Clinical and radiographic outcomes following reverse total shoulder arthroplasty in patients 60 years of age and younger.

Abstract

Although initially indicated for use in older patients, reverse total shoulder arthroplasty (rTSA) is being increasingly used in younger patients. The purpose of this study is to compare the clinical and radiographic outcomes of patients aged <60 years to those aged 60-79 years following primary rTSA. 154 patients aged <60 years and 1763 patients aged 60-79 years were identified from an international multi-institutional Western Institutional Review Board-approved registry with a minimum 2 years' follow-up. All patients were evaluated and scored preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range of motion (ROM) measurements. Patients aged <60 years were more often male (P=.023), had a higher body mass index (P=.001), higher rates of previous surgery (57% vs. 27%, P<.001), higher rates of post-traumatic arthritis (11% vs. 5%, P<.001) and inflammatory arthropathy (13% vs. 4%, P<.001), and lower rates of rotator cuff tear arthropathy (25% vs. 38%, P=.006). There were no differences in ROM between the groups but patients aged <60 years had significantly lower function and outcome metric scores and higher pain scores at latest follow-up. Adverse event rates were similar between the 2 groups, but patients aged <60 years were more likely to require revision (5.2% vs. 1.8%, P=.004). Patients aged <60 years also had lower satisfaction scores (much better/better 86% vs. 92%, P=.006). At a mean follow-up of 47 months, primary rTSA patients aged <60 years had worse clinical outcomes compared with those aged 60-79 years, with lower outcome scores, increased pain, lower function scores, and less patient satisfaction. Patients aged <60 years had higher rates of previous surgery, inflammatory arthropathy, and post-traumatic arthritis, whereas those aged 60-79 years had higher rates of rotator cuff tear arthropathy. Although complications were similar, younger patients had 3 times the risk of revision rTSA.