Anatomic total shoulder arthroplasty at 10 to 15 years: durable implant, gradually fading function

Design

Retrospective single-institution cohort, Prognostic Level III

Population

791 consecutive anatomic total shoulder arthroplasties, 2003 to 2015

Primary outcome

Revision-free survivorship and ASES-based clinically important outcomes at 10 years

Effect

Survivorship 96.1% at 10 years, 93.7% at 15; ASES substantial clinical benefit 55.8%

A single-institution retrospective cohort followed 791 consecutive anatomic total shoulder arthroplasties performed between 2003 and 2015. Kaplan-Meier survivorship free of revision was 96.1% at ten years and 93.7% at fifteen.

Walch B glenoid morphology and younger age were independently associated with revision. Clinical outcomes stayed improved but eased over time. At ten years, 69.5% of shoulders reached the patient acceptable symptom state on the ASES score (threshold 68.1). The minimal clinically important difference and substantial clinical benefit thresholds for ASES change were 14.0 and 39.2, reached by 79.9% and 55.8% of shoulders respectively.

The authors describe the patient-reported outcomes as modest even though survivorship was excellent. That gap matters when counselling: a shoulder that is still in place is not always one the patient rates as a success. Younger patients and those with Walch B morphology deserve a franker discussion of revision risk.

• Survivorship was 96.1% at 10 years and 93.7% at 15 years.
• Younger age and Walch B glenoid morphology were linked to revision.
• At 10 years, 79.9% reached the minimal clinically important difference and 55.8% substantial clinical benefit.
• Function drifted down over time even where the implant survived.
• Use outcome thresholds, not survivorship alone, when counselling about long-term success.

Why it matters

It separates implant survival from patient-rated success, which are not the same thing.

Don't overread it

A retrospective single-institution cohort with an expert surgeon group may not match results elsewhere, and loss to follow-up can flatter survivorship.

The statistics, in plain English

Survivorship counts only revision, not whether the patient is happy. The minimal clinically important difference is the smallest change patients notice; substantial clinical benefit is a larger one. That only 55.8% reached the larger bar shows that survivorship overstates how many patients do very well.

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