Increasing use of reverse total shoulder arthroplasty in younger adults despite higher complication rates

The indications for reverse total shoulder arthroplasty (rTSA) continue to expand. Although there has been an increase in the use of rTSA across the United States, there are limited data to evaluate the outcomes of rTSA in younger patients. We sought to evaluate the trends of rTSA use in the United States and to evaluate medical and surgical complications in patients under 60 years of age undergoing rTSA.

Patients who underwent primary, elective anatomic or reverse TSAs between January 1, 2016, and December 31, 2020, were identified using the Premier Healthcare Database. Patients undergoing rTSA were divided into groups based on age <60 years old. Annual trends in rTSA use in this age group were assessed. These patients were then propensity matched to patients ≥60 years old undergoing rTSA. Multivariable models were conducted to evaluate the effect of age on 90-day surgical and medical complications.

Over the study period, there was a significant increase in the proportion of rTSAs used, with rTSA comprising 48.29% of all TSA in patients <60 years old in 2016 and rising to 58.77% by 2020 (R² = 0.93). After matching, 3,087 patients <60 years old and 9,261 patients ≥60 years old remained. The groups were well balanced for all covariates with a standardized mean difference of <0.1. After adjusting for residual confounding, 1.53 (95% confidence interval 1.13-2.02) times greater odds of 90-day surgical complications in patients <60 years old were observed, without a difference in odds of medical complications.

These results demonstrate the risks associated with younger age in rTSA and suggest that further investigation is required to optimize outcomes of younger patients undergoing rTSA as indications continue to grow.