Cementless surface replacement arthroplasty (CSRA) is an established treatment for glenohumeral osteoarthritis. Few studies however, evaluate its role in cuff tear arthopathy. The purpose of this study is to compare the outcomes of CSRA for both glenohumeral osteoarthritis and cuff tear arthopathy. 42 CSRA with the Mark IV Copeland prosthesis were performed for glenohumeral osteoarthritis (n=21) or cuff tear arthopathy (n=21). Patients were assessed with Oxford and Constant scores, patient satisfaction, range of motion and radiologically with plain radiographs. Mean follow-up and age was 5.2 years and 74 years in both groups. Functional outcomes were significantly higher in OA compared with CTA with OSS improving from 18 to 37.5 and 15 to 26 in both groups respectively. Forward flexion improved from 60° to 126° and 42° to 74° in both groups. Three patients in the CTA group had a deficient subscapularis tendon, two of whom dislocated anteriorly. Humeral head resurfacing arthroplasty is a viable treatment option for glenohumeral osteoarthritis. In patients with CTA, functional gains are limited. We suggest CSRA should be considered in low demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis due to the high risk of dislocation

Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the supraspinatus tendon occurred. Overall, 20 patients (95%) were either very satisfied (n = 18) or satisfied (n = 2) with the outcome. Significant differences (p < 0.0001) were found for all categories of the Constant and Murley score pre- and post-operatively. The mean Constant and Murley score increased from 24.1 points (10 to 45) to 64.5 points (39 to 93), and the relative score from 30.4% (11% to 50%) to 83% (54% to 116%). No clinical or radiological signs of loosening of the implant were seen. For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term

Introduction and Objective. Only few studies have investigated the outcome of exercises in patients with glenohumeral osteoarthritis (OA) or rotator cuff tear arthropathy (CTA), and furthermore often excluded patients with a severe degree of OA. Several studies including a Cochrane review have suggested the need for trials comparing shoulder arthroplasty to non-surgical treatments. Before initiation of such a trial, the feasibility of progressive shoulder exercises (PSE) in patients, who are eligible for shoulder arthroplasty should be investigated. The aim was to investigate whether 12 weeks of PSE is feasible in patients with OA or CTA eligible for shoulder arthroplasty. Moreover, to report changes in shoulder function and range of motion (ROM) following the exercise program. Materials and Methods. Eighteen patients (11 women, 14 OA), mean age 70 years (range 57–80), performed 12 weeks of PSE with 1 weekly physiotherapist-supervised and 2 weekly home-based sessions. Feasibility was measured by drop-out rate, adverse events, pain and adherence to PSE. Patients completed Western Ontario Osteoarthritis of the Shoulder (WOOS) score and Disabilities of the Arm, Shoulder and Hand (DASH). Results. Two patients dropped out and no adverse events were observed. Sixteen patients (89%) had high adherence to the physiotherapist-supervised sessions. Acceptable pain levels were reported. WOOS improved mean 23 points (95%CI:13;33), and DASH improved mean 13 points (95%CI:6;19). Conclusions. PSE is feasible, safe and may improve shoulder pain, function and ROM in patients with OA or CTA eligible for shoulder arthroplasty. PSE is a feasible treatment that may be compared with arthroplasty in a RCT setting

Background. A challenge to obtaining proper glenoid placement in total shoulder arthroplasty is eccentric posterior bone loss and associated glenoid retroversion. This bone loss can lead to poor stability and perforation of the glenoid during arthroplasty. The purpose of this study was to evaluate the three dimensional morphology of the glenoid with associated bone loss for a spectrum of osteoarthritis patients using 3-D computed tomography imaging and simulation software. Methods. This study included 29 patients with advanced glenohumeral osteoarthritis treated with shoulder arthroplasty. Three-dimensional (3D) reconstruction of preoperative CT images was performed using image analysis software. Glenoid bone loss was measured at ten, vertically equidistant axial planes along the glenoid surface at four distinct anterior-posterior points on each plane for a total of 40 measurements per glenoid. The glenoid images were also fitted with a modeled pegged glenoid implant to predict glenoid perforation. Results. The average bone loss was greatest posteriorly in the AP plane at the central axis of the glenoid in the SI plane. Walch A2 and B1 shoulders had bone loss more centrally located, while Walch B2 shoulders displayed more posterior and inferior bone loss. There was a significant difference in the overall average bone loss for patients with no predicted peg perforation compared to patients predicted to have peg perforation (p=0.37). Peg perforation was most common in Walch B2 shoulders, in the posterior direction, and involved the central and posterior-inferior peg. Discussion. These data demonstrate a clear, anatomical pattern of glenoid bone loss for different classes of glenohumeral arthritis. These findings can be used to develop various models of glenoid bone loss to guide surgeons, predict failures, and help develop better glenoid implant

