Summary

A report on patient characteristics, satisfaction, clinical and radiographic outcomes, complications, reoperations and implant survival following RTSA in patients aged 50 and younger compared to ones aged 65 or older presenting matched indications

Abstract

Introduction

Reverse total shoulder arthroplasty (RTSA) was first approved by FDA in 2003 for treatment of rotator cuff tear arthropathy in older patients. An increase in number of cases is reported annually, mainly due to expanding indications. RTSA however remains an unclear choice for younger patients due to questionable long-term durability considering workload and activity levels, high functionality expectations and occurrence of complex types of osteoarthritis.
The purpose of the study was to report patient characteristics, assess satisfaction, clinical and radiographic outcomes and to discuss complications, reoperations and implant survival following RTSA in patients aged 50 and younger with a minimum of 2-year follow-up. The aim of the study is to compare clinical outcomes of those patients, to ones aged 65 or older presenting matched indications. We hypothesized that results in patients aged 50 or younger are going to be at least comparable to outcomes noted among older patients.

Materials & Methods:
This is an IRB-approved retrospective study. Between 2004 and 2021, 1239 primary RTSA procedures were performed by a single surgeon. A cohort of thirty-eight patients was identified. Inclusion criteria consisted of primary RTSA procedure, age at surgery less than or equal to 50 years old, and a minimum of two years of follow-up. Patients were matched 2:1 for procedure indication, gender, and glenoid morphology with a cohort who underwent RTSA at minimum age of 65 years. Patient demographics were collected before surgery. Plain radiographs were obtained preoperatively and postoperatively. Glenoid morphology using the Walch classification was determined with a preoperative CT scan. Humeral and glenoid component loosening as well as scapular notching were determined. Patient reported outcome measures (PROMs) were collected using surveys distributed at patient appointments. Range of motion (ROM) values and postoperative complications were documented.

Results

Within each cohort, a single case of revision was required. The 50≥ group experienced an overall complication rate of 7.89% (n = 3), while the 65≤ group demonstrated a complication rate of 2.53% (n = 2). Walch classifications A1 and A2 were the most prevalent glenoid types in both cohorts. Osteoarthritis was the most common diagnosis in both cohorts. Additionally, 68.42% (n = 26) of the 50≥ group and 82.28% (n = 65) of the 65≤ group demonstrated no postoperative notching. In both cohorts, postoperative ROM improved significantly from preoperative ROM for all metrics studied. The magnitude of improvement did not differ significantly between the groups. The improvements for all ROM metrics in both groups met or exceeded the calculated MCID values, indicating clinically significant improvements defined by patient satisfaction. Both groups demonstrated significant improvements between all preoperative and postoperative PROMs. Postoperative satisfaction was reported to be an average of 83/100 in the 50≥ group versus 92/100 in the 65≤ (p = 0.1).

Discussion

The study shows that clinical outcomes of patients aged 50 and younger who underwent RTSA are comparable to those of aged at least 65 and presenting matched indications. RTSA proves to be a safe and effective procedure for those aged 50 and under.