Primary reverse shoulder arthroplasty in patients aged 65 years or younger

Reverse total shoulder arthroplasty (RTSA) has classically been reserved for patients older than 65 years with rotator cuff arthropathy, pseudoparalysis, and severe pain. This investigation assessed outcomes in a consecutive series of patients aged 65 and younger undergoing primary RTSA.

There were 63 patients (67 shoulders; 40 women, 27 men) with a mean age of 60 years (range, 50-65 years). Indications were cuff tear arthropathy (CTA) in 51, severe glenohumeral arthritis in 15, and osteonecrosis in 1. The primary end point was revision-free implant survival. Pain scale, motion, strength, and radiographic outcomes were also studied.

At a mean follow-up of 3 years (range, 2-8 years), the 2-year and 5-year revision-free survival was 99% and 91%, and reoperation-free survival was 97% and 90%, respectively. Complications occurred in 9%. Smoking increased the risk for revision, reoperation, and complications (P < .03). Patients experienced improvements in pain (P < .0001), active abduction (57.5° vs. 132.4°, P < .0001), and active external rotation (20.1° vs. 39.4°, P < .001). At the most recent follow-up, 90% patients were satisfied with their result, and 85% felt they were better or much better than before surgery. There was an 18% incidence notching, 3% incidence of dislocation, and no loosening.

At both 2 and 5 years, RTSA is a reliable operation in patients aged younger than 65 years. Patients gain significant improvements in pain level, range of motion, and strength, without a large number of early failures. Long-term follow-up is needed to understand late component mechanical problems and loosening.