Revision surgery following Total Shoulder Arthroplasty: Analysis of 2,588 shoulders over 3 decades (1976–2008)

Our objective was to examine the revision rates and its predictors in patients undergoing Total Shoulder Arthroplasty (TSA). We used the prospectively collected data from the Mayo Clinic Total Joint Registry to examine the 5-, 10- and 20-year revision-free survival following TSA and its predictors. We examined patient characteristics (age, gender, BMI, comorbidity), implant fixation (cemented versus not), American Society of Anesthesiologists class, and underlying diagnosis. Univariate and multivariable adjusted hazard rates were calculated using Cox regression analyses. Two thousand two hundred seven patients underwent 2,588 TSAs. Mean age was 65 years with 53% women, and osteoarthritis was the underlying diagnosis in 63%. Two hundred twelve TSAs were revised during the follow-up. At 5-, 10- and 20- years, implant survival rates (95% confidence interval) were 94.2% (93.2%–95.3%), 90.2% (88.7%–91.7%) and 81.4% (78.4%–84.5%). In multivariable analyses, men had higher hazard ratio of revision, 1.72 (95% confidence interval, 1.28–2.31) (p<0.01), than women, and those with rotator cuff disease had hazard ratio of 3.99 (95% confidence interval, 1.91–8.36) (p<0.01), compared to patients with rheumatoid arthritis. We conclude that male gender and rotator cuff disease are independent risk factors for revision. Future studies are needed to understand the biological rationale for these differences.