Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review

Abstract

Background: Despite concerns about the longevity of total shoulder arthroplasty (TSA) in young patients, it remains an attractive option because of the absence of superior options.

Methods: A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. English-language studies were identified with search terms "total shoulder arthroplasty" (title/abstract) or "shoulder replacement" (title/abstract) and "young" (title/abstract) or "under 65 years of age" (title/abstract). Duplicate studies, studies not reporting outcomes, and those using a humeral resurfacing technique were excluded. Outcomes of interest included pain, range of motion, patient-reported outcome scores, patient satisfaction, radiographic changes, complication and revision rates, and implant survival.

Results: Six studies met inclusion criteria. Significant improvements in pain, range of motion, and patient-reported outcomes were found across all studies that reported these measures. At an average of 9.4 years, 17.4% underwent revision and 54% had glenoid lucency. Whereas glenoid loosening is the most common reason for revision (52%), overall implant survivorship was reported at 60% to 80% at 10- to 20-year follow-up. Outcome measures including the Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores were reported, with generally satisfactory but not excellent results between 3 and 10 years from surgery.

Conclusions: Although there is concern with periprosthetic radiolucency and glenoid loosening in the young patient (<65 years) undergoing TSA, overall low revision rates and high implant survivorship are reported in the current literature. Whereas the patient-reported outcomes are inferior to those of the overall TSA population, there is significant improvement from baseline levels in young patients with glenohumeral arthritis.

Keywords: Total shoulder arthroplasty; implant survivorship; outcomes; pain; range of motion; younger patients.