Survivorship Analysis of CAD-CAM Total Shoulder Replacement

Overview

Journal Shoulder Elbow

Date 2024 Sep 25

PMID 39318417

Authors

Sandeep Krishan Nayar

David Butt

Aditya Prinja

Will Rudge

Addie Majed

Deborah Higgs

Mark Falworth

Affiliations

Soon will be listed here.

Abstract

Background: Glenoid bone loss represents a challenge in shoulder arthroplasty and often precludes standard implants. The CAD-CAM total shoulder replacement (TSR) is an option in these cases. This study aimed to assess survivorship and long-term patient outcomes of the CAD-CAM TSR.

Methods: Fifty-eight patients that underwent a CAD-CAM TSR by three surgeons at a single tertiary referral centre between 2009 and 2017 were reviewed. The mean follow-up was 70 months (28-130). Data was collected on survivorship, range of movement, Oxford shoulder score (OSS, 0-48), subjective shoulder value (SSV, 0-100%), pain score (0-10), and overall patient satisfaction.

Results: CAD-CAM TSR was undertaken as a primary procedure in 28% ( = 16) for end-stage arthritis with severe glenoid bone loss, and as a revision procedure in 72% ( = 42). Of the total, 17% ( = 10) required component revision at a mean of 24 months (4x prosthesis loosening, 3x infection, 3x periprosthetic fracture). Forward elevation improved from 45° ± 27° to 59° ± 29° (P = 0.0056), abduction from 43° ± 29° to 55° ± 26° (P = 0.034) and external rotation from 8° ± 11° to 16° ± 14° (P = 0.031). OSS improved from 15 ± 8 to 29 ± 9 (P = 0.0009), SSV from 18 ± 16 to 62 ± 23 (P < 0.0001), and pain score from 8 ± 2 to 2 ± 2 (P < 0.0001). 88% of patients would undergo the procedure again.

Conclusion: CAD-CAM TSR is reserved for complex cases involving severe glenoid bone loss, offering significant improvements in pain and function with overall positive patient satisfaction.

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