Outcomes of reverse shoulder arthroplasty in patients under 55 years old: Results from the New Zealand joint registry

Abstract

Background

The appropriate age at which to perform reverse shoulder arthroplasty is controversial. The aim of this study was to compare the outcomes of reverse shoulder arthroplasty between younger and older patients.

Methods

Patients who underwent primary reverse shoulder arthroplasty between January 2000 and December 2019 were identified from New Zealand Joint Registry records. Patients were stratified into two cohorts according to age at the time of surgery: < 55 years and ≥ 55 years. These two groups were then compared with regard to baseline characteristics, indications for surgery, revision rates, and patient-reported outcomes using the Oxford Shoulder Score and American Shoulder and Elbow Score (ASES).

Results

A total of 5518 primary reverse shoulder arthroplasty cases were identified, with 75 patients < 55 years at the time of surgery (range: 34–54 years). The mean duration of follow-up was 2.36 years (range: 0.11–13.37 years) in the younger cohort and 3.10 years (range: 0.01–16.22 years) in the older patient cohort. Indications for surgery differed significantly between the two groups, with younger patients having higher rates of inflammatory arthritis (p < 0.001), posttraumatic arthritis (p < 0.001), and avascular necrosis (p = 0.049). The younger cohort had an inferior 6-month postoperative Oxford Shoulder Score compared to the older cohort (mean: 28.5 [younger cohort] vs. 35.7 [older cohort]; p < 0.001). There was no significant difference in revision rate between the younger and older patient cohorts during the study period (1.56 [<55 years] vs. 0.74 [≥55 years] revisions per 100 component-years; p = 0.332).

Conclusion

Our early results suggest that younger patients undergoing reverse shoulder arthroplasty demonstrate high implant retention rates, comparable to older patients. Longer-term patient-reported outcomes in younger patients are required to guide appropriate patient selection for reverse shoulder arthroplasty.

Level of evidence

Level III, retrospective case-control study.

Keywords

reverse shoulder arthroplasty <55 years old young reverse shoulder arthroplasty

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References

Cuff

Pupello

Virani

, et al. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 2008; 90: 1244–1251.

Sirveaux

Favard

Oudet

, et al. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004; 86: 388–395.

Young

Everts

Ball

, et al. The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions. J Shoulder Elbow Surg 2009; 18: 622–626.

Ernstbrunner

Andronic

Grubhofer

, et al. Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: a systematic review of longitudinal outcomes. J Shoulder Elbow Surg 2019; 28: 774–781.

van der Merwe

Boyle

Frampton

CMA

, et al. Reverse shoulder arthroplasty compared with hemiarthroplasty in the treatment of acute proximal humeral fractures. J Shoulder Elbow Surg 2017; 26: 1539–1545.

Willis

Min

Brooks

, et al. Proximal humeral malunion treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg 2012; 21: 507–513.

Bonnevialle

Mansat

Lebon

, et al. Reverse shoulder arthroplasty for malignant tumors of proximal humerus. J Shoulder Elbow Surg 2015; 24: 36–44.

Garcia

Taylor

Depalma

, et al. Patient activity levels after reverse total shoulder arthroplasty. Am J Sports Med 2015; 43: 2816–2821.

Favard

Levigne

Nerot

, et al.

Reverse prostheses in arthropathies with cuff tear are survivorship and function maintained over time?

Clin Orthop Relat Res 2011; 469: 2469–2475.

10.

Saltzman

Mercer

Warme

, et al. Comparison of patients undergoing primary shoulder arthroplasty before and after the age of fifty. J Bone Joint Surg Am 2010; 92: 42–47.

11.

Hobbs

Frampton

CMA

Devane

, et al. The New Zealand Joint Registry, Nineteen Year Report, January 1999 to December 2017. 2018.

12.

Ernstbrunner

Suter

Cantanzaro

, et al. Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: long-term results. J Bone Joint Surg Am 2017; 99: 1721–1729.

13.

Otto

Clark

Frankle

. Reverse shoulder arthroplasty in patients younger than 55 years: 2- to 12-year follow-up. J Shoulder Elbow Surg 2017; 26: 792–797.

14.

Neukom

Catanzaro

, et al. Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years. J Shoulder Elbow Surg 2013; 22: 1199–1208.

15.

Muh

Streit

Wanner

, et al. Early follow-up of reverse total shoulder arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 2013; 95: 1877–1883.

16.

Sershon

Van Thiel

Lin

, et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg 2014; 23: 395–400.

17.

Leathers

Ialenti

Feeley

, et al.

Do younger patients have better results after reverse total shoulder arthroplasty?

J Shoulder Elbow Surg 2018; 27: S24–S28.

18.

Rothwell

Hobbs

Frampton

, et al. The New Zealand Joint Registry, Sixteen Year Report, January 1999 to December 2014. NZJR. 2014.

19.

Dawson

Rogers

Fitzpatrick

, et al. The Oxford shoulder score revisited. Arch Orthop Trauma Surg 2009; 129: 119–123.

20.

Kalairajah

Azurza

Hulme

, et al. Health outcome measures in the evaluation of total hip arthroplasties – a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 2005; 20: 1037–1041.

21.

Mazzucco

Spector

. Effects of contact area and stress on the volumetric wear of ultrahigh molecular weight polyethylene. Wear 2003; 254: 514–522.

22.

Terrier

Merlini

Pioletti

, et al. Comparison of polyethylene wear in anatomical and reversed shoulder prostheses. J Bone Joint Surg Br 2009; 91: 977–982.

23.

Cuff

Pupello

Santoni

, et al. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency a concise follow-up, at a minimum of 10 years, of previous reports. J Bone Joint Surg Am 2017; 99: 1895–1899.

24.

Tashjian

Deloach

Green

, et al. Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am 2010; 92: 296–303.

25.

Black

Roberts

Siegel

, et al. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65years of age or younger. J Shoulder Elbow Surg 2014; 23: 1036–1042.

26.

Vancolen

Elsawi

Horner

, et al. Reverse total shoulder arthroplasty in the younger patient (≤ 65 years): a systematic review. J Shoulder Elbow Surg 2020; 29: 202–209.

27.

Magnussen

Mallon

Willems

, et al. Long-term activity restrictions after shoulder arthroplasty: an international survey of experienced shoulder surgeons. J Shoulder Elbow Surg 2011; 20: 281–289.

28.

Lawrence

Ahmadi

Sanchez-Sotelo

, et al. Patient reported activities after reverse shoulder arthroplasty: part II. J Shoulder Elbow Surg 2012; 21: 1464–1469.

29.

Daw

RLC

Gibson

Prescot

, et al.

What is the correlation between patient-reported outcome measure (PROM) scores and patient satisfaction following elective reverse total shoulder replacement?

Shoulder Elbow 2019; 11: 42–47.