Reverse Total Shoulder Arthroplasty in Patients Who Exceeded Their Life-Expectancy: A Retrospective Study

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Biomedical Engineering

Background:

• Reverse total shoulder arthroplasty (RTSA) is a standard treatment for conditions like cuff arthropathy and osteoarthritis.
• The growing elderly population presents unique challenges for shoulder surgeons regarding RTSA suitability.

Purpose of the Study:

• To evaluate the outcomes of RTSA in patients over 83 years old.
• To compare the results of elective RTSA versus RTSA performed for proximal humeral fractures in this age group.

Main Methods:

• Retrospective analysis of 110 patients (age >83) undergoing RTSA.
• Comparison of elective cases (n=48) versus fracture cases (n=62).
• Assessment of demographics, hospital stay, complications, functional outcomes, and mortality.

Main Results:

• Elective RTSA had a shorter hospital stay (P = .014).
• Elective cases showed better functional scores (ASES, subjective shoulder value, VAS) and lower complication rates (2.4% vs 6.5%).
• No significant differences in ROM or quality-adjusted-life-years (QALY); 1-year mortality was 6% for elective and 15% for fracture cases.

Conclusions:

• RTSA can achieve good functional outcomes in elderly patients, irrespective of age.
• Patient activity level and quality of life are more important than chronological age when considering RTSA.
• Elective RTSA demonstrates superior functional outcomes and reduced complications compared to RTSA for fractures in this population.