Glenoid Radiolucent Lines and Subsidence Show Limited Impact on Clinical and Functional Long-Term Outcomes After Anatomic Total Shoulder Arthroplasty: A Retrospective Analysis of Cemented Polyethylene Glenoid Components

TL;DR

This study found that certain radiographic changes after shoulder surgery do not significantly affect long-term patient outcomes.

Contribution

The study provides new evidence that radiolucent lines and subsidence may not always lead to poor clinical outcomes.

Findings

Extensive radiolucent lines were linked to slightly reduced external rotation but below the threshold for clinical concern.

Glenoid subsidence was associated with minor decreases in forward elevation and external rotation, also below clinical significance.

No significant differences were found in pain or overall function between groups with or without these radiographic changes.

Abstract

Background: Glenoid radiolucenct lines (gRLL) and glenoid component subsidence (gSC) after anatomic total shoulder arthroplasty (aTSA) have traditionally been linked to implant loosening and functional decline. However, their impact on long-term clinical outcomes remains unclear. This study aimed to evaluate whether gRLL and gSC are associated with inferior clinical or functional results in patients without revision surgery. Methods: In this retrospective study, 52 aTSA cases (2008–2015) were analyzed with a minimum of five years of clinical and radiographic follow-up. Based on final imaging, patients were categorized according to the presence and extent of gRLL and gSC. Clinical outcomes included the Constant-Murley Score, DASH, VAS for pain, and range of motion (ROM). Radiographic parameters included the critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), and cranial humeral head decentration (DC). Group comparisons were conducted between: (1) ≤2 vs. 3 gRLL zones, (2) 0 vs. 1 zone, (3) 0 vs. 3 zones, (4) gSC vs. no gSC, and (5) DC vs. no DC. Results: Demographics and baseline characteristics were comparable across groups. Functional scores (Constant, DASH), pain (VAS), and ROM were largely similar. Patients with extensive gRLL showed reduced external rotation (p = 0.01), but the difference remained below the MCID. Similarly, gSC was associated with lower forward elevation (p = 0.04) and external rotation (p = 0.03), both below MCID thresholds. No significant differences were observed for DC. Conclusions: Neither extensive gRLL nor gSC significantly impaired long-term clinical or functional outcomes. As these radiographic changes can occur in the absence of symptoms, regular radiographic monitoring is essential, and revision decisions should be made individually in cases of progressive bone loss.

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