Comparing optimum prosthesis combinations of total stemmed, stemless and reverse shoulder arthroplasty revision rates for men and women with glenohumeral osteoarthritis

This study investigated prostheses from a large national arthroplasty registry with the lowest rates of revision, defined as optimum. We compared optimum shoulder arthroplasty revision rates for osteoarthritis (OA) to determine the most suitable/effective procedure for men and women. There were 3 cohort groups of optimum primary shoulder arthroplasties for OA undertaken between January 1, 2008, and December 31, 2022: stemless shoulder arthroplasty with cemented polyethylene glenoids (slTSA), stemmed shoulder arthroplasty with modified central peg polyethylene glenoids (stTSA), and cementless reverse shoulder arthroplasty (rTSA). The cumulative percentage revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age, gender, humeral head/glenosphere size, polyethylene type, and surgeon volume. Possible interactions were examined. A subanalysis from January 1, 2017, captured additional patient demographics, American Society of Anesthesiologists score, BMI, and glenoid morphology. The CPR at 7 years was 4.0% (95% confidence interval [CI] 3.1, 5.1) for slTSA (n = 3041), 3.8% (95% CI 2.7, 5.5) for stTSA (n = 1259), and 4.1% (95% CI 3.7, 4.6) for rTSA (n = 12,341). slTSA had a higher rate of revision compared with rTSA after the first 9 months (P