Complication rates after shoulder arthroplasty in patients aged 45 years and younger

Shoulder arthroplasty is effective for reducing pain and improving shoulder function in older patients, but there is limited information on outcomes in patients aged 45 years and younger. Younger patients may be more active and require prolonged use of their operative shoulder, potentially increasing the risk of arthroplasty failure or revision. This study aimed to evaluate complication rates of anatomic total shoulder arthroplasty (TSA), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA) in younger patients. We hypothesized that the complication rates would be comparable with those of older patients in existing literature.

This multicenter, retrospective study included patients aged 45 years and younger undergoing primary TSA, HA, or rTSA with a minimum 2-year follow-up. Exclusion criteria were patients older than 45 years or those with revision surgeries. Primary outcomes were complications, reoperations, and radiographic analysis of component loosening or failure. Secondary outcomes included American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and range of motion (ROM). Statistical analysis was used to assess differences in outcomes.

Seventy patients, with an average follow-up of 85 months, underwent 35 TSA, 30 HA, and 5 rTSA procedures. The most common operative diagnosis was osteoarthritis (44%). The overall complication rate was 19% and the reoperation rate was 13%, with no significant differences between arthroplasty types. Radiolucent lines were present in 14.3% (10 cases) of the humeral components and 10.0% (7 cases) of the glenoid components. Glenoid radiolucencies were present only in the TSA group, with one (3%) patient undergoing revision for loosening. Clinical outcomes showed significant improvements in American Shoulder and Elbow Surgeons scores, visual analog scale pain, and ROM, with no differences between arthroplasty types.

Younger patients undergoing shoulder arthroplasty have an acceptable complication profile, but a relatively high risk of reoperation. Glenoid component loosening occurred only in the TSA, with a 3% revision rate. All arthroplasty types showed significant improvements in ROM, pain levels, and function, indicating that patients benefit from the procedure. Nevertheless, the relatively high complication and reoperation rates for all three types of arthroplasty should be taken into account when considering shoulder replacement in those patients.