The purpose of this study was to define an age cutoff at which clinical outcomes and revision rates differ for patients undergoing primary anatomic total shoulder arthroplasty (TSA) and patients undergoing primary reverse shoulder arthroplasty (RSA).
This retrospective cohort study included 1250 primary shoulder arthroplasties (1131 patients) with minimum 2-year clinical follow-up (mean, 50 months). TSA (n . 518; mean age, 68.1 years) was performed for osteoarthritis in most cases (99%), whereas the primary diagnoses for RSA (n . 732; mean age, 70.8 years) included rotator cuff arthropathy (35%), massive cuff tear without osteoarthritis (29.8%), and osteoarthritis (20.5%).
In patients younger than 65 years, TSA was associated with a 3.4-fold increased risk of revision.
RSA performed in patients younger than 60 years was associated with a 4.8-fold increased risk of revision.
TSA patients aged 65 years or older and RSA patients aged 60 years or older had better total ASES scores (82 vs. 77 and 72 vs. 62, respectively).
Comment: For appropriate, motivated young patients with osteoarthritis or capsulorrhaphy arthropathy, we consider the ream and run arthroplasty (click on this link). Here is the abstract of a relevant paper:
Ream and run and total shoulder: patient and shoulder characteristics in five hundred forty-four concurrent cases.
Total shoulder (TSA) is commonly used to treat arthritic shoulders with intact rotator cuffs; however, some patients choose a ream and run (RnR) to avoid the potential risks and limitations of a prosthetic glenoid component. Little is known about how patients selecting each of these two procedures compare and contrast.
We analyzed the patient characteristics, shoulder characteristics, and two year clinical outcomes of 544 patients having RnR or TSA at the same institution during the same six year period.
Patients selecting the RnR were more likely to be male (92.0% vs. 47.0%), younger (58 ± 9 vs. 67 ± 10 years), married (83.2% vs. 66.8%), from outside of our state (51.7% vs. 21.7%), commercially insured (59.1% vs. 25.2%), and to have type B2 glenoids (46.0% vs. 27.8%) as well as greater glenoid retroversion (19 ± 11 vs. 15 ± 11 degrees) (p < .001). The average two year SST score for the RnRs was 10.0 ± 2.6 vs. 9.5 ± 2.7 for the TSAs. The percent of maximum possible improvement (%MPI) for the RnRs averaged 72 ± 39% vs. 73 ± 29% for the TSAs. Patients with work-related shoulder problems had lower two year SSTs and lower %MPIs. Younger patients having TSAs did less well than older patients. Female patients having RnRs did less well than those having TSAs (p < 0.001).
Patients selecting the RnR were more likely to be male (92.0% vs. 47.0%), younger (58 ± 9 vs. 67 ± 10 years), married (83.2% vs. 66.8%), from outside of our state (51.7% vs. 21.7%), commercially insured (59.1% vs. 25.2%), and to have type B2 glenoids (46.0% vs. 27.8%) as well as greater glenoid retroversion (19 ± 11 vs. 15 ± 11 degrees) (p < .001). The average two year SST score for the RnRs was 10.0 ± 2.6 vs. 9.5 ± 2.7 for the TSAs. The percent of maximum possible improvement (%MPI) for the RnRs averaged 72 ± 39% vs. 73 ± 29% for the TSAs. Patients with work-related shoulder problems had lower two year SSTs and lower %MPIs. Younger patients having TSAs did less well than older patients. Female patients having RnRs did less well than those having TSAs (p < 0.001).
The poster below summarizes these findings. Note the differences in age, sex, glenoid retroversion and prevalence of B2 glenoids. Note also that the results with TSA are worse for younger patients, but not for those having the ream and run.
To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube video on how the ream and run is done, click on this link.
To see a YouTube video on how the ream and run is done, click on this link.
=====
To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
