Outcomes of reverse total shoulder arthroplasty in patients ≤65 years old

Reverse total shoulder arthroplasty (rTSA) is growing in popularity due to advancements in implant design, improvements in surgical techniques, and expanded indications. Hesitancy to perform rTSA in younger patients is due to concerns regarding implant longevity and functional outcomes. This study investigates outcomes of rTSA in patients ≤65 years old in the largest known cohort to date.

Patients who underwent rTSA by 3 surgeons (C.M.J., M.L.K., W.N.L.) from 2014 to 2025 were retrospectively identified. Exclusion criteria were >65 years old, prior rTSA, and <12 months follow-up. Patient demographics, complications, and clinical outcomes were collected.

One hundred three patients were included. The average age was 59.5 ± 6.5 years and the average follow-up duration was 31.4 ± 27.2 months. Fifty six percent of patients had prior ipsilateral shoulder surgery. The most common diagnosis was cuff tear arthropathy (62.1%). Pre-operatively, 93.2% patients were independent. Post-operatively, 58.3% of patients were discharged the same day and 98.1% of patients went home. Pre-operative forward flexion was 81 ± 48°, external rotation at the side (ER side) was 16 ± 22°, ER at 90° abduction ER 90°) was 53 ± 24°, and internal rotation (IR) was L5. At 2-years post-operatively, forward flexion improved to 146 ± 20 (P < .01), ER side to 34 ± 14° (P < .01), ER 90° abduction to 81 ± 8° (P < .01), and IR to L3 (P < .01). Eight (7.8%) patients developed a post-operative complication that required revision surgery. Such complications occurred at an average of 25.8 ± 15.4 months post-operatively, with baseplate failure (37.5%) being the most common.

rTSA can reliably improve clinical outcomes in patients ≤65 years old. Overall, complication rates are low despite most patients having had prior ipsilateral shoulder surgery.