Clinically relevant results of reverse total shoulder arthroplasty for patients younger than 65 years compared to the older patients

Abstract

Background Reverse total shoulder arthroplasty was originally designed for older patients with rotator cuff arthropathy and produces good results. The main objective of this retrospective study was to compare the patients younger than 65 years vs. the older patients in terms of the complications of reverse total shoulder arthroplasty and the functional recovery. Methods From January 2014 to January 2020, 566 patients who underwent the reverse total shoulder arthroplasty were divided into two groups (group A, ≥ 65 years, n = 506; group B, < 65 years, n = 60). The patients reported the quality of life using the patient-reported Western Ontario Osteoarthritis of the Shoulder index. The Constant score was obtained preoperatively and 3 months postoperatively. The complications and reoperations were compared. Statistical significance was set at P < 0.05. Results Clinically relevant improvements were found in group A and B. There was a multivariate statistically-significant but not clinically relevant difference in the change over time between group A and B. The mean 12-month Western Ontario Osteoarthritis of the Shoulder indexes were 58 in group B and 71 in group A. The mean Constant scores were 44 in group B vs. 43 in group A. Compared to group A, group B had a non-significant odds ratio of 1.9, which did not reach the clinically relevant Western Ontario Osteoarthritis of the Shoulder index of group A. Conclusion In patients younger than 65 years of age, RTSA seems to be a safe procedure in short term follow-up. After 1 year, we found no increased risk of complications, revision, or inferior outcomes compared to patients older than 65 years of age. Consequently, after one-year, RTSA provided clinically relevant improvements in the patients’ quality of life and shoulder strength regardless of age.

Outcome of reverse shoulder arthroplasty secondary to rotator cuff arthropathy in a low-income population

“…Values of FF and ER amplitude increased 51.4 and 14.1 at 24 months, as compared to baseline values. Although hard to compare with other series, our data are encouraging and substantiate that it is worth performing RSA in our patients, particularly given that our results meet previously proposed MCID values [ 19 , 23 , 26 – 28 ].…”

“…Despite using other parameters of evaluations, the occurrence of adverse events was similar to our results. We believe patients with fewer socioeconomic disparities were included, but no socioeconomic data, besides being done in Denmark, a developed and affluent nation, were provided [ 23 ]. Outcome of arthroplasties is highly influenced by careful patient selection and expertise of the surgical team.…”

“…Although life expectancy can be lower among low-income individuals in developing regions, the number of elderly people is expected to increase in the near future [ 6 ]. Being autonomous, particularly for patients with limited economic resources, is highly important, as they cannot afford caregivers, and access to public services for assistance with daily life activities is often challenging [ 4 , 23 ]. We have previously shown, in a similar cohort, that surgical repair of patients with a RCT in our hands proved effective.…”

“…We also had an acceptable percentage of occurrence of adverse events, which is comparable to data from other cohorts, with only one patient needing revision of the implant. Although our evaluation was restricted to a two-year follow-up, revision surgeries, usually linked to infection and loosening issues, commonly occur shortly after surgery, usually within a 1–3 year period following the procedure [ 23 , 28 ]. The fact that one of our patients had a dislocation of the prosthesis because of strenuous exercise linked to his job underscores daily challenges linked to socioeconomic issues.…”