Reverse total shoulder arthroplasty in the younger patient (≤65 years): a systematic review

Vancolen, Seline Y.; Elsawi, Rawaan; Horner, Nolan S.; Leroux, Timothy; Alolabi, Bashar; Khan, Moin

doi:10.1016/j.jse.2019.06.018

Cited by 31 publications

(14 citation statements)

References 21 publications

(95 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Also, the lower activity levels associated with older age may be protective of secondary rotator cuff tears after TSA, as some studies have demonstrated that younger, more active patients are actually at higher risk of requiring revision arthroplasty. 3,6,12,17,19,22,24,30 We did find that there was a progression of anterior and superior humeral head subluxation rates between first postoperative radiographs and final radiographs. These radiographic findings may be indicative of anterosuperior rotator cuff thinning or dysfunction over time.…”

Section: Discussionmentioning

confidence: 67%

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Jensen

Tangtiphaiboontana

Marigi

et al. 2021

Journal of Shoulder and Elbow Surgery

View full text Add to dashboard Cite

Background: The relative indications of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) continue to evolve. Some surgeons favor RSA over TSA for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff due to fear of a postoperative (secondary) rotator cuff tear in this age group. However, RSA is associated with unique complications and a worse functional arc of motion compared with TSA. Therefore, it is important to understand the clinical outcomes and rates of revision surgery and secondary rotator cuff tears in elderly patients undergoing TSA. Methods: Between January 1, 2010, and December 31, 2017, 377 consecutive TSAs were performed for primary GHOA in 340 patients 70 years of age or older. The mean age at surgery was 76.2 years (standard deviation [SD], 4.9). Clinical evaluation included pain, motion, and American Shoulder and Elbow Surgeons score. Radiographs were reviewed for preoperative morphology and postoperative complications. All complications and reoperations were recorded. The average clinical follow-up time was 3.3 years (SD, 2.0). Statistical analyses were performed, and Kaplan-Meier implant survival estimates were calculated. For all analyses, a P value <.05 was considered statistically significant. Results: The mean pain visual analog scale and American Shoulder and Elbow Surgeons score at the final follow-up were 1.6 (SD, 2.2) and 78.0 (SD, 17.8), respectively. Forward elevation and external rotation increased from 96 (SD, 30 ) and 26 (SD, 20 ) preoperatively to 160 (SD, 32 ) and 64 (SD, 26 ) postoperatively (P < .001 for each). The percentage of patients who had internal rotation to L5 or greater increased from 24.8% preoperatively to 71.8% postoperatively (P < .001). Revision surgery was performed in 3 shoulders (0.8%), and the 5-year implant survival estimate was 98.9% (95% confidence interval: 97.3%-100%). There were 3 medical (0.8%), 10 minor surgical (2.7%), and 5 major surgical (1.3%) complications. No shoulder had radiographic evidence of humeral component loosening, whereas 7 (2%) had evidence of some degree of glenoid component loosening. In total, there were 5 secondary rotator cuff tears (1.3%), of which 2 (0.5%) required revision surgery. Conclusion: Elderly patients with primary GHOA and an intact rotator cuff have excellent clinical and radiographic outcomes after This study was reviewed and approved by our institutional review board (#12-007498).

show abstract

Section: Discussionmentioning

confidence: 67%

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Jensen

Tangtiphaiboontana

Marigi

et al. 2021

Journal of Shoulder and Elbow Surgery

View full text Add to dashboard Cite

show abstract

“…However, the incidence of fracture is relatively low in cuff arthropathy due to osteoarthritis [9]. In a review by Vancolen et al [4], the pooled mean complication rate of the RTSA was 18%, with the major and minor complication rates being 13 and 5%, respectively. However, it was likely that the rates were overestimated due to a large number of revision, older implants, and the heterogeneity of patients and indications.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 , 8 ]. When the indications for RTSA are expanding to patients younger than 65 years, the early concern is that young age may be associated with higher complication and revision rates [ 4 ]. In our series, reoperation was associated with the proximal humeral fractures.…”

Section: Discussionmentioning

confidence: 99%

“…In a recently published review (covering 245 participants in 6 studies) by Vancolen et al [4], the pooled mean complication rate was as high as 18%, because the revision rate was 36% due to failed arthroplasties and older patients were included in the studies. Ek et al [5] reported their results based on the operations performed between 1997 and 2006.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…Primary repair results in high failure rates, 1 whereas reverse shoulder arthroplasty is not an ideal solution for these young and active patients due to concerns for long-term outcome and lack of revision options in the event of unexpected complications. 2 In the absence of shoulder arthritis, superior capsule reconstruction with folded fascial lata autograft was first introduced in Japan and recently introduced in the United States using acellular dermal allograft tissue. 3,4 Good-to-excellent early-to mid-term clinical outcomes have been reported 5 ; however, data on long-term clinical outcomes are lacking, and a recent systematic review found graft re-tear rates of up to 36%.…”

mentioning

confidence: 99%

Editorial Commentary: Is It Time to Abandon the Latissimus Dorsi Tendon Transfer as a Salvage Procedure for Patients With Large Irreparable Rotator Cuff Tears That Failed Primary Repair?

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

The management of large irreparable rotator cuff tears in the young and active patient population without arthritis presents a challenge for shoulder surgeons due to the limited number of treatment options available that provide predictable outcomes. Latissimus dorsi tendon transfer (LDTT) for the treatment of large, irreparable posterosuperior rotator cuff tears or as a salvage procedure for failed surgical (arthroscopic or open) repair was originally introduced in 1988. Multiple studies have reported both the short-and long-term outcomes after LDTT; however, the majority of these studies included patients without history of previous surgery or a mixed patient population. However, LDTT as a salvage procedure is not as predictable as a primary procedure in terms of pain relief and functional improvement. This is especially true in patients with severe fatty infiltration of the posterior cuff musculature and preoperative acromiohumeral distance <7 mm on static anteroposterior radiography. Conversely, we should not abandon the LDTT in young and active patients with large irreparable rotator cuff tear and intact or repairable subscapularis without arthritis as a primary procedure for treatment. There is plenty of clinical evidence that demonstrates good-to-excellent outcomes in this subset of patients. However, in the setting of one or multiple failed arthroscopic or open cuff repairs, limited range of motion, acromiohumeral distance <7 mm on static anteroposterior radiograph, and severe fatty infiltration of the posterior cuff musculature, I would caution against the use of LDTT as a salvage procedure due to the high failure rate and unreliable clinical results. Currently, there is no role in my own practice for LDTT as a salvage procedure in this patient population.

show abstract

Reverse total shoulder arthroplasty in the younger patient (≤65 years): a systematic review

Cited by 31 publications

References 21 publications

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

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

Editorial Commentary: Is It Time to Abandon the Latissimus Dorsi Tendon Transfer as a Salvage Procedure for Patients With Large Irreparable Rotator Cuff Tears That Failed Primary Repair?

Contact Info

Product

Resources

About