Background

Rotator cuff atrophy evaluated with computed tomography scans has been associated with asymmetric glenoid wear and humeral head subluxation in glenohumeral arthritis. Magnetic resonance imaging has increased sensitivity for identifying rotator cuff pathology and has not been used to investigate this relationship. The purpose of this study was to use MRI to assess the association of rotator cuff muscle atrophy and glenoid morphology in primary glenohumeral arthritis.

Background

Total shoulder arthroplasty is technically demanding in regards to implantation of the glenoid component, especially in the setting of increased glenoid deformity and posterior glenoid wear. Augmented glenoid implants are an important and innovative option; however, there is little evidence accessible to surgeons to guide in the selection of the appropriate size augmented glenoid.

We reviewed 80 shoulders (77 patients) at a mean follow-up of 44 months after insertion of a Grammont inverted shoulder prosthesis. Three implants had failed and had been revised. The mean Constant score had increased from 22.6 points pre-operatively to 65.6 points at review. In 96% of these shoulders there was no or only minimal pain. The mean active forward elevation increased from 73° to 138°. The integrity of teres minor is essential for the recovery of external rotation and significantly influenced the Constant score. Five cases of aseptic loosening of the glenoid and seven of dissociation of the glenoid component were noted.

This study confirms the promising early results obtained with the inverted prosthesis in the treatment of a cuff-tear arthropathy. It should be considered in the treatment of osteoarthritis with a massive tear of the cuff but should be reserved for elderly patients.

Purpose: The glenoid status is a crucial aspect of planning for shoulder replacements. This study revisits the classification proposed by Walch et al and discusses its value to orthopedic surgeons in terms of reproducibility and reliability.

Method: Three evaluators viewed one hundred-sixteen (116) shoulder CT-scans with primary glenohumeral arthritis and classified glenoid wear according to Walch classification two times. The validation study was done for three sets of data: Set I: the complete classification: A1, A2, B1, B2, C. Set II: regrouping with main categories: A,B,C. Set III: regrouping categories according to glenoid facet morphology; Normal concavity: A1, A2, B1; Biconcave glenoid: B2; Retroverted glenoid: C.

Results: Intra-observer Kappa values for Observer 1, 2, and 3 averaged 0.866 (0.899, 0.927, 0.773) for Set I; for Set II, the values averaged 0.915 (0.955, 0.975, 0.814); and for Set III, the values averaged 0.874 (0.897, 0.948, 0.777), all excellent values. Inter-observer reliability values for Set I averaged 0.621 (0.776, 0.512, 0.574), indicating good agreement; for Set II, the values averaged 0.759 (0.880, 0.713, 0.685), indicating excellent inter-observer agreement; and for Set III, the average was 0.642 (0.825, 0.519, 0.581), indicating good inter-observer agreement.

Conclusion: A clarification of the Walch et al classification of the osteoarthritic glenoid was necessary, especially with regards to the wordings of categories B2 and C. When used properly, it is a reliable and valuable tool for orthopedic surgeons of all levels of experience in the evaluation of the osteoarthritic glenohumeral joint.

Objectives: The aim of this study was a clinical and radiological evaluation of 68 shoulders operated with the Delta reverse-ball-and-socket total shoulder prosthesis by the senior author with a mean follow-up of 42 months.

Methods: This is a retrospective study in one consecutive series of 68 shoulders, operated by the senior author, which were clinically assessed using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. Radiological evaluation was graded by the classification according to Nerot et al. and complications were analysed according to Goslings and Gouma. Patients were evaluated before surgery and at a mean clinical follow-up of 42 months.

Results: There was a significant improvement in all clinical and stability scores. On the average, the Constant score for pain increased from 4.62 to 11.08 points (p< 0.05); the Constant Shoulder Score from 32.65 to 60.31 (p> 0.05); the Oxford Shoulder Score increased from 32.65 to 60.31 (p< 0.05) and the UCLA Shoulder rating scale increased from 15.08 to 27.42 (p< 0.05). The evaluation of stability showed an increase from 49.42 to 80.19 points in the Rowe Score for Instability and from 22.04 to 37.62 in the Oxford Instability score (p< 0.05). According to the Nerot classification, 65 percent of patients were graded as “0”, 20 percent as “1”, 3 percent as “2”, 6 percent as “3” and 6 percent as “4”. Eight complications occurred in terms of a nerve lesion which was graded according to Goslings and Gouma as “1” once, loosening of the humeral stem which was graded as “2” three times and loosening or fracture of the glenoid component which was graded as “2” in five times. At mean follow-up of 42 months, one patient of this series had died of decrepitude which was graded as “4” and one patient was lost of follow-up.

