Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up Study.

Simon Bell,Jennifer Coghlan,Maciej Simon

doi:10.3390/jcm11030540

Abstract

Background: In older patients requiring a total shoulder replacement (TSR) and with an intact rotator cuff, there is currently uncertainty on whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same-aged patients aims to assess clinical and radiological outcomes of older patients (≥75 years) who received either an aTSR or an rTSR. Methods: Consecutive patients with a minimum age of 75 years who received an aTSR (n = 44) or rTSR (n = 51) were prospectively studied. Pre- and post-operative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with an rTSR. Results: We found postoperative improvement for ROM and all clinical assessment scores for both groups. There were significantly better patient reported outcome scores (PROMs) in the aTSR group compared with the rTSR patients (p < 0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR (n = 11) patients and acromioclavicular joint pain for both groups (aTSR = 2; rTSR = 6). Conclusions: This study of older patients (≥75 years) demonstrated that an aTSR for a patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than an rTSR. Level of evidence: Level II—prospective cohort study.

Highlights

In shoulder replacement, the type of shoulder prosthesis chosen for a particular patient is based on the underlying pathology, in particular the status of the rotator cuff, the degree of bony erosion, and the biological age of the patient.Rotator cuff tendons degenerate progressively with increasing age and with secondary wasting of the muscle belly [1,2], and rotator cuff tears are present in almost 50% of the population in their 8th or 9th decade of life [3]
In the other 50% of older patients with an arthritic glenohumeral joint but an intact rotator cuff requiring a total shoulder replacement (TSR), there is at present uncertainty as to which patients would do better with an anatomic TSR (aTSR)
There is a currently an increasing tendency to recommend a reverse total shoulder replacement in patients older than 70 years with an intact rotator cuff [4], which seems to assume that the result of an aTSR vs. an reverse TSR (rTSR) in this age group is similar

Summary

Introduction

The type of shoulder prosthesis chosen for a particular patient is based on the underlying pathology, in particular the status of the rotator cuff, the degree of bony erosion, and the biological age of the patient.Rotator cuff tendons degenerate progressively with increasing age and with secondary wasting of the muscle belly [1,2], and rotator cuff tears are present in almost 50% of the population in their 8th or 9th decade of life [3]. In the other 50% of older patients with an arthritic glenohumeral joint but an intact rotator cuff requiring a total shoulder replacement (TSR), there is at present uncertainty as to which patients would do better with an aTSR. There is a currently an increasing tendency to recommend a reverse total shoulder replacement (rTSR) in patients older than 70 years with an intact rotator cuff [4], which seems to assume that the result of an aTSR vs an rTSR in this age group is similar. TSR (rTSR) is best for the patient This comparison study of same-aged patients aims to assess clinical and radiological outcomes of older patients (≥75 years) who received either an aTSR or an rTSR. Conclusions: This study of older patients (≥75 years) demonstrated that an aTSR for a patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than an rTSR.

Objectives

Methods

Results

Discussion

Conclusion