Arthroplasty & Replacement

Anatomic total shoulder arthroplasty for glenohumeral arthritis with intact cuff vs reverse TSA for cuff tear arthropathy and complex proximal humerus fractures.

Overview

Total elbow arthroplasty serves as a surgical option for end-stage elbow arthritis, with indications expanding from rheumatoid arthritis to osteoarthritis, post-traumatic arthritis, and acute fractures [66]. Lateral resurfacing elbow arthroplasty presents a satisfactory alternative to total elbow arthroplasty, offering lower complication rates and requiring less restrictive activity limitations [1]. For the shoulder, strong consideration should be given to performing total shoulder arthroplasty in patients where all conservative treatment options have failed [16]. Elective shoulder arthroplasty can be performed in patients 90 years of age and older, providing excellent pain relief, improved functional outcomes, and enhanced general health status [2].

Outcomes for total shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis favor pain relief, motion, and implant survival [67]. Conversion of humeral head replacement to total shoulder arthroplasty is complex and frequently yields unsatisfactory results, though excellent results can be accomplished [3]. Ream-and-run arthroplasty provides significant and clinically important improvements in clinical outcomes at minimum 5-year follow-up [9]. Condyle resurfacing prosthesis treatment for full-thickness femoral cartilage lesions carries a 23% reoperation rate with conversion to arthroplasty but can serve as a temporary option for younger patients not eligible for arthroplasty [11]. Total ankle arthroplasty offers a reasonable alternative to ankle arthroplasty in carefully selected patients [13].

Optimized patient outcomes rely on knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms [18]. On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment over arthrodesis in rheumatoid arthritis, despite the minimal increase in utility suggesting surgeons do not view arthroplasty as superior to arthrodesis [58]. More studies and better-designed trials are needed to enrich the evidence on long-term outcomes of pyrocarbon shoulder implants and to compare them with other shoulder replacement options for young and active patients [20].

Anatomy & Pathophysiology

Osseous and Articular Geometry

Resurfacing shoulder arthroplasty reproduces normal anatomy and compensates for glenohumeral wear, though a tendency exists to position the prosthesis in varus due to technical imperfections [54]. Glenoid allografts most accurately restore articular geometry for large glenoid bone defects in anterior shoulder instability [70]. A physiological remodeling process leads to restoration of a more natural glenoid anatomy following arthroscopic implant-free bone grafting for shoulder instability with glenoid bone loss [56]. Statistical models have been constructed to capture coupled variations in arthropathic shoulder anatomy and proximal humeral morphology using clinical datasets [59].

Kinematics and Biomechanics

Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty [43]. In vivo three-dimensional shoulder motions and forces were derived for normal, rotator cuff-deficient, total, and reverse replacement shoulders using fluoroscopy, CT, and mathematical modeling [53]. Reverse total shoulder arthroplasty increases muscle activation compared with normal shoulders [75], and patients tend to have fewer motions at humeral elevations above 100° compared to anatomic shoulder arthroplasty patients [68]. Higher glenosphere center-of-rotation offsets led to an increase in motion in all planes in reverse shoulder arthroplasty [73], whereas increasing glenosphere diameter significantly increased joint load and deltoid force, though the clinical impact of these changes remains unclear [62]. Shear forces are significantly higher when the glenoid component is positioned in the medial center of rotation (MCP) compared with the inferior center of rotation (ICP), a difference more pronounced in early abduction [57]. Nonlateralized reverse total shoulder arthroplasty designs minimize shear forces [63], while lateralized designs decrease impingement and scapular notching [63]. Inferiorly tilting the glenosphere did not reduce inferior scapular neck impingement or subsequent scapular notching at 1-year follow-up compared to other positions [45]. All movement planes showed significant differences in simulated range of motion when comparing preoperative planning protocols with and without adjustment for posture [74].

Soft Tissue and Reconstruction

Repair of the subscapularis in reverse total shoulder arthroplasty did not lead to inferior clinical outcomes, though available biomechanical evidence regarding subscapularis repair strength is limited [47, 49]. Successful application of suture anchors and tacks in shoulder surgery requires understanding the biology and biomechanics affecting use [64]. Tendon transfers can be useful in salvaging irreparable rotator cuff tears in younger patients to reconstruct rotator cuff function and restore shoulder kinematics [72]. Latissimus dorsi transfer for irreparable subscapularis tear improves signs of subscapularis insufficiency, including anterior and/or proximal subluxation, clinical examination maneuvers, and shoulder function in most patients [76]. Overall functional outcomes after total humeral replacement in patients with primary sarcomas were acceptable with good hand and elbow function, but shoulder function was limited [69].

Classification

Shoulder Arthroplasty Systems: The use of a convertible prosthetic system to revise a failed anatomical shoulder arthroplasty reduces morbidity and minimises the rate of complications [19]. Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but unsatisfactory results are frequent [3]. Reverse total shoulder arthroplasty (RTSA) has become the most common primary shoulder arthroplasty over the past decade [26]. The clinical and radiologic results of the short-stem shoulder arthroplasty are comparable to those with the third and fourth generations of standard stem arthroplasty [22]. The overall early functional results of stemless humeral head replacement are comparable to the 3rd and 4th generation of standard stem arthroplasty [86].

Glenoid Bone Loss: A proposed classification system serves as a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty [33]. Patient-specific planning (PSP) brings all surgeons into closer agreement with the recommendations of experts for glenoid classification and surgical planning [65].

Infection Management: Two-stage exchange arthroplasty for periprosthetic shoulder infection is associated with high rates of failure to reimplant and mortality [24].

Other Considerations: The lateral resurfacing elbow arthroplasty is a satisfactory alternative to total elbow arthroplasty with lower rates of complications [1]. The incidence of shoulder replacement and revision is expected to increase in the following years, constituting a burden for the healthcare systems [21]. Wide variation in the value of shoulder arthroplasty is most strongly associated with procedure type and certain preoperative characteristics [79]. Patient-specific planning (PSP) has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually) [65]. Scapular notching in reverse shoulder arthroplasty may be caused by different morphology of the polyethylene component and/or differences in glenosphere offset between prosthetic systems [81]. A deep learning model maintains robust performance in arthritic shoulders for the automatic determination of the resection plane [82]. Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution for total thumb carpometacarpal joint arthroplasty [83].

Clinical Presentation

Lateral resurfacing elbow arthroplasty presents as a satisfactory alternative to total elbow arthroplasty, offering lower complication rates and permitting less restrictive activity levels [1]. In the shoulder, elective arthroplasty is feasible and effective in patients aged 90 years and older, providing excellent pain relief, improved functional outcomes, and enhanced general health status [2]. For failed shoulder arthroplasty, resection arthroplasty effectively relieves pain but is associated with poor postoperative function [5]. In young patients with shoulder chondrolysis, total shoulder arthroplasty shows potential for pain and functional improvement, though progressive glenoid radiolucencies may develop following arthroscopic surgery [6].

Diagnostic Challenges: Subscapularis tears are a common finding after total shoulder arthroplasty but cannot be reliably diagnosed via physical examination or radiographs [12]. Ultrasound evaluation of the subscapularis tendon is limited by timing but may be most useful when interpreted within the clinical context [42]. Inflammatory arthritis patients derive significant pain relief and functional improvement from shoulder arthroplasty [14]. Conversely, male patients require careful postoperative monitoring for P. aeruginosa infection [41]. Further studies are needed to identify diagnostic tests that better detect periprosthetic joint infection (PJI) in patients with inflammatory arthritis [46].

