Purpose
Common surgical treatment of patients with painful and debilitating osteoarthritis of the glenohumeral joint is a total shoulder replacement (TSR). Anatomic TSR (aTSR) is usually performed when there is an intact good functioning rotator cuff, however when the patient reaches the 8th decade there is an increased tendency in these cases to do a reverse prosthesis. This study compares outcomes of patients with the same aTSR below and over the age of 70 years.
Methods
Consecutive patients with glenohumeral arthritis managed with the same stemless aTSR below (n=86) and above (n=75) the age of 70 years were prospectively studied. Pre- and postoperative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a minimum follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis.
Results
A total of 161 patients were initially included in this study. Twenty-six cases were lost to follow-up, withdrew or deceased during the follow-up process. The average follow-up time was 6.5 years with a maximum follow-up of 9 years. Similar postoperative improvement for ROM and all clinical assessment scores was seen in both age groups. Constant scores were 77 in both groups at two-year follow-up. At last follow-up, ASES and SPADI scores were 96.4 vs. 95 (p >0.05) and 3.5 vs. 7.1 (p >0.05) for the below 70 and above 70 years of age groups, respectively. Two cases in the <70 group had to be revised to a reverse TSR and one case in the >70 group had a supraspinatus failure, but did not need a revision. At latest follow-up, both groups had only minor osteolysis on radiographs.
Conclusions
This study demonstrates that patients older than 70 years of age with the same aTSR have as good clinical and radiological outcomes as patients younger than 70 years of age when carefully selected for good rotator cuff muscle function.