Primary reverse shoulder arthroplasty in patients older than 80 years of age

Abstract

Aims Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Patients and Methods Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. Results One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. Conclusion Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520–1525

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

“…Mangano et al's 19 data on 27 of 52 elderly patients (reexamination rate of 51%), showed a satisfying quality of life as measured by the 12-Item Short Form Health Survey and scored well on the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. 5,19,29 This study documents that RTSA performed under regional or combined regional anesthesia in such patients is associated with no increase in mortality and has a low morbidity. This may be due to good patient selection among others reflected by 97% of the patients having ASA II and III scores.…”

“…These findings are corroborated by reports on smaller cohorts that in addition have a much lower follow-up rate. Based on 179 octogenarians of whom unfortunately only 81 (45%) could be followed up for a mean of 27.4 months, Clark et al 5 reported good improvement on strength and range of motion. Triplet et al 29 showed good clinical results in 18 patients with TSA and 33 patients with RTSA at an age older than 80 years.…”

“…These complication rates resulted in very low reoperation rates between 0 and 2%. [17][18][19] Clark et al 5 described an overall mortality of 19% in the median time to death of 67.7 months in the study population. The data are promising and lend support to RTSA for elderly patients.…”

“…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%.…”

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

“…In this meta-analysis, according to the complications described in the literature [11,14,15,20], we found RSA compared to hemiarthroplasty had a lower incidence of complications after surgery, Clark, NJ. [30] clinical trials also proved the point, at the same time, they thought primary RSA was effective in the treatment of PHF, lower in medical and surgical complications, RSA was also effective in patients over 80 years of age after a comprehensive evaluation. However, RSA is not a panacea, and it has its own limitations.…”