Total shoulder arthroplasty in patients aged 80 years and older: a systematic review

Dennis A DeBernardis; Ting Zhang; Andrew Duong; Cassie M Fleckenstein; Mahmoud Almasri; Samer S Hasan

doi:10.1016/j.jse.2023.08.003

Total shoulder arthroplasty in patients aged 80 years and older: a systematic review

J Shoulder Elbow Surg. 2024 Feb;33(2):425-434. doi: 10.1016/j.jse.2023.08.003. Epub 2023 Sep 9.

Authors

Dennis A DeBernardis¹, Ting Zhang², Andrew Duong³, Cassie M Fleckenstein², Mahmoud Almasri², Samer S Hasan⁴

Affiliations

¹ Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA; OrthoCincy, Edgewood, KY, USA.
² Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
³ Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁴ Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA. Electronic address: s1663h@yahoo.com.

PMID: 37696486
DOI: 10.1016/j.jse.2023.08.003

Abstract

Background: Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older.

Methods: A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis.

Results: A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA.

Conclusions: aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.

Keywords: 80 years; Anatomic total shoulder arthroplasty; complications; outcomes; range of motion; reverse shoulder arthroplasty.

Publication types

Systematic Review
Review

MeSH terms

Aged, 80 and over
Arthroplasty, Replacement, Shoulder* / adverse effects
Humans
Pain / etiology
Range of Motion, Articular
Shoulder Fractures / surgery
Shoulder Joint / surgery
Treatment Outcome