Shoulder Arthroplasty Implant Survival Does Not Fully Capture Long-Term Clinical Benefit

A retrospective cohort study published in The Journal of Bone and Joint Surgery evaluated long-term outcomes after 791 consecutive anatomic total shoulder arthroplasties performed between 2003 and 2015. Investigators assessed implant survivorship using Kaplan-Meier analysis and clinical outcomes at a 10-year landmark. Patient satisfaction anchored clinically important thresholds for the American Shoulder and Elbow Surgeons (ASES) score.

Implant survivorship was 96.1% at 10 years and 93.7% at 15 years. At 10 years, 69.5% of shoulders achieved the patient acceptable symptom state threshold of 68.1 ASES points. Minimal clinically important improvement, defined as a 14.0-point increase, was achieved by 79.9%; substantial clinical benefit, defined as a 39.2-point increase, was achieved by 55.8%. Clinical outcomes remained improved, although function gradually declined over extended follow-up.

Younger age and Walch B glenoid morphology were independently associated with revision. Younger age, primary glenohumeral osteoarthritis, and lower preoperative ASES scores were associated with substantial clinical benefit. These findings support considering patient-reported outcomes alongside implant survival when counseling patients about durable success. The retrospective, prognostic Level III design limits causal interpretation, and the supplied report does not specify how many shoulders contributed to the 10-year clinical assessment.