Nick Smeitink

Aims: Primary anatomical total shoulder arthroplasty (aTSA) is generally the preferred treatment for active young patients with increased functional demands who need a shoulder arthroplasty. There is little information, however, about the survival of this implant in patients aged < 65 years. The aim of this study was to investigate the differences in revision rates after primary aTSA in patients aged < 65 years compared with those aged ≥ 65 years, within ten years, hypothesizing that younger patients would have higher revision rates due to increased functional demands and activity levels. Methods: Data on 3,622 primary aTSAs performed between January 2014 and January 2024 were extracted from the Dutch Arthroplasty Register. A total of 1,486 were performed in patients aged < 65 years, and 2,136 in those aged ≥ 65 years. Kaplan-Meier survival and multivariate Cox regression analyses were performed. Results: Within ten years of follow-up, 159 revisions (4%) were required. Significantly more revisions were performed in the younger group (89 (6%)) than in the older group (70 (3%); p < 0.001). The cumulative revision percentages were 11% (95% CI 8 to 14) and 6% (95% CI 4 to 7; p < 0.001), respectively. The most common indications for revision in both groups were cuff rupture, instability, and loosening of the glenoid component. In patients aged ≥ 65 years, both revisions for periprosthetic fracture (8 (11%) vs 2 (2%); p = 0.023) and total revisions were undertaken significantly more often (49 (71%) vs 49 (56%); p = 0.029). In the multivariate Cox regression model, age < 65 years was not associated with worse implant survival (hazard ratio (HR) 1.4 (95% CI 1.0 to 1.9); p = 0.069). Previous surgery on the affected shoulder was associated with significantly worse implant survival in all patients (HR 1.9 (95% CI 1.3 to 2.8); p = 0.002). Conclusion: Patients aged < 65 years had significantly higher revision rates after aTSA, but this was primarily explained by an increased prevalence of previous surgery to the shoulder. After adjustment, age itself was not associated with implant survival. Cite this article: Bone Joint J 2026;108-B(6):793–798.

Background/Objectives: Reverse total shoulder arthroplasty (rTSA) is the preferred treatment for elderly patients with complex proximal humerus fractures. Accurate humeral stem positioning remains challenging in these cases due to complex fracture patterns, which may lead to postoperative complications. Virtual surgical planning (VSP) may assist in optimizing humeral stem and greater tuberosity positioning; however, its clinical impact in fracture-related rTSA has not yet been evaluated. This study aimed to assess whether VSP improves postoperative range of motion (ROM). Methods: A comparative cohort study was conducted, comprising a prospective VSP group and a retrospective control group. Patients underwent rTSA for proximal humerus fractures. Primary outcomes were ROM during forward elevation, abduction, and external rotation at two months and one year postoperatively. Secondary outcomes included complications, procedure time, greater tuberosity repositioning and healing, and postoperative deviation in humeral stem height compared with the preoperative plan. Statistical analyses included independent t-tests, Mann–Whitney U tests, and chi-square tests. Results: A total of 48 patients were included: 27 in the VSP group and 21 in the non-VSP group. At two months, abduction was significantly greater in the VSP group (76° vs. 63°, p = 0.05). Forward elevation and external rotation were numerically higher in the VSP group but did not reach statistical significance (p < 0.1). Stem height deviation was significantly lower in the VSP group (3 mm vs. 12 mm, p < 0.001). Conclusions: VSP enables more accurate humeral stem positioning in rTSA for proximal humerus fractures. Although no statistically significant improvements in ROM were observed at one year, VSP demonstrated superior accuracy in stem positioning.

Aims: Hemiarthroplasty (HA) and total shoulder arthroplasty (TSA) are often the preferred forms of treatment for patients with atraumatic avascular necrosis of the humeral head when conservative treatment fails. Little has been reported about the survival of HA and TSA for this indication. The aim of this study was to investigate the differences in revision rates between HA and TSA in these patients, to determine whether one of these implants has a superior survival and may be a better choice in the treatment of this condition.Methods: Data from 280 shoulders with 159 primary HAs and 121 TSAs, which were undertaken in patients with atraumatic avascular necrosis of the humeral head between January 2014 and January 2023 from the Dutch Arthroplasty Register (LROI), were included. Kaplan-Meier survival analysis and Cox regression analysis were undertaken.Results: Within four years of follow-up, a total of 15 revisions were required, involving seven HAs (4%) and eight TSAs (7%). This difference was not statistically significant (p = 0.523). Two HAs were revised because of progressive glenoid erosion, and three TSAs were revised for loosening of the glenoid component. The cumulative percentages of revision of HA and TSA were 6% and 8%, respectively (HR 1.1 (95% CI 0.5 to 2.7)).Conclusion: We found no significant difference in short- to mid-term implant survival between the use of a HA and a TSA in the treatment of atraumatic avascular necrosis of the humeral head, without significant glenoid wear.Cite this article: Bone Joint J 2025;107-B(1):97–102.