Inlay TSA improves function, reduces pain in patients with glenohumeral arthritis
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Published results showed anatomic total shoulder arthroplasty with a non-spherical humeral head and inlay glenoid replacement yielded functional improvements, pain relief and satisfaction in patients with advanced glenohumeral arthritis.
John W. Uribe, MD, and colleagues at Miami Orthopedics and Sports Medicine Institute in Coral Gables, Florida analyzed 36 patients (39 shoulders) who underwent inlay total shoulder arthroplasty (TSA) for advanced glenohumeral osteoarthritis (OA). Among the cohort (mean age of 65.9 years), 93% had grade 3 OA and 7% had grade 2 OA. Outcome measures included American Shoulder and Elbow Surgeons (ASES) score, VAS pain score, range of motion (ROM), patient satisfaction, according to the study.
Uribe and colleagues used the Walch classification to determine preoperative glenoid morphology. Among the cohort, 25.6% of patients had an A1 classification; 25.6% had an A2 classification; 20.5% had a B1 classification; 25.6% had a B2 classification; and 2.6% had a C classification.
Researchers found mean ASES score improved from 30.4 to 77.1; mean VAS pain score improved from 8.1 to 1.5; and patient satisfaction was 9.1 of 10. ROM also improved preoperatively to postoperatively, they noted.
“Treatment of advanced glenohumeral arthritis with inlay TSA resulted in high patient satisfaction, excellent pain relief and functional improvement at an average follow-up of 41 months,” Uribe and colleagues wrote in the study. “No implants were revised during this study, and secondary procedures were limited to one shoulder requiring arthroscopic lysis of adhesions at 2 years,” they added.
Perspective
Back to TopGrant E. Garrigues, MD, and Mariano E. Menendez, MD
Uribe and colleagues present their experience evaluating outcomes after anatomic shoulder arthroplasty with a non-spherical head and inlay glenoid component in a cohort of 36 patients. At a mean follow-up of 41 months, the authors reported significant improvements in patient-reported outcomes and only one reoperation for arthrofibrosis.
The design combination of an inlay glenoid component and a non-spherical humeral head may more closely replicate native patient anatomy and is put forward as treatment option for active younger patients with glenohumeral osteoarthritis. While limited in cohort size and shorter-term follow-up, the results of this study are both encouraging and consistent with previously published case series on this implant.
Unsolved clinical questions include where to put the inlay component (inferior two-thirds or more central) and how far to inset these types of glenoids for optimal peripheral rim fixation without compromising subchondral support. Longer-term studies are critical to determine if these excellent results will continue, especially in the subset of challenging, young, active, heavy-demand patients.
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