Summary

Patients 75 years and older treated with inlay total shoulder arthroplasty for advanced glenohumeral arthritis demonstrated similar improvement and maintenance trends in patient reported outcomes over the course of 5 years when compared to younger age groups suggesting that health benefits of shoulder replacement are robust for both older and younger patients.

Abstract

Introduction

Improved quality of life and advancements in medical care result in a growing elderly population living with glenohumeral arthritis. Shoulder demands differ across various age groups influencing the decision-making process for surgical intervention. Patients 75 years and older often present with unique challenges for treatment and postoperative recovery due to their aging physiology and comorbidities. The purpose of this study was to determine if this age group achieves similar outcome benefits following inlay total shoulder arthroplasty (iTSA) when compared to younger age groups.

Methods

Outcome trends of patients treated with iTSA for primary osteoarthritis were assessed in a historic cohort. Group I was defined as 75 and older, Group II as 65-74, and Group III as younger than 65 years. Stata v.15 software (College Station, TX) was used to perform descriptive analyses on the American Shoulder and Elbow Surgeon’s (ASES) score, visual analog scale for pain (VAS-Pain) and shoulder range of motion (ROM). Longitudinal trends and statistically significant (alpha=0.05 level) periods of improvement, maintenance, and decline in outcome scores using calculated monthly percent change (MPC) were identified using joinpoint regression analysis (Version 5.0.2, National Cancer Institute) over the observational period of 60 months.

Results

Between 2011 and 2024, 583 shoulders underwent iTSA and 510 (88%) were included in this study (156 bilateral) with 103 shoulders in Group 1, 179 in Group 2, and 228 in Group 3. The mean age was 64.8 years ±10.8 (132 females, 300 males) and the mean follow-up was 32.4 months ±32.4. 1350 ASES and 1360 VAS-Pain scores were included in the trending analysis. Two phases were observed for all patients: Significant improvement in ASES and VAS-Pain from baseline to 6 months (MPC: 13.5%, -21.3%) and maintenance from 6 months to 60 months (MPC: 0.0%, -1.9%). Age-based stratification mirrored timelines and phases: Group I ASES significantly improved from 0-6 months at an MPC of 13.8% (Group II: 14.4%, Group III: 13.5%) and was maintained until 60 months postoperative at an MPC of –0.1% (Group II: 0.0%, Group III: 0.1%). VAS-Pain significantly improved in Group I from 0-6 months at an MPC of –24.1% (Group II: -21.3%, Group III: -18.0%) and was maintained until 60 months postoperative at an MPC of –1.3% (Group II: -1.9%, Group III: -1.2%). At last follow-up, median PROs significantly improved (p < 0.001) in all patients from 35 (22-48) to 85 (70-95) on ASES and 7 (5-8) to 0 (0-3) on VAS-pain. Median ROM significantly improved (p < 0.001) from 95 (80-130) to 160 (140-170) on forward flexion and 20 (10-30) to 50 (40-60) on external rotation. Group 1 ASES and VAS-Pain improved the most from baseline to last follow-up, followed by Group 3 and 2.

Conclusions

Patients 75 years and older treated with inlay total shoulder arthroplasty for advanced glenohumeral arthritis demonstrated similar improvement and maintenance trends in patient reported outcomes over the course of 5 years when compared to younger age groups suggesting that health benefits of shoulder replacement are robust for both older and younger patients.