%), B1 (22%), B2 (25%), and C (3%). All PROs improved significantly ( P < .001) with a mean American Shoulder and Elbow Surgeons score from 30.4 to 77.1, a pain visual analog scale from 8.1 to 1.5, and excellent (9.1/10) patient satisfaction. PRO-related responder rates for minimal clinically important difference and substantial clinical benefit were ≥85%. Forward elevation improved from 107° to 155°, and external rotation from 22° to 51°. One intraoperative glenoid rim fracture led to advanced radiolucency; no other clinically relevant lucency was observed. Conclusion Treatment with inlay total shoulder arthroplasty demonstrated significant functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid morphology types. Our initial results provide further support for this new option in primary shoulder replacement.

Anatomic total shoulder arthroplasty with inlay glenoid component: A systematic review

“…Five studies with a total of 133 patients (148 shoulders) met the criteria for inclusion. 17,[22][23][24][25] One of the included articles is level III evidence, 17 while the remaining four are level IV evidence. [22][23][24][25] Three are retrospective studies 17,24,25 and two are prospective studies.…”

“…17,[22][23][24][25] One of the included articles is level III evidence, 17 while the remaining four are level IV evidence. [22][23][24][25] Three are retrospective studies 17,24,25 and two are prospective studies. 22,23 All articles were published between 2019 and 2022.…”

“…[22][23][24][25] Three are retrospective studies 17,24,25 and two are prospective studies. 22,23 All articles were published between 2019 and 2022. 17,[22][23][24][25] The mean age of patients across all studies was 61.1 years (range, 41-81).…”

“…22,23 All articles were published between 2019 and 2022. 17,[22][23][24][25] The mean age of patients across all studies was 61.1 years (range, 41-81). The minimum follow-up was 14 months in one study 22 with 24 months of follow-up in the remaining four.…”

Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty

“… 55 , 56 Inlay TSA has successfully treated primary glenohumeral arthritis, resulting in significant functional improvement and pain relief for varying glenoid morphologies. 57 Davis et al 58 studied inset mini-glenoids in nine shoulders with severe glenoid dysplasia and medial glenoid bone loss and found that the component led to satisfactory clinical outcomes. Gunther and Tran 59 reported significant long-term clinical improvements with no loosening or revision in a study of 21 patients with severely deficient bone treated using inset glenoids.…”