Complication Patterns: Distinct demographic and radiographic factors, including female sex and the absence of glenoid loosening, are associated with aseptic humeral loosening [8]. Heterotopic ossification is a common radiographic finding after modern total hip arthroplasty, with prevalence ranging from 10% to 40% depending on the surgical approach [15]. Stiff or unstable total shoulder arthroplasty requires an organized diagnostic and management approach to improve both patient satisfaction and long-term survival [38]. Reviews summarize processes for diagnosing and treating complications after reverse shoulder arthroplasty to help clinicians reduce complications and perform appropriate procedures when they occur [39].

Joint-Specific Outcomes: Ream-and-run arthroplasty provides significant, clinically important improvements in clinical outcomes at minimum 5-year follow-up [9]. In revision hip replacement, acetabular impaction grafting without cage reinforcement yields satisfactory clinical scores for pain relief, with no difference in scores between cups appearing stable versus radiologically loose [10]. Pyrocarbon prostheses for the proximal interphalangeal joint report good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, though no improvement in range of motion is noted [17]. Routine pathological examination of specimens from primary total hip or knee replacements for osteoarthritis has limited cost-effectiveness due to the low prevalence of findings altering management [37].

Management Frameworks: Reviews describe challenges in diagnosing and managing glenohumeral arthritis and provide treatment frameworks for challenging patients [40]. For persistent postoperative symptoms in failed thumb carpometacarpal arthroplasty, reviews offer an algorithmic treatment approach based on the history of CMC arthroplasty and reasons for failure [44].

Investigations

Plain radiography: This modality demonstrates the highest diagnostic accuracy for evaluating aseptic loosening of the acetabular component [88]. In total shoulder arthroplasty, plain radiography may reveal progressive glenoid radiolucencies in young patients with chondrolysis [6] and can identify radiographic osteolysis that leads to clinically important complications such as aseptic loosening [27]. While subscapularis tears are a common finding after total shoulder arthroplasty, they cannot be diagnosed reliably by radiographs [12]. Radiographic follow-up of cemented, all-polyethylene pegged glenoid components in anatomic total shoulder arthroplasty showed that 36% had signs of radiolucency, yet no patients underwent revision for glenoid loosening [99]. Conversely, five patients in an anatomical total shoulder arthroplasty group demonstrated radiographic evidence of glenoid loosening, whereas no patients in a reverse shoulder arthroplasty group demonstrated prosthetic loosening [106]. In proximal interphalangeal joint surface replacement, the uncemented group had significantly more cases with radiologic evidence of loosening compared to the cemented group (p < .001) [101]. For reverse total shoulder arthroplasty in proximal humerus fractures, radiographic findings of loosening were primarily radiographic, with both cemented and uncemented groups showing satisfying functional outcomes and low revision rates at 2-year follow-up [107]. Additionally, plain radiography is the basis for a quantitative method to determine the rate of medial migration of the humeral head, which is inexpensive, practical, and reproducible [111].

Other Considerations: Preoperative radiographic evaluation of glenoid component loosening may often differ from intraoperative findings [96]. In acetabular impaction grafting without cage reinforcement for revision hip replacement, clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose [10]. Female sex is a demographic factor associated with aseptic humeral loosening, as is the absence of glenoid loosening [8]. Heterotopic ossification is a common radiographic finding after modern total hip arthroplasty, with a prevalence ranging from 10% to 40% depending on the surgical approach [15]. Regarding implant design, radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants, though stemless implants show improved restoration of the native humeral neck angle [113]. More bone between the central peg's radial fins of a partially cemented pegged all-poly glenoid component imparted fewer overall component radiolucencies [110]. Early results of glenoid bone grafting with a reverse design prosthesis are encouraging [28]. Clinical and radiologic results of short-stem shoulder arthroplasty are comparable to those with third and fourth generations of standard stem arthroplasty [22]. A pyrocarbon prosthesis replacing the proximal interphalangeal joint reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, though it showed no improvement in range of motion at 5 years [17]. The use of a convertible prosthetic system to revise a failed anatomical shoulder arthroplasty reduces morbidity and minimises the rate of complications [19].

Treatment

Non-Operative

Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures, with selection depending on disease stage and patient factors [87]. Strong consideration should be given to performing total shoulder arthroplasty in patients in whom all conservative treatment options have failed [16]. Data on health care resource utilization in the 2 years prior to total shoulder arthroplasty provide a baseline for understanding current trends regarding nonarthroplasty treatment of shoulder pathology before shoulder replacement [102].

Operative

Indications: Elective shoulder arthroplasty can be performed in patients 90 years of age and older, providing excellent pain relief, improved functional outcome, and enhanced general health status [2]. The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear, and it appears to be contraindicated in patients with rheumatoid arthritis [51]. In non-arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears, both joint-preserving and joint-replacing procedures yielded good clinical midterm results [97]. Total ankle arthroplasty offers a reasonable alternative to ankle arthroplasty in carefully selected patients [13].

Surgical Approach / Technique: The anteromedial approach is a reliable technique to improve surgical exposure in difficult shoulder arthroplasty cases [29]. The subscapularis-sparing, minimally invasive approach provides adequate exposure for humeral head replacement [34]. Arthroscopic procedures successfully treated 46% of patients (6 of 13) with painful shoulder arthroplasty, preventing the need for revision arthroplasty [31]. Arthroscopic interpositional arthroplasty for Freiberg's disease is easy, can be performed on an outpatient basis, and helps preserve joint space [36].

Implant Selection: Lateral resurfacing elbow arthroplasty is a satisfactory alternative to total elbow arthroplasty with lower rates of complications and does not require activities to be restricted to the same extent [1]. Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but the surgery is complex and unsatisfactory results are frequent [3]. Resection arthroplasty is effective in relieving pain, but patients have poor postoperative function [5]. A 23% reoperation rate with conversion to arthroplasty was found in the treatment of full-thickness femoral cartilage lesions using a condyle resurfacing prosthesis, suggesting the treatment can be a temporary option for younger patients not eligible for arthroplasty [11]. Total shoulder arthroplasty with an all-polyethylene, pegged glenoid component utilizing hybrid fixation demonstrates excellent clinical and radiological outcomes at long term follow-up [78]. Results with a conventional prosthesis in impaction-grafted standard-length humeral components can serve as a basis for comparison for new component designs and fixation methods [50]. Constrained reverse prostheses were associated with a higher reoperation rate without any functional benefit compared with unconstrained hemiarthroplasty-type articulations in musculoskeletal tumor resections [85]. Revision surgery rates due to persistent pain and instability were higher with the use of implants in thumb carpometacarpal joint hemiresection interposition arthroplasty [80].

Alignment / Balancing Strategy: Patient and diagnostic factors play a role in implant survival in shoulder arthroplasty; implant type and method of fixation are less important [48]. Knowledge of the array of shoulder prostheses currently available, the indications for each, and the use of treatment algorithms can lead to optimized patient outcomes [18].

Pain Management: Patients undergoing shoulder arthroplasty have decreased postoperative pain and opioid consumption and shorter hospital stays when given a multimodal analgesia regimen [71]. Periarticular injection of a local anesthetic solution provides reliable and consistent pain control with a trend toward less immediate postoperative opioid use after total shoulder arthroplasty compared with regional blocks [98]. Use of an indwelling interscalene nerve block provides superior pain management in the immediate postoperative setting as demonstrated by decreased narcotic medication consumption and lower subjective pain scores compared to liposomal bupivacaine in shoulder arthroplasty [100].

Adjuncts: Guidelines for perioperative management of antirheumatic medication in rheumatic patient populations undergoing TKAs or THAs present an extremely useful set of recommendations [7].

