PurposeYounger and older patients alike are undergoing shoulder arthroplasty at increased rates. As payment models shift toward a focus on value, it is increasingly important to understand sources of suboptimal patient-reported outcomes and experience. We examined and compared expectations and mid-term functional outcomes between patients younger and older than 65 years undergoing primary anatomic TSA. MethodsPreoperatively, 74 consecutive patients selected 3 main expectations for improvement and completed the American Shoulder and Elbow Surgeons (ASES) questionnaire and the Short-Form Health Survey (SF-12). At a minimum follow-up of 3 years, 63 patients (85%) completed the ASES and SF-12 questionnaires and reported whether their preoperative expectations were met. ResultsTop expectations for both age groups were the ability to participate in sports and the ability to sleep painlessly. Younger patients more often expected to maintain employment (P = 0.046), whereas older patients expected to better participate in recreational activity (P = 0.02). Both cohorts reported similarly high rates of met expectations, although there was a marginal tendency towards increased dissatisfaction with the ability to participate in sports among younger patients (P = 0.21). The magnitude of improvement in function and pain was similar in both groups, but younger patients reported higher residual levels of pain (P = 0.03). ConclusionsPatients older and younger than 65 years of age have similar expectations for TSA, but younger patients want to maintain employment at higher rates. While both age groups experience substantial improvements, we observed that younger patients report higher levels of residual pain and 1 in 5 are dissatisfied with the ability to exercise or play sports. Level of evidenceLevel III; Retrospective Cohort Study with Prospective Data