Conclusions: We summarize, that there were significant advantages identified in terms of the Constant score for pain, all clinical scores and the instability scores. Radiological analyses showed 85 percent of patients without or with a small notch only. On the other hand, the rate of complications should be taken into account. We conclude that shoulder arthroplasty with the Delta prosthesis shows significant benefits in terms of less shoulder pain, a higher stability and a gain of range of motion but on the other hand, we emphasize that this treatment remains a salvage procedure in the elderly only.

Aims

Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans.

Aims

Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty.

Purpose of the study: There are few reports onlong-term outcome after Bankart procedure. The purpose of this study was to determine the rate of recurrent dislocation, the clinical results and the incidence of glenohumeral osteoarthritis after a minimum 10-year follow-up. Material and methods: Ninety-seven Bankart procedures were performed in 97 patients between 1972 and 1986 for treatment of anterior shoulder instability with recurrent dislocations. We retrospectively reviewed 74 patients and obtained 64 complete radioclinical evaluations for an average follow-up of 16 years. Clinical evaluation was based on the G. Walch and the Duplay group score but for easier comparisons, we also calculated the Rowe et al. score. Radiographical evaluation was established on the Samilson and Prieto classification but real glenohumeral osteoarthritis with joint narrowing was noted independently as grade four. We also studied the contralateral shoulder. Results: At last follow-up, 7 shoulders (9.5%) had recurrent dislocation, but two of them occurred subsequent to severe trauma over 18 months. Most patients (95%) were satisfied or very satisfied. Six patients (8.1%) had persistent apprehension but in some it was not due to anterior apprehension. According to the Duplay score (or the Rowe score), 25 shoulders (44.6%) had an excellent result (35/61.4%) 16 (28.6%) a good result (7/12.3%), 11 (19.7%) a fair result (11.19.3) and 4 (5.4%) a poor result (4/7%). Operated shoulders were pain free for 75% and painful for forced movements only for 25%. External rotation at 90° of abduction was reduced by 8.7 ± 15.7°. There was no limitation of internal rotation. Patients returned to preoperative sports activities at the same level for 70.9% and at a lower level for 12.7%. According to the Samilson classification, 7 (13%) of the shoulders had grade 2 and 2 (3.7%) had grade 3 glenohumeral osteoarthritis. We found 4 cases (7.4%) of real glenohumeral osteoarthritis (grade four) and 2 of these patients had contralateral osteoarthritis of a non unstable shoulder. There was no perioperative complication. Discussion: In our hands the Bankart procedure is appeared as a safe procedure with a low rate of glenohumeral osteoarthritis and a high rate of patient satisfaction

We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years’ follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations

Aims. Both anatomical and reverse total shoulder arthroplasty (aTSA and rTSA) provide functional improvements. A reported benefit of aTSA is better range of motion (ROM). However, it is not clear which procedure provides better outcomes in patients with limited foward elevation (FE). The aim of this study was to compare the outcome of aTSA and rTSA in patients with glenohumeral osteoarthritis (OA), an intact rotator cuff, and limited FE. Methods. This was a retrospective review of a single institution’s prospectively collected shoulder arthroplasty database for TSAs undertaken between 2007 and 2020. A total of 344 aTSAs and 163 rTSAs, which were performed in patients with OA and an intact rotator cuff with a minimum follow-up of two years, were included. Using the definition of preoperative stiffness as passive FE ≤ 105°, three cohorts were matched 1:1 by age, sex, and follow-up: stiff aTSAs (85) to non-stiff aTSAs (85); stiff rTSAs (74) to non-stiff rTSAs (74); and stiff rTSAs (64) to stiff aTSAs (64). We the compared ROMs, outcome scores, and complication and revision rates. Results. Compared with non-stiff aTSAs, stiff aTSAs had poorer passive FE and active external rotation (ER), whereas there were no significant postoperative differences between stiff rTSAs and non-stiff rTSAs. There were no significant differences in preoperative function when comparing stiff aTSAs with stiff rTSAs. However, stiff rTSAs had significantly greater postoperative active and passive FE (p = 0.001 and 0.004, respectively), and active abduction (p = 0.001) compared with stiff aTSAs. The outcome scores were significantly more favourable in stiff rTSAs for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, and the Constant score, compared with stiff aTSAs. When comparing the proportion of stiff aTSAs versus stiff rTSAs that exceeded the minimal clinically important difference and substantial clinical benefit, stiff rTSAs achieved both at greater rates for all measurements except active ER. The complication rate did not significantly differ between stiff aTSAs and stiff rTSAs, but there was a significantly higher rate of revision surgery in stiff aTSAs (p = 0.007). Conclusion. Postoperative overhead ROM, outcome scores, and rates of revision surgery favour the use of a rTSA rather than aTSA in patients with glenohumeral OA, an intact rotator cuff and limited FE, with similar rotational ROM in these two groups. Cite this article: Bone Joint J 2023;105-B(12):1303–1313

