Long-term survival outcomes following total shoulder arthroplasty: An implant-level systematic review and meta-analysis of case series and registry data with more than 13 years follow-up.

Aims: It is known that survival of primary total shoulder arthroplasty at 10 years is excellent; however, evidence beyond this time-point is limited. We aimed to evaluate the long-term survival of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) implants, at ≥13 years follow-up, using case series and international joint registry data. Methods: CENTRAL, Embase, and MEDLINE databases were searched for studies reporting TSA survival data at ≥13 years follow-up. National joint registries were contacted for implant data. Pooled survival at 13, 15, and 20 years was calculated for case series and registry data using a random-effects model. Results: Data from four national joint registries and seven studies were analysed. Pooled aTSA registry data showed survival of 91.50% (89.36-93.64) at 13-years and 90.82% (88.25-93.38) at 15-years. Pooled rTSA registry data showed survival of 93.19% (91.78-94.60) at 13-years and 90.74% (85.73-95.74) at 15-years. Data from case series gave pooled aTSA survival estimates of 88.69% (76.97-100.42), 90.23% (85.87-94.58) and 82.08% (70.30-93.88) at 13, 15 and 20 years, respectively. Conclusion: Our analysis suggests approximately 90% of shoulder replacements last up to 15 years without revision. Variation between individual implants highlights the need for granular implant-level data to guide patient and clinician decision making.