Do patients outlive their shoulder prosthesis?

Total shoulder arthroplasty (TSA) is projected to exponentially increase in the near future. Despite having excellent long-term survivorship, revision surgery remains a key metric in the implant's success. With an increasingly aging population, it is key to understand the relative incidence of death compared to revision surgery to better guide patients counseling and surgical decision-making. In this study, we aim to compare the rates of revision surgery and mortality following TSA in patients aged <65 and ≥ 65.

We queried the TriNetX database for patients undergoing TSA. Patients were grouped into two cohorts depending on age at surgery (<65 and ≥ 65), and were followed up for 10 years after surgery. Incidence of death and revision surgery were compared between the two cohorts. Significance was set for p < 0.05.

135,021 patients were initially included in this study. 106,777 patients formed the cohort aged ≥65 compared to 28,244 patients in the cohort aged <65. The cumulative incidence of mortality was 22.9 % while that of revision was 6.1 % for the ≥65 cohort, while the cumulative incidence of mortality was 7.0 % and revision was 9.4 % for the <65 cohort. The old cohort had significantly lower odds of revision compared to the younger cohort (3.2 % vs 3.5 %, OR = 0.911, p = 0.011), however had significantly higher odds of mortality compared to the young cohort (7.2 % vs 1.9 %, OR = 4.021, p < 0.0001).

Patients younger than 65 years had a higher risk of revision surgery but a lower risk of mortality compared to those older than 65 years. Younger patients appear more likely to require revision during their lifetime, whereas older patients are more likely to outlive their implants. These findings underscore distinct risk profiles across age groups and can guide individualized counseling and surgical planning.