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Background: This study investigated prostheses from a large national arthroplasty registry with the lowest rates of revision, defined as optimum. We compared optimum shoulder arthroplasty revision rates for osteoarthritis (OA) to determine the most suitable/effective procedure for men and women., Methods: There were 3 cohort groups of optimum primary shoulder arthroplasties for OA undertaken between January 1, 2008, and December 31, 2022: stemless shoulder arthroplasty with cemented polyethylene glenoids (slTSA), stemmed shoulder arthroplasty with modified central peg polyethylene glenoids (stTSA), and cementless reverse shoulder arthroplasty (rTSA). The cumulative percentage revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age, gender, humeral head/glenosphere size, polyethylene type, and surgeon volume. Possible interactions were examined. A subanalysis from January 1, 2017, captured additional patient demographics, American Society of Anesthesiologists score, BMI, and glenoid morphology., Results: The CPR at 7 years was 4.0% (95% confidence interval [CI] 3.1, 5.1) for slTSA (n = 3041), 3.8% (95% CI 2.7, 5.5) for stTSA (n = 1259), and 4.1% (95% CI 3.7, 4.6) for rTSA (n = 12,341). slTSA had a higher rate of revision compared with rTSA after the first 9 months (P < .001). rTSA had a lower revision rate than stTSA from 3 months on (P = .004). After adjusting for other confounders, prosthesis type and gender were associated with revision rates (P < .001) whereas surgeon volume was not. Additionally, gender and prosthesis type strongly interacted (P = .013) and the combined model exhibited greater predictive performance when including this interaction. Women had lower rates of revision than men for both stTSA and rTSA but not slTSA. Most revisions were for infection in men, especially rTSA. After 3 months, the rate of revision for slTSA vs. rTSA for women was increased (P < .001) and revision rates for men did not significantly differ. However, in a subanalysis of procedures in males since 2017 with additional adjustments, slTSA had a lower revision rate than stTSA (P = .010)., Conclusions: The optimum shoulder arthroplasty revision rates vary for both the gender and implant type for the diagnosis of OA. A model combining optimum prostheses and gender predicted revision better than optimum implants alone. After 3 months, rTSA was associated with lower revision rates compared with slTSA in women, whereas there were no significant differences between optimum prostheses in men. However, surgeons may also consider lower revision risk of optimum slTSA at subanalysis and increased cumulative incidence of infection for rTSA requiring revision to resolve decision making for male patients., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Abstract Background Glenohumeral osteoarthritis can, in the most severe cases, require surgery with insertion of a shoulder arthroplasty. A design with a stem in the humeral bone canal is currently regarded as the standard treatment option in patients who have an intact rotator cuff function, but complications related to the stem including humeral fractures can have devastating consequences. By using a stemless humeral component, stem-related complications can be reduced. The aim of this study is to compare the Comprehensive Nano stemless total shoulder arthroplasty (intervention group) with the Comprehensive stemmed total shoulder arthroplasty (control group). Materials and methods This is a randomized controlled trial comparing the stemless and the stemmed total shoulder arthroplasty. All Danish citizens with glenohumeral osteoarthritis indicating a total shoulder arthroplasty referred to the orthopedic department at Copenhagen University Hospital in Herlev/Gentofte will be offered participation. The following exclude from participation: below 18 years of age, cognitive or linguistic impairment, insufficient function of the rotator cuff, poor bone quality, and ASA groups 4–5. A total of 122 patients will be included of which 56 will be part of a radiostereometric analysis (RSA) study of humeral component migration. The primary outcomes are magnitude of migration of the humeral component assessed by RSA and patient-reported outcome by Western Ontario Osteoarthritis of the Shoulder index (WOOS). The secondary outcomes are additional patient-reported outcomes, functional outcome, readmission, complications, revisions, and changes in bone mineral density (BMD) of the proximal humerus assessed by duel energy x-ray absorptiometry (DXA) and economy (cost-utility analysis). The patients are examined before the operation and 3, 6, 12, and 24 months postoperative. Discussion To our knowledge, RSA has never been used to access migration of a stemmed or a stemless humeral component nor has the stemmed and the stemless humeral component been compared with regard to pain relief and shoulder function in a randomized clinical trial. Today, the two designs are considered equal in the treatment of osteoarthritis. The study will provide surgeons and patients with information about shoulder arthroplasty for osteoarthritis and assist them in decision-making. Trial registration ClinicalTrials.gov NCT04105478 . Registered on 25 September 2019