Anatomic and Reverse Total Shoulder Arthroplasty in Patients Older Than 80 Years

Triplet, Jacob J.; Everding, Nathan G.; Levy, Jonathan C.; Formaini, Nathan T.; O’Donnell, K. P.; Moor, Molly; Virraroel, Leonardo D

doi:10.3928/01477447-20151002-58

Cited by 48 publications

(56 citation statements)

References 41 publications

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“…8,23 The outcome of RTSA in patients older than 80 years is underreported, with only a few studies in the current literature. 5,19,29 Recently, Clark et al 5 published a series of 179 patients, 81 of them personally followed up after primary RTSA mainly for cuff tear arthropathy (80%) and osteoarthritis (8%), and found satisfactory improvement in clinical outcomes and an acceptable surgical complication rate of 12%. The main complications were acromial fracture in 4%, delayed wound healing in 3%, and heterotopic ossification in 1.7%.…”

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confidence: 99%

“…The main complications were acromial fracture in 4%, delayed wound healing in 3%, and heterotopic ossification in 1.7%. Mangano et al 19 and Triplet et al 29 , studying 2 cohorts smaller than 33 patients with a followup between 24 and 87 months, reported promising improvement in clinical outcomes and a surgical nonsystemic complication rate of 10% and 15%, respectively. These complication rates resulted in very low reoperation rates between 0 and 2%.…”

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confidence: 99%

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Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Kriechling¹,

Loucas²,

Loucas

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The use of reverse total shoulder arthroplasty (RTSA) has spread worldwide as a result of an expansion of indications and an aging society. However, the value of RTSA for very old patients is rarely analyzed. This study was conducted to investigate the outcome of primary RTSA in patients older than 80 years. Methods: We identified 171 shoulders (159 patients) treated with RTSA at an age of more than 80 years between January 2005 and March 2018. The primary outcome parameters were Subjective Shoulder Value (SSV) and the Constant-Murley score, mortality, complications, and reoperation rates. Secondary outcomes were adverse radiographic outcomes. A minimum follow-up of 1 year was accepted in 14 patients (8%) because of these patients' older age. Results: We included 171 cases (159 patients; 120 female) with a mean age of 84 AE 3 years (range 80.1-94). The main indication for RTSA was cuff tear arthropathy (43%), isolated rotator cuff tear (22%), and fracture (21%). A total of 136 patients (79%) were eligible for physical examination with a mean follow-up of 41 AE 25 months (12-121). Relative Constant-Murley scores improved significantly from 39% AE 19% to 77% AE 16% and SSV from 31% AE 18% to 74% AE 22%. The range of motion and force improved significantly as well. The surgical site complication rate was 30%, with a reoperation rate of 8% (13 patients) mainly due to fracture and glenoid loosening. The overall mortality was 16% with a mean time to death of 53 AE 31 months (95% confidence interval 15, 120), thereby no higher than the age-adjusted, expected mortality rate without this procedure. Conclusion: Despite a quite high postoperative complication rate, RTSA is a valid therapeutic option in patients older than 80 years, with an unexpectedly low medical complication rate and good to excellent improvement of shoulder function and pain.

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confidence: 99%

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confidence: 99%

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Kriechling¹,

Loucas²,

Loucas

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Complication rates are limited to 30-day outcomes, and although the use of RTSA is becoming more prevalent, CPT code 23472 was not able to separate reverse from anatomic arthroplasty. However, previous studies have found both anatomic TSA and RTSA to have similar complication rates, revision rates, and patient-reported outcomes, and this study focuses on short 30-day hospital quality metrics 15, 23, 33…”

