Comparison of anatomic total shoulder arthroplasty outcomes in younger and older patients with primary glenohumeral arthritis

Abstract

BackgroundElective shoulder arthroplasty is commonly performed in elderly patients with end-stage arthritis. However, a significant number of young patients also undergo this procedure. The surgical outcomes for young patients are not extensively studied compared to older patients. This study aimed to assess the short-term outcomes of anatomic total shoulder arthroplasty (aTSA) in patients aged 18-50 years with primary glenohumeral arthritis and compare them to patients aged 65-75 years. MethodsA retrospective review was conducted on aTSA procedures performed for glenohumeral arthritis at a single hospital system between January 1st, 2005, to September 15th, 2023. Patients aged 18-50 years with a minimum 2-years of follow-up were compared to a cohort of patients aged 65-75 years. Data included range of motion and patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH], American Shoulder and Elbow Surgeons, Simple Shoulder [SS], and Visual Analog Scale pain scores), which were compared between the two groups preoperatively and at final follow-up. ResultsThe younger group included 19 shoulders with a mean age of 44.2 ± 6.4 years at the time of surgery and a mean follow-up of 3.9 ± 1.9 years. The older group included 27 shoulders with a mean age of 70.3 ± 3.0 years at the time of surgery and a mean follow-up of 2.5 ± 0.8 years. The younger group failed to show improvements in all range of motion parameters at final follow-up, while the older group demonstrated improvement in range of motion for all measures. The older group had superior forward elevation and abduction at final follow-up. Both groups exhibited improvements in pain and shoulder function at final follow-up. The younger group did not show significant improvement in DASH scores at final follow-up. Preoperatively, the older group had significantly better DASH and SS scores compared to the younger group. The older group had significantly better DASH, American Shoulder and Elbow Surgeons, SS, and pain scores at final follow-up compared to the younger group. DiscussionBoth groups experienced significant improvement in pain and subjective outcome measures after a 2-year follow-up. Despite this, the younger cohort had worse shoulder range of motion outcomes and lower function and higher pain scores than the older cohort. Nonetheless, aTSA remains a valuable treatment option for young patients in the short-term. However, it is crucial to consider that younger patients may experience dissatisfaction and receive less pain relief compared to older patients, and these factors should be considered when determining the suitability of this treatment approach.