Which Patients Are Most at Risk for Glenoid Loosening and Rotator Cuff Tears after aTSA

Which patient and implant factors most accurately predict rotator cuff failure and glenoid loosening after aTSA?

While aTSA is a reliable procedure for patients with an intact cuff, rotator cuff tears (RCT) and aseptic glenoid loosening remain the two most common reasons for failure. Parada and colleagues analyzed a multicenter international database of 3,772 primary aTSA patients to identify patients most at risk for these complications. By comparing patients who experienced these complications vs. those who did not, the authors identified the specific demographic and implant-related risk factors.

• Low incidence rates: Rotator cuff tears occurred in 3.2% (122/3,772) of aTSA patients, while aseptic glenoid loosening occurred in 3.3% (123/3,772) of aTSA patients.
• Predictors for RCT: Previous shoulder surgery and the use of small size glenoids as the primary risk factors for rotator cuff failure.
• Predictors for glenoid loosening: Younger patients (≤62 years), the use of a small size glenoid, and the use of nonhybrid (all-polyethylene) glenoids were the primary risk factors for aseptic glenoid loosening.
• The power of accumulation: Risk increases dramatically when risk factors combine; for example, patients ≤62 years using small, nonhybrid glenoids were 2.84 times more likely to experience glenoid loosening.
• Poorer outcomes: Patients experiencing either RCT or glenoid loosening had significantly worse clinical scores (ASES, Constant, SAS) and significantly less range of motion compared to other aTSA patients.

Identifying patients with a high-risk for RCT and glenoid loosening preoperatively allows surgeons to refine their approach and better manage patient expectations. In cases where multiple risk factors are present, such as a younger patient with a small glenoid vault, surgeons should consider alternative strategies like reverse shoulder arthroplasty (rTSA) to mitigate the potential for these serious complications and ensure more predictable long-term results.

These findings are limited by the retrospective nature of the study and the reliance on retrospective radiographic evaluation by the implanting surgeons.