Patient age affects expectations and outcomes in primary total shoulder arthroplasty for glenohumeral osteoarthritis

Lowe, Jeremiah T.; Menendez, Mariano E.; Dasti, Umer; Mahendraraj, Kuhan A.; Miller, Suzanne L.; Ring, David; Jawa, Andrew

doi:10.1053/j.sart.2020.04.006

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…We observed similar findings in both multivariate models, indicating that, for every 1-year increase in age, ASES score would be 0.63 or 0.69 points higher and VAS pain scores 0.08 or 0.08 points lower. Typically, younger patients have higher physical demands, expectations, and life expectancy compared with the average patient undergoing aTSA [32][33][34]. This discrepancy in expectations and increased physical demands may contribute to worse patient-reported outcome scores in the younger population because differences in range of motion measurements were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effects of age on the long-term functional outcomes following anatomic total shoulder arthroplasty

Li,

Duey,

White

et al. 2023

Clin Shoulder Elb

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Background: In the past decade, the number of anatomic total shoulder arthroplasty (aTSA) procedures has steadily increased. Patients over 65 years of age comprise the vast majority of recipients, and outcomes have been well documented; however, patients are opting for definitive surgical treatment at younger ages.We aim to report on the effects of age on the long-term clinical outcomes following aTSA.Methods: Among the patients who underwent TSA, 119 shoulders were retrospectively analyzed. Preoperative and postoperative clinical outcome data were collected. Linear regression analysis (univariate and multivariate) was conducted to evaluate the associations of clinical outcomes with age. Kaplan-Meier curves and Cox regression analyses were performed to evaluate implant survival.Results: At final follow-up, patients of all ages undergoing aTSA experienced significant and sustained improvements in all primary outcome measures compared with preoperative values. Based on multivariate analysis, age at the time of surgery was a significant predictor of postoperative outcomes. Excellent implant survival was observed over the course of this study, and Cox regression survival analysis indicated age and sex to not be associated with an increased risk of implant failure.Conclusions: When controlling for sex and follow-up duration, older age was associated with significantly better patient-reported outcome measures. Despite this difference, we noted no significant effects on range of motion or implant survival.Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

Evaluating the effects of age on the long-term functional outcomes following anatomic total shoulder arthroplasty

Li,

Duey,

White

et al. 2023

Clin Shoulder Elb

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“…4 The ability to continue employment is particularly important for younger patients. 43 Despite the growing importance of revision shoulder arthroplasty the evidence base centres around relatively small case series. In comparison the revision knee arthroplasty literature is supported by larger and more established joint registries which provide data on re-revision rates.…”

Section: Discussionmentioning

confidence: 99%

Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis

Davies

Selmi

Sabharwal

et al. 2022

Journal of Shoulder and Elbow Arthroplasty

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The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.

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“…[40][41][42] Patients wish to be well informed about arthroplasty surgery, and have high expectations about return to function. 43 Participation in sport, pain relief and the ability to continue work are priorities. 43 However patients may be less concerned about the risk of revision surgery or adverse events, particularly in the younger population.…”

Section: Discussionmentioning

confidence: 99%

“… 43 Participation in sport, pain relief and the ability to continue work are priorities. 43 However patients may be less concerned about the risk of revision surgery or adverse events, particularly in the younger population. 44 This distinction is important when counselling patients about implants.…”

Section: Discussionmentioning

confidence: 99%

Anatomical shoulder replacements in young patients: A systematic review and meta-analysis

et al. 2022

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Introduction Increasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to investigate the survivorship and clinical effectiveness of hemiarthroplasty and anatomical total shoulder arthroplasty (TSA) in patients younger than 65 years. Method A systematic review was performed of MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports. The primary outcomes were implant survival and change in perioperative shoulder scores. Results Meta-analysis of implant survivorship was performed of six studies reporting on 416 patients. Implant survival was 86.1% (72.1,100) at 10 years for hemiarthroplasty and 82.3% (64.6,100) for TSA. 20 year survival was 80.0% for hemiarthroplasty (72.5,87.4) and 75.0% (56.9,93.1) for TSA. Ten studies were included in the meta-analysis of shoulder scores, multiple instruments were used. The standardised mean difference between pre-operative and post-operative shoulder scores was 2.15 (1.95, 2.35) for TSA at 4.2–4.9 years, and 2.72 (1.98,3.47) for hemiarthroplasty at 3.8–6 years. Conclusion Over 80% of shoulder replacements last more than 10 years, and 75% last more than 20 years. Significant improvements in shoulder scores are shown at all time points.

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Patient age affects expectations and outcomes in primary total shoulder arthroplasty for glenohumeral osteoarthritis

Cited by 6 publications

References 27 publications

Evaluating the effects of age on the long-term functional outcomes following anatomic total shoulder arthroplasty

Evaluating the effects of age on the long-term functional outcomes following anatomic total shoulder arthroplasty

Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis

Anatomical shoulder replacements in young patients: A systematic review and meta-analysis

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