Rapidly progressive destructive arthrosis (RPDA) of the glenohumeral joint: a radiologic classification and mid-term outcomes following shoulder arthroplasty

Rapidly progressive destructive arthrosis (RPDA) of the glenohumeral joint is a rare but distinct clinical entity characterized by rapid humeral head collapse of unclear etiology. This study aimed to characterize the clinical, radiologic, and intraoperative features of RPDA, to propose a three-stage radiologic classification, and to evaluate short-term outcomes following shoulder arthroplasty (reverse or total) according to disease stage. From March 2015 to December 2023, 23 patients were diagnosed with RPDA of the glenohumeral joint based on clinical and radiologic findings. After excluding those with alternative etiologies, 19 patients who underwent shoulder arthroplasty (17 reverse total shoulder arthroplasties and 2 anatomic total shoulder arthroplasties) were included in tha analysis. Patients were classified into three radiologic stages (early, mid, and late RPDA) and evaluated at a minimum follow-up of two years. All 19 patients were female, with a mean age of 73.8 ± 7.9 years. The mean duration of symptoms before humeral head collapse was 14.7 ± 18.4 months (range, 3–60 months). Patients were classified into three distinct radiologic stages based on imaging findings. Preoperatively, 47% (9/19) had a history of trauma or prior rotator cuff surgery. At the final follow-up, all patients showed significant improvement in clinical outcomes. Postoperative ASES and SST scores, as well as preoperative symptom duration, differed significantly among the three stages (p < 0.05). No significant differences were observed in postoperative range of motion or complication rates. Two complications occurred: one acromial fracture and one periprosthetic humeral shaft fracture. RPDA of the shoulder often progresses rapidly and may be overlooked in its early stages. Radiologic staging with MRI and plain radiography facilitates timely diagnosis and appropriate surgical planning. Shoulder arthroplasty—either reverse or anatomic TSA—resulted in favorable clinical and radiological outcomes, particularly when performed before advanced humeral head collapse or glenoid involvement. Early recognition and timely intervention are therefore essential to optimize patient outcomes. Level 4, case series study.