Total shoulder replacement is relatively effective in elderly patients

Foruria AM. J Bone Joint Surg Br. 2010;92(7):970-974.

Total shoulder replacement offers elderly patients a comfortable, functional shoulder, but it requires more intense perioperative care, according to Spanish researchers.

Antonio M. Foruria, MD, PhD, Fundacion Jimenez Diaz-Capio, Madrid, Spain, and colleagues reviewed the safety and outcome of total shoulder replacements in 44 patients (50 shoulders). Mean patient age was 82 years. They analyzed patients’ health and shoulder status, the operation and postoperative course, including pain, movement, patient satisfaction, medical and surgical complications, radiographs and the need for revision as well as implant and patient survival.

Twenty-seven patients were either ASA class III or IV, and medical abnormalities were common. Thirteen shoulders had a bony glenoid deficiency, nine of which required grafting. Hospital stays were prolonged and blood transfusions were common in these patients. No patients died perioperatively. Mean follow-up was 5.5 years.

These patients had significantly less pain (P<.001) and improved motion in active elevation as well as external and internal rotation (P<.001). Based on the Neer scale, 40 shoulders (80%) had an excellent or satisfactory result.

There were 17 medical or surgical complications. Four shoulders had loosened glenoid components, seen on radiographs; three had a poor outcome. Three other shoulders had to be revised; two were revised for instability.

At the time of this review, 39 patients had died from unrelated causes at a mean 7.5 years (range, 0.8 to 16.4 years) after surgery, the researchers wrote.

Although the perioperative care is more intense in elderly patients undergoing total shoulder replacement, the authors concluded that the majority of elderly patients will have a comfortable functional shoulder for the remainder of their lives.