Revision: Even after revision without implant removal, total elbow arthroplasty in patients with hemophilia provides good functional and subjective long-term results [77]. The use of strut allografts in revision total elbow arthroplasty did not show a significant association with a lower incidence of aseptic loosening, although it may still have clinical value [25]. Articles on revision TJA epidemiology, surgical techniques, novel technology, implant design, and outcome optimization are presented to provide guidance in navigating challenging clinical scenarios associated with revision TJA [32].

Other Considerations: Radiographic osteolysis after total shoulder arthroplasty may lead to clinically important complications such as aseptic loosening [27]. Early results of glenoid bone grafting with a reverse design prosthesis are encouraging, but further clinical and radiologic assessment is necessary [28]. More studies and better-designed trials are needed to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients [20]. The future of shoulder arthroplasty has the potential to integrate multiple advanced technologies that could improve preoperative planning, intraoperative execution, and patient outcomes [30]. Shoulder arthroplasty provides significant pain relief and functional improvement for patients with inflammatory arthritis [14]. Uncemented fixation in reverse total shoulder arthroplasty may provide several benefits over cemented fixation, including simplified operative technique, no cement-related complications, greater ease of revision, and long-lasting biologic fixation [61]. Press-fit fixation may provide a lower risk to stem loosening in reverse total shoulder arthroplasty [52]. Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up in total shoulder arthroplasty [84]. Routine synovectomy in total knee replacement undertaken for osteoarthritis cannot be recommended [55]. The document describing the randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty does not report final results or conclusions as the study was ongoing at the time of publication [4]. There is insufficient evidence to conclusively support the hypothesis that a specific surgical approach or minimally invasive technique provides faster recovery and return to function after total hip arthroplasty, and long-term data do not exist to confirm implant longevity [35].

Complications

Infection (PJI): The risk of periprosthetic joint infection after primary shoulder arthroplasty is significantly elevated in patients with a history of prior nonarthroplasty-related surgery [114], and prior nonshoulder periprosthetic joint infection increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision [115]. Undergoing an arthroscopic procedure within 3 months before arthroplasty is associated with the highest risk of prosthetic joint infection [144]. While the periprosthetic infection rate remains low at 20-year follow-up [123], two-stage exchange arthroplasty for periprosthetic shoulder infection achieves high eradication rates, though a considerable subset of patients never undergoes the second stage [24]. For total elbow arthroplasty, two-stage reimplantation successfully eradicated deep infection in 69% of cases [129], and intravenous vancomycin powder was associated with almost half the risk of developing PJI (13.6% vs. 7.7%), though this finding was not statistically significant likely due to underpowering [136]. Reported success rates for two-stage exchanges often do not consider complications in their definition of success [140].

Aseptic loosening: Distinct demographic and radiographic factors, including female sex and absence of glenoid loosening, are associated with aseptic humeral loosening [8]. Females also exhibit higher rates of postoperative complications and revision surgery compared to males following anatomic total shoulder arthroplasty [141]. In primary reverse shoulder arthroplasty for patients aged 65 years or younger, there is no increase in revisions owing to aseptic loosening [105]. With removal of the component due to aseptic loosening as the endpoint, survivorship was 98% for the stem and 96% for the cup in a contemporary metal-on-metal total hip arthroplasty [109]. In revision total elbow arthroplasty, the use of strut allografts did not show a significant association with a lower incidence of aseptic loosening, although it may still have clinical value [25]. Complication and revision rates for unconstrained shoulder prostheses increase substantially with longer follow-up duration [118].

Thromboembolism: The prevalence of venous thromboembolism (VTE) after total shoulder arthroplasty is low [117], with rates generally less than 1% for arthroplasty and even lower for arthroscopy [119]. Patients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty [138].

Other Considerations: Primary reverse shoulder arthroplasty in patients aged 65 years or younger yields good short-term to medium-term outcomes with high implant survival, though smoking increases the risk for revision, reoperation, and complications [23]. Complication, reoperation, and revision rates following primary reverse total shoulder arthroplasty in patients younger than 65 years were similar to those seen in older patient cohorts [105]. Revision surgery with implant revision after primary total elbow arthroplasty is common [112], and the risk of short-term complications after revision total elbow arthroplasty is comparable to that of primary total elbow arthroplasty [143]. A high rate of complications and revisions was observed with follow-up for semiconstrained total elbow arthroplasty performed for arthritis in patients under 55 years old [135]. Primary arthroplasty as treatment of distal humeral fractures produces reliable results regarding revisions and other adverse events [116], though a systematic review indicated that patient-reported outcome measures and range of motion mostly favor hemiarthroplasty over total elbow arthroplasty for unreconstructable distal humeral fractures in patients aged over 65 years, with similarly high complication rates in both procedures [124]. The unique limitations, complications, and revision rates for total elbow arthroplasty versus open reduction–internal fixation must be carefully weighed for each patient [130]. Clinical scores for pain relief remained satisfactory in acetabular impaction grafting without cage reinforcement, with no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose [10]. Despite the higher rate of early complications, the intermediate-term outcomes of arthroplasties in which the glenoid implant is inserted without cement are comparable with those of arthroplasties with cementing of the glenoid component [120]. Secondary outcomes were not significantly different between subscapularis tenotomy and peel groups in anatomic shoulder arthroplasty [137]. Personalized instrumentation does not consistently deliver commensurate clinical benefit in primary total shoulder arthroplasty, and its routine use cannot be endorsed until further evidence emerges [131]. Patients and surgeons must accept a significant complication rate and likelihood for reoperation with biological glenoid resurfacing for glenohumeral osteoarthritis [133]. Complications and reoperations associated with reverse shoulder arthroplasty occurred at much lower rates than in previous reports [134]. Revision shoulder arthroplasty remains challenging with a high rate of complications [121]. The incidence of shoulder replacement and revision is expected to increase in the following years, constituting a burden for the healthcare systems [21].

Recovery

Light activity (weeks): Patients undergoing primary reverse shoulder arthroplasty or total shoulder arthroplasty can typically resume light activities of daily living and desk work within the timeframe required to achieve optimal pain relief, though specific week ranges for driving or light ADLs are not explicitly quantified in the provided evidence [2, 23, 90, 93].

Full activity (months): Functional outcomes and health-related quality of life for reverse shoulder arthroplasty patients stabilize to levels similar to healthy controls at a mean of 5 years post-operatively [125]. Anatomic total shoulder arthroplasty patients demonstrate superior ability to return to work, return to sport, and perform higher-demand activities compared to reverse total shoulder arthroplasty patients when they perceive their shoulder as normal [94].

Complete recovery / outcome plateau (months): Total shoulder arthroplasty using a keeled glenoid demonstrates satisfactory implant survival and functional improvement at 5 years' follow-up in young adults [128]. Primary reverse shoulder arthroplasty in patients aged 65 years or younger yields good short-term to medium-term outcomes with high implant survival [23]. Older patients undergoing total shoulder arthroplasty are unlikely to require revision in their lifetime, suggesting a plateau in long-term recovery needs [95].

Rehabilitation protocol: Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [93]. A 1-stage procedure for shoulder and elbow arthroplasty reduces hospitalization time without adversely affecting clinical outcomes compared to a 2-stage procedure [104].

Functional milestones: Elective shoulder arthroplasty in patients 90 years of age and older provides excellent pain relief, improved functional outcome, and enhanced general health status [2]. Ream-and-run arthroplasty provides significant and clinically important improvements in clinical outcomes at minimum 5-year follow-up [9]. In patients with surviving implants following hemiarthroplasty of the elbow for posttraumatic arthritis, 57% achieved good to excellent Mayo Elbow Performance Scores with predictable improvement in range of motion [139]. Satisfactory clinical results are achieved with staged bilateral primary total shoulder arthroplasties, showing excellent pain relief and improvements in motion and ability to carry out activities of daily living, though strength likely remains unchanged [90].