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confidence: 99%

Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications

et al. 2019

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Background Although studies have shown improved pain, function, and patient satisfaction after total shoulder arthroplasty (TSA), preoperative factors predicting poor outcomes are unexplored. Comparison of postoperative complications between osteoarthritis (OA), cuff arthropathy (CA), and fracture patients is important for identifying at-risk patients. Methods Primary TSAs from 2014 to 2016 with preoperative OA, CA, and proximal humerus fractures as indications were queried from the National Surgical Quality Improvement Program database. Short-interval postoperative complications were compared using multivariate binary logistic regression, and postoperative time to discharge between groups was analyzed using univariate analysis of variance with Tukey comparison. Statistical significance was defined as P < .05 using SPSS software version 23.0 (IBM Corp., Armonk, NY, USA). Results Of 9684 TSA cases, the primary indication was OA in 6571 patients, CA in 725 patients, and fractures in 646 patients. Compared with fractures, OA patients had statistically significant lower risk of dislocation, readmission, return to operating room, nonhome discharge, surgical site infection, perioperative bleeding requiring transfusion, and pulmonary embolism (all P < .05). Statistically significant lower risk of dislocation, nonhome discharge, and transfusion was also found between CA and fracture patients (all P < .03). However, in comparing CA vs. OA as preoperative indications, only postoperative venous thromboembolism (odds ratio, 4.5; P = .01) and surgical site infection (odds ratio, 3.7; P = .007) were significant. Mean differences in discharge time were significant between both OA and CA groups compared with fractures ( P < .001), but there was no significance between OA and CA ( P = .116). Conclusion Proximal humerus fracture is a risk factor for increased postoperative complications compared with OA and CA. With new outcomes-based reimbursement models, nonroutine discharge and increased discharge time should be considered in arthroplasty planning.

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“…Differences in indications for TSA and RSA likely contributed to this discrepancy, as patients undergoing RSA typically have pathologies, such as rotator cuff deficiency, that negatively influence preoperative baseline function. 30 In addition, age may have played a role in these differences, as TSA/TSA patients were significantly younger than TSA/RSA or RSA/ RSA patients. As one may expect, postoperative outcomes were found to be superior in this cohort compared with TSA/ RSA and RSA/RSA patients.…”

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes of Various Combinations of Bilateral Shoulder Arthroplasty

Kurowicki

Triplet

Rosas

et al. 2019

Hand (New York, N,Y.)

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Background: In the setting of bilateral shoulder arthroplasty (BSA), differences in functional outcomes and motion between anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are unknown. The purpose of this study was to compare the effectiveness of treatment for various combinations of TSA procedures. Methods: A review of prospectively collected data from an institutional shoulder surgery repository was performed for patients who underwent any combination of bilateral TSA or RSA surgery. Based on the combination of shoulder arthroplasty, patients were divided into the following subgroups: bilateral TSA (TSA/TSA), bilateral RSA (RSA/RSA), or unilateral TSA with contralateral RSA (TSA/RSA). A total of 73 patients (146 shoulders), with a minimum of 2-year follow-up, who underwent any combination of bilateral TSA or RSA from 2007 to 2014 were included. Pre- and postoperative patient-reported outcome measures and measured motion were evaluated between the 3 groups. Results: There were 47 TSA/TSA, 17 RSA/RSA, and 9 TSA/RSA patients with a mean age of 72 years and mean follow-up of 51 months. Preoperatively, TSA/TSA had significantly higher Simple Shoulder Test scores, Visual Analog Scale (VAS) function, active elevation, and active external rotation compared with RSA/RSA. Postoperative scores were significantly superior in TSA/TSA compared with other combinations of shoulder arthroplasty except VAS pain and function. Change in pre- to postoperative (effectiveness of treatment) internal rotation was superior in the TSA/TSA group compared with RSA/RSA and TSA/RSA; however, no other differences were observed. Conclusions: Bilateral TSA patients have higher preoperative function and motion. Although some postoperative outcomes differ among combinations of BSA, the overall effectiveness of treatment for patients undergoing BSA is similar between various combinations of arthroplasty.

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Anatomic and Reverse Total Shoulder Arthroplasty in Patients Older Than 80 Years

Cited by 48 publications

References 41 publications

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications

Comparative Outcomes of Various Combinations of Bilateral Shoulder Arthroplasty

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