2017 ISAKOS Biennial Congress ePoster #2208

 

Rotator Cuff Repair Result in Over Seventy Year Old’s: Clinical Improvements are Significant and Healing Rates are Good but Inferior to Younger Patients but Beware of Postoperative Compliance

Mark David Haber, MBBS, FRACS, Wollongong, NSW AUSTRALIA
Yuval Arama, MB. BS, Sydney, NSW AUSTRALIA
Eran Dolev Demshchak, MD, Even Yehuda ISRAEL
Shahrulazua Ahmad, MBBS(Lon), MRCS(Edin), MMedOrth(USM), MAdvSurgOrth, Sungai Buloh, Selangor MALAYSIA
Desmond John Bokor, MB, BS, MHEd (Med), FRACS, FAOrthA, Macquarie University, NSW AUSTRALIA

Southern Orthopaedics, Wollongong, NSW, AUSTRALIA

FDA Status Not Applicable

Summary

The over 70-year-old group had larger tears and more pain prior to surgery but achieved better pain relief (compared to the younger cohort) and good healing rates however postoperative compliance and healing were inferior to the under 70-year-old group stressing the importance of sound preoperative patient selection and postoperative counselling in the older age group.

Abstract

Background

The incidence of rotator cuff increases with age. Older patients tend to have larger tears and greater pain. Establishing clinical outcomes and healing rates of patients over the age of 70 years old compared to younger patients and observing factors relating to patient who re-tear is of significant clinical importance. Numerous papers have established pre-operative and intra-operative factors that predispose to re-tearing. There has been little written about post-operative factors which predispose to re-tearing, especially in the elderly. Understanding post-operative outcomes in the over 70’s may greatly assist in the decision making in this age group which are becoming increasingly active. There is no indication to exclude patient from surgery on age alone.

Material And Methods

Prospective data on 727 patients who had undergone arthroscopic rotator cuff repair between February 2010 and February 2016 by one surgeon was analyzed. The minimum patient follow-up period was 26 weeks; the mean period was 48 months. These patients were divided onto two groups. Group 1 consisting of patients under the age of 70 years old and group 2 were over 70. Group 1 comprised of 394 males and 232 females with an average age at surgery of 56.7 years. group 2 comprised of 63 males and 38 females with an average age of 74.6 years. Intraoperative variables and preoperative and postoperative Constant Shoulder Scores (CSS), Western Ontario Rotator Cuff Index (WORC) and Oxford Shoulder Score (OSS) were assessed. Rehabilitation compliance was assessed with a standard questionnaire.

Results

Re-tear rates were 9.6 % in Group 1 and 16.7% in group2. Full compliance rate at 6 months were 90.9% in Group 1 and 77.8% in Group 2.
Average Preoperative Constant Score was 58.6 in group 1 and 49.4 in group 2. Average 24-month Constant Score was 91.0 in group 1 and 82.3 in group 2.
Re-tear significantly correlates to tear size, especially in Group 2 who had poorer bone quality and were less compliant. Re-tear trends to poorer tendon quality in both groups.

Discussion

In this case series performed by one surgeon, results show that preoperative pain is higher and Constant scores were poorer in the over 70 group (group 2). They had larger tears and poorer quality bone and tendon. This group were less compliant with the rehabilitation and have marginally higher rate of re-tear at 6 months.
Post-operative function based on the Constant score is less good in group 2. Nevertheless, there were significant improvements from a preoperative score of 49.4, improving for two years and achieving 82.3 at 24 months. They had better improvement in pain scores. Poorer compliance to the critical rehabilitation may contribute to the higher re-tear rates.

Conclusion

Patients in group 2 with an average age of 75, had slightly lower healing rates and significantly better pain relief but tend to be less complaint with the rehabilitation compared to their younger cohorts. They therefore require more postoperative assistance and careful counselling about the rehabilitation to optimize outcomes. Patients should not be excluded from surgery on age alone.