Other Considerations: Resection arthroplasty is effective in relieving pain but results in poor postoperative function [5]. Early results of total shoulder arthroplasty in young patients with shoulder chondrolysis show improvements in pain and function, though progressive glenoid radiolucencies may develop [6]. A 23% reoperation rate with conversion to arthroplasty was found for condyle resurfacing prosthesis treatment of full-thickness femoral cartilage lesions, suggesting the treatment can be a temporary option for younger patients not eligible for arthroplasty [11]. Smoking increases the risk for revision, reoperation, and complications in primary reverse shoulder arthroplasty in patients aged 65 years or younger [23]. There is a substantial reduction in serious complications after reverse shoulder arthroplasty with increased surgeon experience [92]. Functional outcomes and high prosthesis survivorship are reported at midterm follow-up for B2 and B3 glenoid osteoarthritis treated with corrective and concentric reaming of the glenoid combined with pyrocarbon hemiarthroplasty [122]. At short-term follow-up, there is no difference in functional outcome or revision between two different short press-fit humeral stem designs in total shoulder arthroplasty [126]. Outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [132]. Resection arthroplasty can be an acceptable salvage procedure for treatment of an infection after total elbow arthroplasty for low-demand patients [142]. The Aptis-Scheker distal radioulnar joint replacement improved the functional status of the extremity in patients under 40 years old [103]. Reverse total shoulder arthroplasty has become the most common primary shoulder arthroplasty procedure over the past decade [26], with utilization of primary shoulder arthroplasty significantly increasing in a 3-year time span, with a major contribution from reverse shoulder arthroplasty in 2011 [91].

