Reverse total shoulder arthroplasty is safe and effective in patients ≥90 Years old

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Arthroplasty Research

Background:

• Surgeons express hesitation towards reverse total shoulder arthroplasty (rTSA) in elderly patients due to medical complexity and frailty.
• Existing literature on hip and knee arthroplasty suggests higher complication and mortality rates in older adults.
• This study investigates the outcomes and complications of rTSA specifically in patients aged 90 years and above.

Purpose of the Study:

• To analyze the safety and efficacy of reverse total shoulder arthroplasty (rTSA) in patients aged 90 years and older.
• To identify and assess postoperative complications associated with rTSA in this specific geriatric cohort.
• To evaluate the functional outcomes, including range of motion, following rTSA in nonagenarian patients.

Main Methods:

• Retrospective review of patients aged ≥90 who underwent primary rTSA between 2010 and 2024.
• Collection of patient demographics, perioperative data, and range of motion measurements (preoperative and at 3, 6, 12 months).
• Identification of postoperative and radiographic complications; statistical analysis using paired t-tests for outcome comparison.

Main Results:

• Thirteen patients (average age 92.2 years) were included, with diverse medical histories including cardiac conditions and high American Society of Anesthesiologists scores (≥3).
• Significant improvements in shoulder range of motion (flexion, external rotation, internal rotation) were observed from preoperative to 1-year follow-up (P < .05).
• Low complication rates were noted, including transient acute kidney injury and resolved axillary nerve palsy; no blood transfusions were required.

Conclusions:

• Reverse total shoulder arthroplasty (rTSA) is a safe and effective procedure for patients aged 90 years and older.
• Preoperative and intraoperative strategies can mitigate risks and decrease complication rates.
• Patients and families should anticipate the need for rehabilitation and potential inpatient stays post-surgery, irrespective of preoperative independence levels.