Aims. To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Methods. Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed. Results. A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted. Conclusion. Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway. Cite this article: Bone Jt Open 2021;2(9):728–736

In reverse shoulder arthroplasty (RSA), a high complication rate is noted in the international literature (24.7%), and limited local literature is available. The complications in our developing health system, with high HIV, tuberculosis and metabolic syndrome prevalence may be different from that in developed health systems where the literature largely emanates from. The aim of this study is to describe the complications and complication rate following RSA in a South African cohort. An analytical, cross-sectional study was done where all patients’ who received RSA over an 11 year period at a tertiary hospital were evaluated. One-hundred-and-twenty-six primary RSA patients met the inclusion criteria and a detailed retrospective evaluation of their demographics, clinical variables and complication associated with their shoulder arthroplasty were assessed. All fracture, revision and tumour resection arthroplasties were excluded, and a minimum of 6 months follow up was required. A primary RSA complication rate of 19.0% (24/126) was noted, with the most complications occurring after 90 days at 54.2% (13/24). Instability was the predominant delayed complication at 61.5% (8/13) and sepsis being the most common in the early days at 45.5% (5/11). Haematoma formation, hardware failure and axillary nerve injury were also noted at 4.2% each (1/24). Keeping in mind the immense difference in socioeconomical status and patient demographics in a third world country the RSA complication rate in this study correlates with the known international consensus. This also proves that RSA is still a suitable option for rotator cuff arthropathy and glenohumeral osteoarthritis even in an economically constrained environment like South Africa

Reverse Total shoulder arthroplasty (RTSA) was initially introduced to treat rotator cuff arthropathy. With proven successful long-term outcomes, it has gained a noteworthy surge in popularity with its indications consequently being extended to treating various traumatic glenohumeral diseases. Several countries holding national registries remain a guide to the use the prosthesis, however a notable lack of epidemiological data still exists. More so in South Africa where the spectrum of joint disease related to communicable diseases such as HIV and tuberculosis may influence indications and patient demographics. By analysing the epidemiology of patients who underwent RTSA at our institution, we aimed to outline the local disease spectrum, the patients afflicted and indications for surgery. A retrospective review of all patients operated within the sports unit between 1 January 2019 and 31 December 2022 was conducted. An analysis of the epidemiological data pertaining to patient demographics, diagnosis, indications for surgery and complications were recorded. Included in the review were 58 patients who underwent primary RTSA over the 4-year period. There were 41 females and 17 male patients, age <55 years (n= 14) >55 years (n=44). The indications included 23 rotator cuff arthropathy (40%), 12 primary glenohumeral osteoarthritis (OA) (20%), 10 avascular necrosis (AVN) humeral head (17%), 7 inflammatory OA (12%), 4 chronic shoulder dislocation (7%) and 2 sequalae of proximal humerus fractures (4%). The study revealed RTSA being performed in patients older than 55 years of age, the main pathologies included rotator cuff arthropathy and primary OA, however AVN and shoulder dislocations secondary to trauma contributed significantly to the total tally of surgeries undertaken. This highlights the disease burden of developing countries contributing to patients presenting for RTSA