Key Evidence

• [L4] It is a satisfactory alternative to total elbow arthroplasty with lower rates of complications and does not require activities to be restricted to the same extent. (10.1302/0301-620x.100b3.bjj-2017-0865.r1)
• [L4] Elective shoulder arthroplasty can be performed in patients 90 years of age and older, providing excellent pain relief, improved functional outcome, and enhanced general health status. (10.1016/j.jse.2007.09.005)
• [L4] Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but the surgery is complex and unsatisfactory results are frequent. (10.1016/j.jse.2008.09.006)
• [L2] This document describes the protocol for a randomised controlled trial comparing Total Hip Arthroplasty and Resurfacing Arthroplasty; it does not report final results or conclusions as the study was ongoing at the time of publication. (10.1186/1471-2474-11-8)
• [L4] Resection arthroplasty is effective in relieving pain, but patients have poor postoperative function. (10.1016/j.jse.2012.05.025)
• [L4] Early results of total shoulder arthroplasty show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients. (10.1016/j.jse.2007.11.004)
• [L5] This timely collaborative effort between experts in orthopaedics and rheumatology presents an extremely useful set of guidelines for perioperative medication management in rheumatic patient populations undergoing TKAs or THAs. (10.1016/j.arth.2017.07.022)
• [L4] Distinct demographic and radiographic factors, including female sex and absence of glenoid loosening, are associated with aseptic humeral loosening. (10.1016/j.jse.2024.03.004)
• [L4] Ream-and-run arthroplasty can provide significant and clinically important improvements in clinical outcomes at minimum 5-year follow-up. (10.1016/j.jse.2023.01.024)
• [L3] Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose. (10.1302/0301-620x.96b2.32121)
• [L4] A concerning 23% reoperation rate with conversion to arthroplasty was found, suggesting the treatment can be a temporary option for younger patients not eligible for arthroplasty. (10.1007/s00167-015-3726-1)
• [L4] Subscapularis tear after total shoulder arthroplasty is a common finding that cannot be diagnosed reliably by physical examination or radiographs. (10.1016/j.jse.2010.04.001)
• [L4] Total ankle arthroplasty offers a reasonable alternative to ankle arthroplasty in carefully selected patients. (10.1302/2058-5241.3.170029)
• [L3] Shoulder arthroplasty provides significant pain relief and functional improvement for patients with inflammatory arthritis. (10.2106/00004623-200411000-00020)
• [L5] Heterotopic ossification is a common radiographic finding after modern total hip arthroplasty, with prevalence ranging from 10% to 40% depending on the surgical approach. (10.5435/jaaos-d-22-01070)
• [L4] Strong consideration should be given to performing total shoulder arthroplasty in patients in whom all conservative treatment options have failed. (10.1016/j.jse.2012.04.019)
• [L4] The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion. (10.1177/1753193413479527)
• [L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. (10.5435/00124635-200907000-00002)
• [L4] The use of a convertible prosthetic system to revise a failed anatomical shoulder arthroplasty reduces morbidity and minimises the rate of complications. (10.1302/0301-620x.97b12.35176)
• [L1] More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients. (10.1177/24715492231152143)
• [L3] The incidence of shoulder replacement and revision is expected to increase in the following years, constituting a burden for the healthcare systems. (10.1186/s12891-022-05849-x)
• [L4] The clinical and radiologic results of the short-stem shoulder arthroplasty are comparable to those with the third and fourth generations of standard stem arthroplasty. (10.1016/j.jse.2015.08.044)
• [L3] Primary reverse shoulder arthroplasty in patients aged 65 years or younger yields good short-term to medium-term outcomes with high implant survival, though smoking increases the risk for revision, reoperation, and complications. (10.1016/j.jse.2016.05.026)
• [Abstract] While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. (10.1016/j.jse.2022.01.044)
• [L3] The use of strut allografts did not show a significant association with a lower incidence of aseptic loosening, although it may still have clinical value. (10.1016/j.jse.2025.01.043)
• [L4] Over the past decade, RTSA has become the most common primary shoulder arthroplasty, reflecting the clinical success of the procedure. (10.5435/jaaos-d-17-00075)
• [L5] Radiographic osteolysis after total shoulder arthroplasty may lead to clinically important complications such as aseptic loosening. (10.5397/cise.2021.00738)
• [L4] Early results are encouraging, but further clinical and radiologic assessment is necessary. (10.1016/j.jse.2006.02.002)
• [L4] The anteromedial approach is a reliable technique to improve surgical exposure in difficult shoulder arthroplasty cases. (10.1016/j.jse.2009.10.016)
• [L5] The future of shoulder arthroplasty is exciting, with the potential to integrate multiple advanced technologies that could improve preoperative planning, intraoperative execution, and, ultimately, patient outcomes. (10.1016/j.jseint.2024.04.007)
• [L4] We were able to successfully treat 46% of patients (6 of 13) with arthroscopic procedures, preventing the need for revision arthroplasty. (10.1016/j.arthro.2020.01.045)
• [L5] In this special issue, articles on revision TJA epidemiology, surgical techniques, novel technology, implant design, and outcome optimization are presented to provide guidance to the Arthroplasty readership in navigating the challenging clinical scenarios associated with revision TJA. (10.1186/s42836-025-00298-y)
• [L4] The proposed classification system is a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty. (10.1302/0301-620x.98b3.36664)
• [L4] The subscapularis-sparing, minimally invasive approach provides adequate exposure for humeral head replacement. (10.1016/j.jse.2014.07.020)
• [L4] There is insufficient evidence to conclusively support the hypothesis that a specific surgical approach or minimally invasive technique provides faster recovery and return to function after total hip arthroplasty, and long-term data do not exist to confirm implant longevity. (10.2106/jbjs.i.00343)
• [L4] The technique is easy, can be performed on an outpatient basis, and helps preserve joint space. (10.1007/s00167-006-0189-4)
• [L3] Routine pathological examination of surgical specimens from patients undergoing primary total hip or knee replacement because of the clinical diagnosis of osteoarthritis had limited cost-effectiveness at our hospital due to the low prevalence of findings that altered patient management. (10.2106/00004623-200011000-00002)
• [L5] An organized approach to diagnose and manage stiff or unstable total shoulder arthroplasty is needed to improve patient satisfaction and long-term survival. (10.5435/jaaos-21-01-23)
• [L4] This review article summarizes the processes related to diagnosis and treatment of complications after reverse shoulder arthroplasty with the aim of helping clinicians reduce complications and perform appropriate procedures if/when complications occur. (10.5397/cise.2021.00066)
• [L5] This review describes the challenges associated with the diagnosis and management of glenohumeral arthritis and provides a treatment framework for use in these challenging patients. (10.1016/j.jse.2007.03.011)
• [L2] Shoulder arthroplasty performed on the male population must be carefully checked after surgery for the possible presence of P. (10.1186/s12891-020-03332-z)
• [L4] The utility of ultrasound examination of the subscapularis tendon following shoulder arthroplasty is limited by timing and may be most useful when used by the physician within clinical context. (10.1177/2471549219832442)
• [L5] A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. (10.1186/s12891-023-06273-5)
• [L5] The purpose of this review is to provide insights into the history of CMC arthroplasty and reasons for failure and to offer an algorithmic treatment approach for the clinical problem of persistent postoperative symptoms. (10.1016/j.jhsa.2018.03.052)
• [L3] Despite previous biomechanical studies' predictions that inferiorly tilting the glenosphere might reduce inferior scapular neck impingement and subsequent scapular notching, our data showed no difference at 1-year follow-up. (10.1016/j.jse.2010.11.026)
• [L2] Further studies are needed to explore diagnostic tests that will better detect PJI in patients with inflammatory arthritis. (10.1016/j.arth.2019.01.051)
• [L3] Repair of the subscapularis did not lead to inferior clinical outcomes as predicted by biomechanical models. (10.1016/j.jse.2016.09.027)
• [L4] Patient and diagnostic factors play a role in implant survival; implant type and method of fixation are less important. (10.1016/j.jse.2009.04.011)
• [L4] Available biomechanical evidence is limited, and further studies are needed. (10.1016/j.xrrt.2022.05.006)
• [L4] These results with a conventional prosthesis can serve as a basis for comparison for new component designs and fixation methods. (10.1016/j.jse.2019.03.016)
• [L3] The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear, and it appears to be contraindicated in patients with rheumatoid arthritis. (10.2106/jbjs.e.00851)
• [L3] Press-fit fixation may provide a lower risk to stem loosening. (10.1016/j.jse.2015.02.007)
• [L4] The study successfully derived in vivo three-dimensional shoulder motions and forces for normal, rotator cuff-deficient, total, and reverse replacement shoulders using fluoroscopy, CT, and mathematical modeling. (10.2106/jbjs.e.00483)
• [L4] The resurfacing shoulder arthroplasty reproduces the normal anatomy and compensates glenohumeral wear, although there was a tendency to position the prosthesis in varus due to technical imperfections. (10.1016/j.jse.2012.07.014)
• [L1] We cannot recommend routine synovectomy in TKR undertaken for OA. (10.1302/0301-620x.95b9.31253)
• [L4] A physiological remodeling process leads to restoration of a more natural glenoid anatomy. (10.1177/0363546515625283)
• [L5] Shear forces are significantly higher when the glenoid component is positioned in the MCP compared with the ICP, and this is more pronounced in early abduction. (10.1016/j.jse.2014.12.017)
• [L4] On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment, though the minimal increase in utility over arthrodesis suggests surgeons do not view arthroplasty as superior. (10.1016/j.jhsa.2008.06.022)
• [L5] This study developed the first two-body scapulohumeral shape model that captures coupled variations in arthropathic shoulder anatomy and the first proximal-humeral statistical model constructed using a clinical dataset. (10.1186/s13018-025-05855-4)
• [L3] Uncemented fixation may provide several benefits over cemented fixation, including simplified operative technique, no cement-related complications, greater ease of revision, and long-lasting biologic fixation. (10.1016/j.jse.2013.11.032)
• [L5] Although increasing glenosphere diameter significantly increased joint load and deltoid force, the clinical impact of these changes is presently unclear. (10.1016/j.jse.2014.10.018)
• [L4] The review summarizes biomechanical concepts and clinical outcomes, noting that nonlateralized designs minimize shear forces while lateralized designs decrease impingement and scapular notching. (10.1177/1758573220937412)
• [L5] Successful application requires understanding the biology and biomechanics affecting use, as well as knowledge of factors that can affect subsequent clinical outcomes. (10.1177/0363546505282621)
• [L4] The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. (10.1302/0301-620x.102b3.bjj-2019-1153.r1)
• [L4] Total elbow arthroplasty is a surgical option for end-stage elbow arthritis with indications expanding from rheumatoid arthritis to osteoarthritis, post-traumatic arthritis, and acute fractures. (10.1016/j.jhsa.2018.11.005)
• [L4] These results favor total shoulder arthroplasty in terms of pain relief, motion, and implant survival. (10.1016/j.jse.2010.05.006)
• [L4] RTSA, although the latter tended to have fewer motions at humeral elevations above 100°. (10.1016/j.jse.2017.09.023)
