Total shoulder replacement for osteoarthritis in patients 80 years of age and older

Abstract

This study was performed to review the safety and outcome of total shoulder replacements in patients who are > or = 80 years of age. A total of 50 total shoulder replacements in 44 patients at a mean age of 82 years (80 to 89) were studied. Their health and shoulder status, the operation and post-operative course were analysed, including pain, movement, patient satisfaction, medical and surgical complications, radiographs, the need for revision surgery, and implant and patient survival. A total of 27 patients had an ASA classification of III or IV and medical abnormalities were common. Of the 13 shoulders with bony deficiency of the glenoid, nine required grafting. The duration of hospital stay was prolonged and blood transfusions were common. There were no peri-operative deaths. The mean follow-up was for 5.5 years (2 to 12). Pain was significantly reduced (p < 0.001) and movement improved in active elevation and both external and internal rotation (p < 0.001). Using the Neer scale for assessing outcome, 40 (80%) shoulders had an excellent or satisfactory result. There were medical or surgical complications in 17 cases. Four shoulders developed radiological evidence of loosened glenoid components, and three of these had a poor outcome. Three other shoulders required revision, two for instability. By the time of this review 39 of the patients had died from unrelated causes at a mean of 7.5 years (0.8 to 16.4) after surgery. Total shoulder replacement is a relatively effective treatment in this elderly group of patients. However, there is a requirement for more intense patient care in the peri-operative period, and non-fatal medical or surgical complications are common. Most of these elderly patients will have a comfortable functional shoulder for the rest of their lives.

A ten-year radiologic comparison of two-all polyethylene glenoid component designs: a prospective trial

“…16 We did not see a difference between men and women, which has been previously reported. 15,22 Other authors have also reported that the development of rotator cuff tears after surgery influences the development of RLLs, but this was not found in our series.…”

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

“…Although the different types of shoulder arthroplasty usually are successful for treatment of a wide range of glenohumeral disorders [4,10,15,20,31,32,46,47,49,52], the results of these procedures are unpredictably variable: a substantial number of patients having shoulder arthroplasty experience minimal to no improvement or complications. Some of the factors previously associated with poorer results include patients with shoulders with multiple surgeries before the arthroplasty, patients with shoulders with work acquired injuries, patients with comorbidities, and surgeons with limited arthroplasty experience [3, 5, 7, 17, 21, 25, 27-29, 41, 54, 56, 57].…”

Good function after shoulder arthroplasty

“…The improvement in shoulder function and pain as measured by the OSS was both statistically and clinically significant. Previous studies of shoulder arthroplasty in patients with RA and OA have similarly found improvement in function and pain (Norris and Iannotti 2002, Deshmukh et al 2005, Haines et al 2006, Sperling et al 2007, Raiss et al 2008, Foruria et al 2010, Ekelund and Nyberg 2011). …”