90歳以上の患者におけるリバース型全肩人工関節置換術の安全性と有効性

Surgeons may be hesitant to perform reverse total shoulder arthroplasty (rTSA) in elderly patients due to medical complexity, frailty, and possibility of higher rates of complications and mortality. Credence is given to this notion by reports from the hip and knee arthroplasty literature, which show higher rates of postoperative complications and mortality in elderly patients. As such, the purpose of the current study is to analyze outcomes and complications following rTSA in patients ≥90 years old.

All patients ≥90 years old who underwent primary rTSA from 2010 to 2024 were retrospectively identified. Patient demographics and perioperative data were recorded. Range of motion was assessed preoperatively and at 3, 6, and 12 months postoperatively. Postoperative and radiographic complications were identified. Paired student's t-tests were used to compare preoperative to postoperative outcomes.

Thirteen patients (38.5% males) age 92.2 ± 1.7 years old were included. Average follow-up was 11.9 ± 11.0 months. Seven (53.9%) patients lived alone and 6 (46.1%) lived with family. Ten (76.9%) patients required no assistive device and 3 (23.1%) patients used a walker. Seven (53.8%) had cuff tear arthropathy and 6 (42.9%) had proximal humerus fractures. Seven (53.8%) patients had a heart condition and/or prior heart surgery. Eleven patients (84.6%) had an American Society of Anesthesiolgists score ≥3. Average operative time was 85.2 ± 20.3 minutes. Average estimated blood loss was 163.0 cc. Three (23.1%) patients achieved same day discharge. Average inpatient stay was 4.3 days. Six (46.1%) patients were discharged home, 6 (46.1%) to a subacute rehabilitation facility, and 1 (7.7%) to an acute rehabilitation facility. All patients ultimately returned to their preoperative living arrangements. From preoperatively to 1 year follow-up there were improvements in forward flexion from 35.4° to 144.3° (P < .05), external rotation at the side from 3.1° to 37.1° (P < .05), external rotation at 90° shoulder abduction from 10.0° to 85.0° (P < .05), and internal rotation from S1 to L2 (P < .05). Two (15.4%) inpatients experienced acute kidney injuries that resolved and 1 (7.7%) patient had an axillary motor nerve palsy during follow-up that resolved. No patients required a blood transfusion.

Performing rTSA is safe and effective in patients ≥90 years old. Various preoperative and intraoperative measures can be taken to decrease the risk of complications. Regardless of preoperative independence level, patients and family members should be prepared for the likelihood of rehabilitation and inpatient stay following surgery.