• [L4] Overall functional outcomes were acceptable with good hand and elbow function, but shoulder function was limited. (10.1016/j.jse.2024.09.030)
• [L5] Overall, glenoid allografts most accurately restored articular geometry. (10.1016/j.arthro.2017.04.002)
• [L2] Patients undergoing shoulder arthroplasty have decreased postoperative pain and opioid consumption and shorter hospital stays when given a multimodal analgesia regimen. (10.1016/j.jse.2017.11.015)
• [L5] For rotator cuff tears that are deemed irreparable, the use of tendon transfers in younger patients to reconstruct rotator cuff function and restore shoulder kinematics can be useful in salvaging this difficult problem. (10.1016/j.jse.2009.03.013)
• [L5] Higher glenosphere center-of-rotation offsets led to an increase in motion in all planes. (10.1016/j.jse.2012.02.004)
• [L4] All movement planes showed significant differences in simulated range of motion when comparing protocols with and without adjustment for posture. (10.1302/0301-620x.106b11.bjj-2024-0110.r1)
• [L3] RTSA increases muscle activation compared with normal shoulders. (10.1016/j.jse.2013.05.005)
• [L4] Most patients improve in many of the signs of subscapularis insufficiency, including anterior and/or proximal subluxation, clinical examination maneuvers, and shoulder function. (10.1016/j.jse.2020.02.019)
• [L4] However, even after revision without implant removal, it provides good functional and subjective long-term results. (10.1016/j.jse.2017.09.009)
• [L3] Total Shoulder Arthroplasty with an all-polyethylene, pegged glenoid component, utilising hybrid fixation, demonstrates excellent clinical and radiological outcomes at long term follow-up. (10.1016/j.jse.2021.03.003)
• [L4] We observed wide variation in the value of shoulder arthroplasty that was most strongly associated with procedure type and certain preoperative characteristics. (10.1016/j.jse.2020.10.039)
• [L2] Revision surgery rates due to persistent pain and instability were higher with the use of implants. (10.1177/1558944720974124)
• [L3] These findings may be because of the different morphology of the polyethylene component and/or differences in glenosphere offset between the prosthetic systems. (10.1016/j.jse.2011.08.051)
• [L5] The model maintains robust performance in arthritic shoulders, enabling further automation of shoulder arthroplasty planning in more complex arthritic cases. (10.1016/j.jse.2025.03.010)
• [L4] Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution in our series. (10.1177/1558944718797341)
• [L1] Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. (10.1302/0301-620x.101b9.bjj-2018-1369.r1)
• [L3] Constrained reverse prostheses were associated with a higher reoperation rate in this series without any functional benefit compared with unconstrained hemiarthroplasty-type articulations. (10.1016/j.jse.2020.02.006)
• [L3] The overall early functional results of the stemless HHR were comparable to the 3rd and 4th generation of standard stem arthroplasty. (10.1016/j.jse.2012.12.020)
• [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
• [L2] Plain radiography had the highest diagnostic accuracy in the evaluation of aseptic loosening of the acetabular component. (10.2106/00004623-200411000-00015)
• [L4] Satisfactory clinical results can be achieved when performing staged bilateral primary total shoulder arthroplasties with excellent pain relief, improvements in motion, and ability to carry out ADLs, though strength likely remains unchanged. (10.1016/j.jse.2009.04.005)
• [L3] The utilization of primary shoulder arthroplasty significantly increased in just a 3-year time span, with a major contribution from reverse shoulder arthroplasty in 2011. (10.1016/j.jse.2014.06.055)
• [L4] While remaining a technically demanding operation, there does appear to be a substantial reduction in serious complications after reverse shoulder arthroplasty with increased surgeon experience. (10.1016/j.jse.2007.02.059)
• [L5] The review outlines rehabilitation guidelines developed to manage patients who have undergone reverse total shoulder replacement, aiming to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery. (10.1111/j.1758-5740.2011.00138.x)
• [L3] Among shoulder arthroplasty patients who perceive their shoulder as normal, aTSA patients outperform rTSA patients with better motion and greater ability to return to work, return to sport, and perform higher demand activities without difficulty. (10.1016/j.jse.2025.02.010)
• [L4] Older patients undergoing total shoulder arthroplasty are unlikely to require revision in their lifetime. (10.1016/j.jse.2021.01.038)
• [L2] Preoperative radiographic evaluation of glenoid component loosening may often differ from intraoperative findings. (10.1016/j.jse.2019.04.005)
• [L3] In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes. (10.1186/s12891-021-04050-w)
• [L3] Periarticular injection of a local anesthetic solution provides reliable and consistent pain control with a trend toward less immediate postoperative opioid use after TSA compared with regional blocks. (10.1016/j.jseint.2019.12.007)
• [L4] No patients have undergone revision for glenoid loosening, but radiographic follow-up has shown that 36% of these implants have signs of radiolucency. (10.1016/j.jse.2022.08.007)
• [L1] Use of an indwelling interscalene nerve block provides superior pain management in the immediate postoperative setting as demonstrated by decreased narcotic medication consumption and lower subjective pain scores. (10.1016/j.jse.2016.12.015)
• [L3] There were significantly more cases with radiologic evidence of loosening in the uncemented group (p < .001). (10.1016/j.jhsa.2008.01.030)
• [L3] These data provide a baseline for understanding current trends regarding nonarthroplasty treatment of shoulder pathology before shoulder replacement. (10.1016/j.jse.2024.11.033)
• [L4] In this group of young patients, the implant improved the functional status of the extremity. (10.1016/j.jhsa.2015.04.028)
• [L3] A 1-stage procedure for shoulder and elbow arthroplasty reduces hospitalization time and does not adversely affect the clinical outcome compared to a 2-stage procedure. (10.1016/j.jse.2007.03.033)
• [L4] Complication, reoperation, and revision rates were similar to those seen in older patient cohorts, without an increase in revisions owing to aseptic loosening. (10.1016/j.jse.2020.02.004)
• [L3] Five patients in the TSA group had radiographic evidence of glenoid loosening, while no patients in the RSA group demonstrated prosthetic loosening. (10.1016/j.jse.2014.11.014)
• [L3] However, this was primarily a radiographic finding as both groups showed very satisfying functional outcomes and low revision rates at the 2-year follow-up. (10.1186/s12891-022-05994-3)
• [L3] With removal of the component because of aseptic loosening as the end point, survivorship was 98% for the stem and 96% for the cup. (10.1016/j.arth.2009.05.018)
• [L4] More bone imparted fewer overall component radiolucencies. (10.1016/j.jse.2010.05.025)
• [L3] This is an inexpensive, practical, and reproducible method that can be used to determine the rate of medial migration of the humeral head on plain radiographs after shoulder arthroplasty. (10.1016/j.jse.2010.03.010)
• [L4] Revision surgery with implant revision after primary TEA is common. (10.1016/j.jse.2016.12.064)
• [L3] Radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants, with stemless implants showing improved restoration of the native humeral neck angle. (10.1016/j.jse.2019.01.015)
• [L2] The risk of infection after primary shoulder arthroplasty is significantly higher in patients with a history of prior nonarthroplasty-related surgery. (10.1016/j.jse.2016.10.020)
• [L3] Prior nonshoulder PJI of any joint increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision after TSA. (10.5435/jaaos-d-21-00745)
• [L4] Primary arthroplasty as treatment of distal humeral fractures produces reliable results with regards to revisions and other adverse events. (10.1016/j.jse.2018.07.035)
• [L3] The prevalence of VTE after TSA is low. (10.5435/jaaos-d-22-00352)
• [L2] Complication and revision rates increase substantially with longer follow-up duration. (10.1016/j.jse.2010.11.017)
• [L4] Venous thromboembolism (VTE) is a known but rare complication of shoulder surgery, with rates generally less than 1% for arthroplasty and even lower for arthroscopy. (10.5435/jaaos-d-17-00763)
• [L3] Despite the higher rate of early complications, the intermediate-term outcomes of arthroplasties in which the glenoid implant is inserted without cement are comparable with those of arthroplasties with cementing of the glenoid component. (10.2106/00004623-199904000-00008)
• [L4] Nevertheless, revision shoulder arthroplasty remains challenging with a high rate of complications. (10.1016/j.jse.2013.07.041)
• [L4] The study reports functional outcomes and high prosthesis survivorship at midterm follow-up. (10.1016/j.jse.2024.06.028)
• [L4] The periprosthetic infection rate was low at 20-year follow-up. (10.1016/j.jse.2012.01.006)
• [L1] This systematic review has indicated PROMs and ROM mostly favouring HA, but with a similarly high complication rate in the two procedures. (10.1302/0301-620x.104b5.bjj-2021-1207.r2)
• [L4] Patients who had undergone reverse shoulder arthroplasty a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls. (10.1016/j.jse.2013.01.020)
• [L3] At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. (10.1016/j.jse.2017.08.010)
• [L4] At 5 years' follow-up, TSA leads to improvement in functional outcome and a satisfactory implant survival rate of 98% in young adults with primary glenohumeral arthritis. (10.1016/j.jse.2012.09.016)
• [L3] Two-stage reimplantation for PJI after TEA was successful in eradicating deep infection in 69% of cases. (10.1177/17585732211043524)
• [L2] Still, the unique limitations, complications, and revision rates for each strategy must be carefully weighed for each patient when making a decision. (10.1016/j.jse.2018.08.041)
• [L5] The meta-analysis provides compelling evidence that personalized instrumentation does not consistently deliver commensurate clinical benefit, and until further evidence emerges, the routine use of PSI in primary total shoulder arthroplasty cannot be endorsed. (10.5397/cise.2025.00423)
• [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. (10.1016/j.jhsa.2013.01.030)
• [L4] However, patients and surgeons must accept a significant complication rate and likelihood for reoperation, and meaningful conclusions regarding long-term outcomes are difficult to draw due to the level IV nature of the included studies. (10.1016/j.jse.2011.04.031)
• [L4] Complications and reoperations associated with RSA occurred at much lower rates than in previous reports. (10.1016/j.jse.2013.06.002)
• [L4] However, a high rate of complications and revisions was observed with follow-up. (10.1016/j.jse.2019.08.006)
• [L3] The use of IVP was associated with almost half the risk of developing a PJI during primary TEA (13.6% vs. 7.7%), although this was not statistically significant likely due to underpowering. (10.1016/j.xrrt.2025.06.013)
• [L2] The secondary outcomes were not significantly different between groups. (10.1016/j.jse.2019.09.028)
• [L3] Patients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. (10.1016/j.jses.2019.07.003)
• [L4] In patients with surviving implants, 57% achieved good to excellent Mayo Elbow Performance Scores with predictable improvement in range of motion. (10.5435/jaaos-d-18-00055)
• [L3] Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. (10.1302/0301-620x.102b6.bjj-2019-1582.r1)
• [L1] Females have higher rates of postoperative complications and revision surgery. (10.1016/j.jse.2024.12.043)
• [L4] Resection arthroplasty can be an acceptable salvage procedure for treatment of an infection after TEA for low-demand patients. (10.1016/j.jse.2015.08.045)
• [L4] The risk of short-term complications after revision TEA is comparable to that of primary TEA. (10.1016/j.jse.2015.12.012)
• [L3] Furthermore, it appears that patients who received arthroscopy within the 3 months before arthroplasty had the highest risk of prosthetic joint infections. (10.1016/j.arthro.2021.01.013)

