Abstract
Background
Shoulder replacement is an increasingly common treatment for end-stage degenerative shoulder conditions. Some shoulder replacements will fail and further operations may be required. It is important for patients and clinicians to know how long shoulder replacements last and how effectively they improve pain and function. This study aims to determine the longevity and long-term efficacy of shoulder replacements.
Methods
In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles reporting 10-year or greater survival of Total Shoulder Replacements (TSR), Humeral Hemiarthroplasties (HA) and Reverse Total Shoulder Replacements (RTSR). Survival, implant and Patient Reported Outcome Measures (PROMs) data were extracted. National joint replacement registries were reviewed and analysed separately. We weighted each series and calculated a pooled survival estimate at 10, 15 and 20 years. For PROMs we pooled the Standardised Mean Difference (SMD) at 10 years.
Findings
We identified 10 series reporting all-cause survival of 529 TSRs and 420 HA, no series for RTSR met our inclusion criteria. The estimated 10-year survival for TSR was 95·6% (95% CI 93·6, 97·6) and HA 90·4% (95% CI 87·0, 94·0). A single registry contributed 7941 TSRs, 3495 HAs and 8049 RTSRs. The pooled registry 10-year survival for TSR was 92·0% (95% CI 91·0, 93·0), HA 90·5% (95% CI 81·8, 95·1) and RTSR 94·4% (95% CI 93·1, 95·7) for osteoarthritis and 93·6% (95% CI 91·0, 95·4) for rotator cuff arthropathy. Pooled 10-year PROMs revealed a substantial improvement from baseline scores (SMD 2·13 95% CI 1·93, 2·34).
Interpretation
Over 90% of shoulder replacements last more than 10 years and patient reported benefits are sustained. This long overdue information will be of use to patients and health-care providers.
Shoulder replacement is an increasingly common treatment for end-stage degenerative shoulder conditions. Some shoulder replacements will fail and further operations may be required. It is important for patients and clinicians to know how long shoulder replacements last and how effectively they improve pain and function. This study aims to determine the longevity and long-term efficacy of shoulder replacements.
Methods
In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles reporting 10-year or greater survival of Total Shoulder Replacements (TSR), Humeral Hemiarthroplasties (HA) and Reverse Total Shoulder Replacements (RTSR). Survival, implant and Patient Reported Outcome Measures (PROMs) data were extracted. National joint replacement registries were reviewed and analysed separately. We weighted each series and calculated a pooled survival estimate at 10, 15 and 20 years. For PROMs we pooled the Standardised Mean Difference (SMD) at 10 years.
Findings
We identified 10 series reporting all-cause survival of 529 TSRs and 420 HA, no series for RTSR met our inclusion criteria. The estimated 10-year survival for TSR was 95·6% (95% CI 93·6, 97·6) and HA 90·4% (95% CI 87·0, 94·0). A single registry contributed 7941 TSRs, 3495 HAs and 8049 RTSRs. The pooled registry 10-year survival for TSR was 92·0% (95% CI 91·0, 93·0), HA 90·5% (95% CI 81·8, 95·1) and RTSR 94·4% (95% CI 93·1, 95·7) for osteoarthritis and 93·6% (95% CI 91·0, 95·4) for rotator cuff arthropathy. Pooled 10-year PROMs revealed a substantial improvement from baseline scores (SMD 2·13 95% CI 1·93, 2·34).
Interpretation
Over 90% of shoulder replacements last more than 10 years and patient reported benefits are sustained. This long overdue information will be of use to patients and health-care providers.
| Original language | English |
|---|---|
| Pages (from-to) | e539-e548 |
| Number of pages | 10 |
| Journal | Lancet Rheumatology |
| Volume | 2 |
| Issue number | 9 |
| Early online date | 26 Aug 2020 |
| DOIs | |
| Publication status | Published - 1 Sept 2020 |