Survival rate and outcomes of reverse total shoulder arthroplasty with a minimum ten-year follow-up using a trabecular metal implant

Listen to Brian and Lisa discuss the paper 'Survival rate and outcomes of reverse total shoulder arthroplasty with a minimum ten-year follow-up using a trabecular metal implant' published in the October 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper 'Survival rate and outcomes of reverse total shoulder arthroplasty with a minimum ten-year follow-up using a trabecular metal implant', published in October 2025 by S Watanabe and colleagues. I am Brian and I'm joined by my co-host Lisa.

Hello, Brian. Let's begin with why this research into reverse total shoulder arthroplasties or RTSAs was undertaken. Could you shed some light on that? The primary motivation for this research was the paucity of long-term data on the outcomes of RTSA with trabecular metal implants.

The study sought to determine the ten-year survival rate of these implants and evaluate clinical and radiological outcomes over the same period. This long-term data is pivotal as it aids in understanding the durability and efficacy of the implants.

Indeed long-term data is crucial for shaping future clinical decisions [00:01:00] and patient outcomes. The study examines cases from October 2007 to July 2013, covering 206 RTSAs performed at one institution. Let's explore the methods they employed.

The procedures were performed by two seasoned surgeons using the Zimmer trabecular metal Reverse Shoulder System. They adopted a standardized deltopectoral approach in all cases. The implants comprised a circumferential, metaphysical, trabecular metal-coated humeral component, and a trabecular metal-backed glenosphere.

And what about the clinical and radiological evaluations? How are those handled? For clinical evaluations, the American Shoulder and Elbow Surgeons, ASES score was utilized, encompassing both pain and functional scores.

They also assessed range of motion in various directions. Radiologically they used set criteria to evaluate complications such as scapular notching, and glenoid radiolucency. The evaluations were independently conducted by two authors for accuracy with any discrepancies [00:02:00] resolved through discussion with a senior author.

The results were quite fascinating. The study found 13 failures out of 206 RTSAs. The five-year implant survival rate was 94.7%, and the ten-year rate was 90.5%. It's impressive that such a high survival rate was maintained over time.

Indeed, and even more impressive is the improvement in the ASES scores.

The study reported a significant uptick in both pain and functional scores from an average preoperative score of 38.3 to an average of 85 and an 11.3 year follow-up. This indicates that clinical outcomes remained favorable even after a decade.

Nevertheless, there were some radiological findings to note. Scapular notching was observed in 77.5% of cases while grade III or IV notching was less frequent, it was found in 12.5% of the cases. Glenoid radiolucency and humeral [00:03:00] loosening were also observed, albeit at lower rates. 

Yes and the impact of these radiological findings on clinical outcomes remains a topic of debate. Some studies suggest that severe scapular notching could impact clinical scores like the Constant score. This study did find lower ASES scores in cases with grade III or IV notching. 

Moreover, it's important to consider the broader implications. This is the first study to present 10 year survival data for RTSA using trabecular metal implants. The survival rate was on par with, if not better than other implant types, studied over similar periods

Precisely, this research not only provides valuable long-term data but also demonstrates that RTSA with trabecular metal implants is a dependable option with a high rate of clinical success over a decade. It's a significant contribution to the field.

Before we conclude, let's recap the key points. The study showed a ten-year survival rate of [00:04:00] 90.5% for trabecular metal implants in RTSA, noteworthy improvements in ASES scores and some significant radiological findings. These insights are invaluable for clinicians and researchers alike.

And for our listeners, if you wish to delve deeper, the full details are available in the Bone & Joint Open, October 2025 issue. Thanks for tuning into AI talks with Bone & Joint. We hope you found this discussion informative. Thank you everyone.