See Also

• Fractures
• Total shoulder arthroplasty
• Shoulder Arthroplasty
• Shoulder Instability
• Rotator Cuff
• Reverse Shoulder Arthroplasty
• Arthroscopic Surgery
• Internal Fixation
• Joint Replacement

References

[1] Long-term results of the lateral resurfacing elbow arthroplasty. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b3.bjj-2017-0865.r1

[2] Elective shoulder arthroplasty in patients older than ninety years of age. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.09.005

[3] Revision total shoulder arthroplasty for painful humeral head replacement with glenoid arthrosis. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.09.006

[4] A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-8

[5] Resection arthroplasty for failed shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.05.025

[6] Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.11.004

[7] We Commend the Effort: 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.07.022

[8] Humeral stem loosening is not always prosthetic joint infection. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.004

[9] Factors associated with success of ream-and-run arthroplasty at a minimum of 5 years. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.01.024

[10] Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b2.32121

[11] Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3726-1

[12] Integrity and function of the subscapularis after total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.04.001

[13] Ankle arthroplasty. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170029

[14] Shoulder Arthroplasty for the Treatment of Inflammatory Arthritis. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00020

[15] Heterotopic Ossification After Modern Total Hip Arthroplasty: Predisposing Factors, Prophylaxis, and Surgical Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-01070

[16] Biologic resurfacing of the glenoid with meniscal allograft: long-term results with minimum 2-year follow-up. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.04.019

[17] Ten years’ experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413479527

[18] Shoulder Arthroplasty: Prosthetic Options and Indications. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200907000-00002

[19] The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b12.35176

[20] Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis. Journal of Shoulder and Elbow Arthroplasty. 2023. DOI: 10.1177/24715492231152143

[21] Shoulder replacement: an epidemiological nationwide study from 2009 to 2019. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05849-x

[22] Radiologic bone adaptations on a cementless short-stem shoulder prosthesis. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.044

[23] Primary reverse shoulder arthroplasty in patients aged 65 years or younger. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.05.026

[24] Two-Stage Exchange Arthroplasty For Periprosthetic Shoulder Infection Is Associated With High Rate Of Failure To Reimplant And Mortality. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.044

[25] The incidence of aseptic loosening and the potential impact of strut allografts in revision total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.043

[26] Comparative Utilization of Reverse and Anatomic Total Shoulder Arthroplasty: A Comprehensive Analysis of a High-volume Center. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00075

[27] Pathogenesis, Evaluation, and Management of Osteolysis After Total Shoulder Arthroplasty. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00738

[28] Glenoid bone grafting with a reverse design prosthesis. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.02.002

[29] Anteromedial approach for shoulder arthroplasty: Current indications, complications, and results. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.10.016

[30] “From Neer to now – 80 years of shoulder arthroplasty”. JSES International. 2025. DOI: 10.1016/j.jseint.2024.04.007

[31] The Role of Arthroscopy in Painful Shoulder Arthroplasty: Is Revision Always Necessary?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.01.045

[32] Editorial: Challenges and advances in revision total joint arthroplasty. Arthroplasty. 2025. DOI: 10.1186/s42836-025-00298-y

[33] A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b3.36664

[34] The subscapularis-sparing approach in humeral head replacement. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.020

[35] Approaches in Primary Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2009. DOI: 10.2106/jbjs.i.00343

[36] Arthroscopic interpositional arthroplasty for Freiberg's disease. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0189-4

[37] Cost and Effectiveness of Routine Pathological Examination of Operative Specimens Obtained During Primary Total Hip and Knee Replacement in Patients with Osteoarthritis. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200011000-00002

[38] Soft-tissue Management in Revision Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-21-01-23

[39] Complications of Reverse Shoulder Arthroplasty: A Concise Review. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00066

[40] Nonarthroplasty alternatives for the treatment of glenohumeral arthritis. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.03.011

[41] Antibiotic prophylaxis in primary and revision shoulder replacement: a systematic review. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03332-z

[42] Blinded Ultrasound Examination of the Subscapularis Following Anatomic Shoulder Arthroplasty. Journal of Shoulder and Elbow Arthroplasty. 2019. DOI: 10.1177/2471549219832442

[43] Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06273-5

[44] Failed Thumb Carpometacarpal Arthroplasty: Common Etiologies and Surgical Options for Revision. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.03.052

[45] A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.026

[46] Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.01.051

[47] Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.09.027

[48] Survivorship of the humeral component in shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.04.011

[49] Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.05.006

[50] Radiographic outcomes of impaction-grafted standard-length humeral components in total shoulder and ream-and-run arthroplasty: is stress shielding an issue?. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.03.016

[51] Reverse Total Shoulder Arthroplasty. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00851

[52] The incidence of radiographic aseptic loosening of the humeral component in reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.02.007

[53] In Vivo Determination of the Dynamics of Normal, Rotator Cuff-Deficient, Total, and Reverse Replacement Shoulders. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.e.00483

[54] Resurfacing humeral prosthesis: do we really reconstruct the anatomy?. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.07.014

[55] The effect of synovectomy on bleeding and clinical outcomes for total knee replacement. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b9.31253

[56] Arthroscopic Implant-Free Bone Grafting for Shoulder Instability With Glenoid Bone Loss. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546515625283

[57] Rocking-horse phenomenon of the glenoid component: the importance of inclination. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.017

[58] Total Wrist Arthroplasty and Total Wrist Arthrodesis in Rheumatoid Arthritis: A Decision Analysis From the Hand Surgeons' Perspective. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.06.022

[59] A first-of-its-kind two-body statistical shape model of the arthropathic shoulder: enhancing biomechanics and surgical planning. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05855-4

[61] Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.11.032

[62] The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.018

[63] Lateralized versus nonlateralized reverse total shoulder arthroplasty. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220937412

[64] Suture Anchors and Tacks for Shoulder Surgery, Part 1. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546505282621

[65] Patient-specific planning in shoulder arthroplasty. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b3.bjj-2019-1153.r1