Purpose of the study: Posterior shoulder instability is a rare condition. Several surgical treatments have been proposed. Material and methods: This was a retrospective series of 21 posterior bone block procedures performed between 1984 and 2001 and analyzed with mean follow-up of six years. Fifteen patients (n=16) had experienced one or more episodes of posterior dislocation. Thirteen patients were athletes and five had traumatic subluxation with chronic posterior instability. Voluntary recurrent dislocations were not observed in these patients. Male gender predominated (n=19 men, 1 woman). Mean age at surgery was 24.8 years (range 17–40). The dominant side was involved in 12 patients (57%). The Constant and Duplay scores were noted as were the pre- and postoperative x-ray findings. There were ten glenoid fractures, two glenoid impactions, ten anterior humeral notches. Mean retroversion, measured on the scans (n=17) was 9.6° (range 0–21°). Results: All patients (n=20) were satisfied or very satisfied. At last follow-up, the mean Constant score was 93.3 (range 80–103) and the mean Duplay score (n=21) 85.6 (40–100); 68.2% of patients (n=15) resumed sports activities at the same level. Failure was noted in three patients, one with recurrent posterior dislocation and two with major apprehension. For two patients, glenohumeral osteoarthritis developed postoperatively. Discussion: Most of the series in the literature have reported results for patients with recurrent posterior subluxations and not for traumatic posterior dislocation, the much more uncommon entity presented here. The rate of bony lesions was high in our series compared with former series in the literature. These results can be explained by two facts. The first that this was a group of recurrent posterior dislocations and second that the analysis of the osteoarticular lesions was made on plain x-rays and/or CT scans. For the two cases of glenohumeral osteoarthritis which developed postoperatively, the position of the bone block does not appear to be involved. Conclusion: The posterior bone block remains the treatment of choice for recurrent posterior dislocation. The risk of developing osteoarthritis appears to be low but a longer follow-up would be necessary for confirmation

Introduction. Osteoarthritis of the glenohumeral joint leads to global degeneration of the shoulder and often results in humeral or glenoid osteophytes. It is established that the axillary neurovascular bundle is in close proximity to the glenohumeral capsule. Similar to other compressive neuropathies, osteophytic impingement of the axillary nerve could result in axillary nerve symptoms. The purpose of this study was to compare the proximity of the axillary neurovascular bundle to the inferior humerus in shoulders to determine distance of the neurovascular bundle as the osteophyte (goat's beard) of glenohumeral osteoarthritis develops. Methods. In this IRB approved study, preoperative MRI's of 98 shoulders (89 patients) with primary osteoarthritis (OA group) were compared to 91 shoulders (86 patients) with anterior instability (Control group). For MRI measurements (mm) two coronal-oblique T1 or proton density weighted images were selected for each patient located at 5 and 6 o'clock position of the glenoid in the parasagittal plane. Humeral head diameter to standardize the glenohumeral measurements, size of the spurs, and 6 measurements between osseus structures and axillary neurovascular bundle were obtained on each image using a calibrated measurement system (Stryker Office PACS Power Viewer). Level of significance was set at p>.05. Results. Since results were both significant at 5 and 6 o'clock, for clarity we will only give the results at 6 o'clock. Humeral head osteophytes were present in 52% (51/86) of arthritic patients with an average size of 9.90 mm (range 0–24.31). Distance between humeral head or inferior osteophyte and neurovascular bundle was significantly decreased (p<0.05) in the OA group, 19.74 mm (range 2.80–35.12) compared to the control group 23.8 mm (14.25–31.89). If we compare the same distance between the Control group, OA group with a spur and OA group without a spur, the difference is only significant between the Control group and OA with spur. (p<0.05) In non-arthritic patients, the neurovascular bundle was closest to the inferior glenoid rim in all patients (91/91). By contrast, the neurovascular bundle was closest to the humeral head in 26.5% (26/98) of arthritic patients. Among these 26 patients, a large humeral head osteophyte was present in 96% (25/26). The neurovascular bundle distance and humeral head osteophyte size were inversely correlated (r=−0.45 at 5 o'clock, r=−0.546 at 6 o'clock) in the arthritic group (p<0.05). Discussion. The axillary neurovascular bundle was significantly closer to the osseous structures (humerus) in arthritic patients compared to non-arthritic patients (p<0.05). The neurovascular bundle was significantly closer to the bone when there was a humeral osteophyte, and the distance was inversely proportional to humeral osteophyte size (p<0.05). This study indicates humeral osteophytes are capable of encroaching on the axillary nerve. Axillary nerve entrapment may be a contributing and treatable factor of pain in patients with glenohumeral osteoarthritis

Aims. Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components. Materials and Methods. A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, . sd. 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint. Results. A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years’ follow-up, the rate of implant survival was 74% (. sd.  0.09) for polyethylene components and 24% (. sd.  0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component. Conclusion. The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure. Cite this article: Bone Joint J 2018;100-B:485–92