Reverse total shoulder arthroplasty outcomes in elderly patients

Previous studies have found varied outcomes for elderly patients following reverse total shoulder arthroplasty (rTSA). Results for very old patients are rare. The purpose of this study was to analyze functional and radiographic outcomes after rTSA in patients aged 85 years and older and to compare them to a younger population.

Of 1460 patients treated with rTSA from 2005 to 2020, 5% (n = 74) were ≥85 years. 32 patients were excluded due to travel difficulties, death, refuse to participate and lost to follow-up. 42 patients with a minimum follow-up of 2 years were included and matched for sex, body mass index, American Society of Anesthesiologists Score, surgical indication, smoking, alcohol consume, and follow-up time to a younger population with a mean age of 69.5 ± 9 years. Statistical analysis was performed based on preoperative and postoperative range of motion (ROM), pain scores and patient satisfaction. Postoperative X-rays were evaluated for notching, radiolucency, bone formation and resorption, implant migration and periprosthetic fractures.

42 cases with a mean age of 87 ± 2 years were included, 71% female. Indications for rTSA were rotator cuff (RC) tear with arthritis (36%), RC arthropathy (17%), RC tear without arthritis (17%), primary arthritis (17%), proximal humeral fracture (10%), failed osteosynthesis (7%), and instability (2%). Mean follow-up was 47 ± 22 months. Except for age, there were no significant differences in the matching cohort. In the elderly cohort, relative Constant-Murley Score (CMS) improved postoperative significantly from 41 ± 20 to 83 ± 11 and subjective shoulder value from 38 ± 20 to 80 ± 19. All aspects of ROM, except for external rotation, improved significantly. Abduction force and pain improved as well. Radiolucency around the glenoid (21%), bone formation (4.9%) and implant migration (4.9%) were significantly associated with poorer outcome in the absolute CMS (P = .013, P = .002 and P = .008). One patient (1/42, 2.4%) suffered multiple shoulder dislocations and needed a revision. No other reoperations were performed. Comparison between patients over 85 years and the younger matched control group showed no significant differences in relative CMS, subjective shoulder value, and ROM at final follow-up.

Patients aged 85 years and older can expect significant improvement in shoulder function and significant reduction of pain after rTSA. Overall clinical outcome is comparable to a younger population. Complication and revision rates are low. Age should not be a limiting factor when considering rTSA.