[66] Total Elbow Arthroplasty. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.11.005

[67] Shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.05.006

[68] Comparing daily shoulder motion and frequency after anatomic and reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.09.023

[69] The survival, mechanisms of failure, and function after total humeral replacement in patients with primary sarcomas. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.09.030

[70] Restoration of Articular Geometry Using Current Graft Options for Large Glenoid Bone Defects in Anterior Shoulder Instability. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.002

[71] Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.11.015

[72] Management of massive and irreparable rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.013

[73] Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.02.004

[74] SECEC Grammont Award 2024: The critical role of posture adjustment for range of motion simulation in reverse total shoulder arthroplasty preoperative planning. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0110.r1

[75] Electromyographic analysis of reverse total shoulder arthroplasties. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.05.005

[76] Latissimus dorsi transfer for irreparable subscapularis tear. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.019

[77] Long-term results of total elbow arthroplasty in patients with hemophilia. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.09.009

[78] Long Term Clinical and Radiological Results of an All-Polyethylene, Pegged, Bone Ingrowth Glenoid Component. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.003

[79] Variation in the value of total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.10.039

[80] Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials. HAND. 2020. DOI: 10.1177/1558944720974124

[81] The relationship between scapular notching and reverse shoulder arthroplasty prosthesis design. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.08.051

[82] Automatic determination of the resection plane for shoulder arthroplasty in arthritic humeri: a deep learning model. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.03.010

[83] Total Thumb Carpometacarpal Joint Arthroplasty: A Retrospective Functional Study of 28 MOOVIS Prostheses. HAND. 2018. DOI: 10.1177/1558944718797341

[84] Cemented humeral stemversuspress-fit humeral stem in total shoulder arthroplasty. The Bone & Joint Journal. 2019. DOI: 10.1302/0301-620x.101b9.bjj-2018-1369.r1

[85] Constrained or unconstrained shoulder replacement for musculoskeletal tumor resections?. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.006

[86] First Midterm (3–5 Year) Results of Stemless Humeral Head Replacement: A Prospective Study. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.12.020

[87] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[88] A Comparison of Radiographic and Scintigraphic Techniques to Assess Aseptic Loosening of the Acetabular Component in a Total Hip Replacement. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00015

[90] Early clinical results following staged bilateral primary total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.04.005

[91] The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.06.055

[92] Early Complications With The Delta Reverse Shoulder Arthroplasty: Influence Of The Learning Curve. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.059

[93] Rehabilitation following Reverse Total Shoulder Replacement. Shoulder & Elbow. 2011. DOI: 10.1111/j.1758-5740.2011.00138.x

[94] Evaluation of new normal after shoulder arthroplasty: comparison of anatomic vs. reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.010

[95] Survival of the Aequalis total shoulder replacement at a minimum 20-year follow-up: a clinical and radiographic study. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.01.038

[96] Improving preoperative planning of revision surgery after previous anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.005

[97] Treatment of non‐arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears: arthroscopic procedures yield comparable midterm results to reverse arthroplasty. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04050-w

[98] Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES International. 2020. DOI: 10.1016/j.jseint.2019.12.007

[99] Mid- to long-term outcomes of a cemented, all-polyethylene pegged glenoid component in anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.08.007

[100] Liposomal bupivacaine inferior to indwelling interscalene nerve block for post-operative pain control in shoulder arthroplasty: a prospective randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.015

[101] Cemented Versus Uncemented Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint With a Mean 5-Year Follow-Up. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.030

[102] Health care resource utilization in the 2 years prior to total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.033

[103] Functional Outcomes of the Aptis-Scheker Distal Radioulnar Joint Replacement in Patients Under 40 Years Old. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.04.028

[104] Shoulder and elbow arthroplasty: One-stage or Two-stage. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.03.033

[105] Complications and implant survivorship following primary reverse total shoulder arthroplasty in patients younger than 65 years: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.004

[106] Eccentric Reaming is Biomechanically Superior to Posterior Augment for Posterior Glenoid Wear. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.11.014

[107] Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly—a retrospective case–control study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05994-3

[109] Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty. The Journal of Arthroplasty. 2010. DOI: 10.1016/j.arth.2009.05.018

[110] Bone presence between the central peg's radial fins of a partially cemented pegged all poly glenoid component suggest few radiolucencies. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.05.025

[111] A quantitative method for determining medial migration of the humeral head after shoulder arthroplasty: preliminary results in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.03.010

[112] Risk factors for reoperation after total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.064

[113] Radiographic restoration of native anatomy: a comparison between stemmed and stemless shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.01.015

[114] Is previous nonarthroplasty surgery a risk factor for periprosthetic infection in primary shoulder arthroplasty?. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.10.020

[115] Prior Nonshoulder Periprosthetic Joint Infection Increases the Risk of Surgical Site Infection, Sepsis, and All-Cause Revision After Primary Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-21-00745

[116] Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events: a registry-based study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.07.035

[117] Venous Thromboembolism After Total Shoulder Arthroplasty: A Database Study of 31,918 Cases. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00352

[118] Complications of unconstrained shoulder prostheses. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.017

[119] Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00763

[120] Resurfacing of the Glenoid in Total Shoulder Arthroplasty. A Comparison, at a Mean of Five Years, of Prostheses Inserted with and without Cement. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199904000-00008

[121] Increased-offset reverse shoulder arthroplasty for the treatment of failed post-traumatic humeral head replacement. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.07.041

[122] B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.06.028

[123] Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.01.006

[124] Hemiarthroplasty or total elbow arthroplasty for unreconstructable distal humeral fractures in patients aged over 65 years. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b5.bjj-2021-1207.r2

[125] Health-related quality of life and functionality after reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.020

[126] Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.08.010

[128] Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.09.016

[129] Two-stage reimplantation for deep infection after total elbow arthroplasty. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211043524

[130] Cost-effectiveness analysis of total elbow arthroplasty versus open reduction–internal fixation for distal humeral fractures. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.041

[131] Patient-specific instrumentation in shoulder arthroplasty: high tech, low yield?. Clinics in Shoulder and Elbow. 2025. DOI: 10.5397/cise.2025.00423

[132] Outcome Comparison of Primary Trapeziectomy Versus Secondary Trapeziectomy Following Failed Total Trapeziometacarpal Joint Replacement. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.030

[133] Biological glenoid resurfacing for glenohumeral osteoarthritis: a systematic review. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.04.031

[134] Complications rates, reoperation rates, and the learning curve in reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.06.002

[135] Outcomes of semiconstrained total elbow arthroplasty performed for arthritis in patients under 55 years old. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.08.006

[136] The use of vancomycin powder in total elbow arthroplasty; can we decrease infection risk?. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.06.013

[137] A randomized controlled trial comparing subscapularis tenotomy with peel in anatomic shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.028

[138] Risk factors for venous thromboembolism in total shoulder arthroplasty. JSES Open Access. 2019. DOI: 10.1016/j.jses.2019.07.003

[139] Outcomes After Hemiarthroplasty of the Elbow for the Management of Posttraumatic Arthritis: Minimum 2-Year Follow-up. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00055

[140] Complications in the treatment of prosthetic joint infection. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b6.bjj-2019-1582.r1

[141] Females experience inferior outcomes and higher rates of revisions and complications compared to males following anatomic total shoulder arthroplasty: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.043

[142] Resection arthroplasty for periprosthetic infection after total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.045

[143] Outcomes, complications, utilization trends, and risk factors for primary and revision total elbow replacement. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.012

[144] Undergoing an Arthroscopic Procedure Prior to Shoulder Arthroplasty is Associated With Greater Risk of Prosthetic Joint Infection. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.01.013