Monday, October 31, 2016

What becomes of total shoulder arthroplasty performed in a young, high-demand population?

Clinical Outcomes of Anatomical Total Shoulder Arthroplasty in a Young, Active Population.

These authors conducted a study of the clinical outcomes of total shoulder arthroplasty (TSA) for arthritis in a young, high-demand population as found in the Military Health System Management Analysis and Reporting Tool database. They reviewed the cases of all US military service members who had undergone anatomical TSA (Current Procedural Terminology code 23472) between 2007 and 2014.

Twenty-four service members (26 shoulders) met the inclusion criteria. The cohort was predominantly male (n = 25). Mean age was 45.8 years (range, 35-54 years). 

The most common etiology of glenohumeral arthritis was post-instability arthropathy (50.0%). 

At mean follow-up of 41 months, 9 patients had a total of 12 complications (46.2%), including 6 component failures, neurologic injury (2 cases), adhesive capsulitis (2), and venous thrombosis (2). 

Six reoperations (23.1%) were performed for 6 component failures (2 traumatic dislocations of the prosthesis resulting in acute glenoid component failure, 3 cases of atraumatic glenoid loosening, 1 case of humeral stem loosening after periprosthetic  fracture). Atraumatic glenoid component loosening occurred a mean (SD) of 40.6 (14.2) months after surgery (range, 20.8-54.2 months).

By a mean follow-up of 3.5 years, only a third of the service members had returned to active duty, roughly a third had retired, and more than a third had been medically discharged because of persistent disability attributable to the shoulder.

They concluded that while TSA in young, active patients can provide improvement in range of motion and pain; roughly one-third of patients in this study were unable to continue high-demand activities by 2 years after surgery. They call attention to the short-term complication rate (46.2%) and the reoperation rate for component failure (23.1%).

Comment: It is noteworthy that the great majority of these cases had arthritis resulting from either instability or trauma rather than primary osteoarthritis. As we've pointed out before (see this link), the pathology in younger patients with arthritis is different than the typical 65 year old. There is no perfect solution for the young arthritic shoulder. In carefully selected patients we discuss the option of a ream and run (see this link and this link). 


Information about shoulder exercises can be found at this link.

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