Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty With a Nonspherical Humeral Head and Inlay Glenoid in Elite Weight Lifters: A Prospective Case Series

Abstract

Background: Weight lifting after total shoulder arthroplasty (TSA) can place significant stresses on implants that could lead to instability, loosening, and increased wear. A TSA system with nonspherical humeral head resurfacing and inlay glenoid—which improves the biomechanics and thus reduces instability, wear, and potential loosening—may be able to tolerate repetitive loads from weight lifting. Purpose: To determine clinical and radiographic outcomes after TSA in weight lifters. Study Design: Case series; Level of evidence, 4. Methods: We prospectively enrolled 16 weight lifters (mean ± SD age, 57.2 ± 7.8 years; 15 male) undergoing primary anatomic TSA (n = 17 shoulders, 1 staged bilateral) with nonspherical humeral head resurfacing and inlay glenoid replacement for glenohumeral osteoarthritis between February 2015 and February 2019. Exclusion criteria were rotator cuff deficiency, revision TSA, post-traumatic arthritis, and inflammatory arthritis. Outcome measures included the rate of return to weight lifting, results of patient-reported outcome measures (Penn Shoulder Score, Kerlan-Jobe Orthopaedic Clinic, and 12-Item Veterans RAND Health Survey), radiographic outcomes, and complication rate. Results: Follow-up was obtained on all patients at a mean of 38 months (range, 14-63 months). All patients returned to competitive weight lifting at 15.6 ± 6.9 weeks. Compared to the preoperative weight lifting level, at last follow-up patients reported performance at the following level: lighter weight, 1 (6%); same weight, 8 (50%); heavier weight, 7 (44%). Preoperative eccentric posterior glenoid wear was common (71% Walch B2 classification; 12/17), but posterior humeral subluxation improved at follow-up according to the Walch index (mean, 55.5% preoperative vs 48.5% postoperative; P < .001) and contact point ratio (mean, 63.9% preoperative vs 50.1% postoperative; P < .001). Pre- to postoperative improvements were seen in Penn Shoulder Score (44.3 vs 82.6; P < .001), Kerlan-Jobe Orthopaedic Clinic (50.6 vs 91.1; P < .001), and 12-Item Veterans RAND Health Survey physical component score but not mental component score. No signs of radiographic loosening were detected in follow-up images, nor were there any postoperative instability episodes or revision surgeries. Conclusion: There were substantial improvements in shoulder function and a high rate of return to weight lifting after TSA with a nonspherical humeral head resurfacing and inlay glenoid component. Radiographically, the humeral head centralized on the glenoid after surgery, and there was no evidence of component loosening at a mean 38-month follow-up.

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

“…Studies have shown that inlay glenoids are also effective in active populations, showing no signs of loosening at short-to-midterm follow-up and allowing a high rate of return to sport and weightlifting. 61 , 62 While few glenoid inlay components are currently available on the market, studies to date are encouraging, and further testing is warranted to evaluate potential benefits over traditional onlay designs.…”