Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Abstract

Background: The relative indications of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) continue to evolve. Some surgeons favor RSA over TSA for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff due to fear of a postoperative (secondary) rotator cuff tear in this age group. However, RSA is associated with unique complications and a worse functional arc of motion compared with TSA. Therefore, it is important to understand the clinical outcomes and rates of revision surgery and secondary rotator cuff tears in elderly patients undergoing TSA. Methods: Between January 1, 2010, and December 31, 2017, 377 consecutive TSAs were performed for primary GHOA in 340 patients 70 years of age or older. The mean age at surgery was 76.2 years (standard deviation [SD], 4.9). Clinical evaluation included pain, motion, and American Shoulder and Elbow Surgeons score. Radiographs were reviewed for preoperative morphology and postoperative complications. All complications and reoperations were recorded. The average clinical follow-up time was 3.3 years (SD, 2.0). Statistical analyses were performed, and Kaplan-Meier implant survival estimates were calculated. For all analyses, a P value <.05 was considered statistically significant. Results: The mean pain visual analog scale and American Shoulder and Elbow Surgeons score at the final follow-up were 1.6 (SD, 2.2) and 78.0 (SD, 17.8), respectively. Forward elevation and external rotation increased from 96 (SD, 30 ) and 26 (SD, 20 ) preoperatively to 160 (SD, 32 ) and 64 (SD, 26 ) postoperatively (P < .001 for each). The percentage of patients who had internal rotation to L5 or greater increased from 24.8% preoperatively to 71.8% postoperatively (P < .001). Revision surgery was performed in 3 shoulders (0.8%), and the 5-year implant survival estimate was 98.9% (95% confidence interval: 97.3%-100%). There were 3 medical (0.8%), 10 minor surgical (2.7%), and 5 major surgical (1.3%) complications. No shoulder had radiographic evidence of humeral component loosening, whereas 7 (2%) had evidence of some degree of glenoid component loosening. In total, there were 5 secondary rotator cuff tears (1.3%), of which 2 (0.5%) required revision surgery. Conclusion: Elderly patients with primary GHOA and an intact rotator cuff have excellent clinical and radiographic outcomes after This study was reviewed and approved by our institutional review board (#12-007498).

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

“…However, the distinction between these two conditions is important given that patients with RTC arthropathy tend to have lower-grade glenohumeral joint disease on initial presentation and are often managed non-surgically for longer periods [ 20 , 21 ]. In addition, primary glenohumeral OA is more commonly managed by aTSA whereas surgical intervention for RTC arthropathy typically involves rTSA due to the compromised function of the RTC [ 20 , 22 ].…”

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 2

“…When discussing shoulder arthroplasty as a definitive surgical solution in older patients with primary glenohumeral joint osteoarthritis with an intact rotator cuff, the treating surgeon should discuss both aTSA and rTSA. The patients should be informed of the risks, benefits, expectations, complications, and postoperative rehabilitation in detail, so that they can make a fully informed choice between aTSA and a rTSA-since the literature supports the use of aTSA for older adults [23].…”

Does pre-arthroplasty antiviral treatment for hepatitis C reduce complication rates after total shoulder arthroplasty? A matched cohort study

“…Total shoulder arthroplasty (TSA) is a highly successful treatment for traumatic and degenerative pathologies of the shoulder. Anatomic TSA and reverse TSA commonly yield excellent patient outcomes with improved joint function and significant pain reduction, 21 , 26 , 33 and both procedures are reported to have similar rates of postoperative complications. 17 , 22 , 28 Furthermore, annual TSA volume is growing exponentially at a rate that surpasses both total hip arthroplasty and total knee arthroplasty.…”