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Results of Cemented Total Shoulder Replacement with a Minimum Follow-up of Ten Years
Patric Raiss, MD1; Markus Schmitt, MD1; Thomas Bruckner, PhD2; Philip Kasten, MD, PhD3; Guido Pape, MD1; Markus Loew, MD, PhD4; Felix Zeifang, MD, PhD1
1 Department of Orthopaedic Surgery and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200 A, 69118 Heidelberg, Germany. E-mail address for P. Raiss: Patric.Raiss@med.uni-heidelberg.de. E-mail address for M. Schmitt: SL-991@gmx.de. E-mail address for G. Pape: guido.pape@googlemail.com. E-mail address for F. Zeifang: Felix.Zeifang@med.uni-heidelberg.de
2 Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany. E-mail address: Bruckner@imbi.uni-heidelberg.de
3 Universitätsklinikum Carl Gustav Carus, an der Technischen Universität Dresden, Anstalt des öffentlichen Rechts des Freistaates Sachsen, Fetscherstrasse 74, 01307 Dresden, Germany. E-mail address: Philip.Kasten@gmx.de
4 Department for Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany. E-mail address: Loew@atos.de
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Investigation performed at the Clinic for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Dec 05;94(23):e171 1-10. doi: 10.2106/JBJS.K.00580
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The purpose of this study was to assess the clinical and radiographic long-term outcomes of patients treated with a third-generation cemented total shoulder replacement and followed for at least ten years.


The results of thirty-nine arthroplasties were analyzed clinically with use of the Constant score and on radiographs in two projections, with special regard to glenoid component loosening, at a mean of eleven years (range, ten to fifteen years) postoperatively.


The mean Constant score was 27 points (range, 11 to 54 points) preoperatively and 61 points (range, 21 to 86 points) postoperatively (p < 0.0001). Mean shoulder flexion increased from 84° (range, 40° to 150°) preoperatively to 133° (range, 40° to 180°) postoperatively; mean abduction, from 77° (range, 40° to 110°) to 123° (range, 40° to 180°); and mean external rotation, from 11° (range, −20° to 40°) to 35° (range, 0° to 60°). No humeral components but 36% of the glenoid components were radiographically loose at the time of follow-up. Kaplan-Meier survivorship of the glenoid component was 100% after thirteen years with revision as the end point, whereas survivorship with radiographic loosening as the end point was only 48% after thirteen years. We found no correlation between glenoid loosening on radiographs and clinical findings such as the Constant score. Cranial migration of the humerus was seen in 69% of the cases.


With the implants, cementation, and surgical technique utilized in this group of patients with primary glenohumeral osteoarthritis, radiographic loosening of the glenoid component and rotator cuff deficiency were very common at the ten to fifteen-year review. The follow-up was not long enough to fully identify the clinical sequelae of these findings.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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