Low complication rate for RSA observed in patients aged older than 80 years
With excellent functional and pain improvements and low complication rates, primary reverse total shoulder arthroplasty may be a safe and effective option for patients aged older than 80 years, according to published study results.
Between January 2005 and March 2018, researchers from the department of orthopedics at Balgrist University Hospital in Zürich, Switzerland, identified 159 patients (171 shoulders) aged older than 80 years who underwent RSA. Mean patient age was 84 years, ranging from 80 to 94 years.
Researchers assessed patient outcomes using Subjective Shoulder Value (SSV) and Constant-Murley scores. They also analyzed mortality, complications, reoperation rates and radiographic data for adverse outcomes, according to their report.
Constant-Murley scores improved “significantly” from 39% to 77%, and SSV improved from 31% to 71%. Additionally, researchers noted that range of motion and force improved among the cohort, with medical complication rates that were “unexpectedly low.”
“The surgical site complication rate was 30% with a reoperation rate of 8% (13 patients) mainly due to fracture and glenoid loosening,” the researchers wrote. “The overall mortality was 16% with a mean time to death of 53 months, thereby no higher than the age-adjusted, expected mortality rate without this procedure,” they added.
Perspective
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Reverse shoulder arthroplasty has been shown to reliably improve pain and shoulder function in patients with rotator cuff arthropathy. A frequent question to shoulder surgeons from patients is, “Am I too old for the operation?” The current study attempts to address that question. The authors clearly show that reverse shoulder arthroplasty can be safely and reliably performed in elderly patients older than the age of 80 years with improvement in function comparable to younger age patients. Increased complication and revision rates primarily due to fracture must be considered in decision-making process as high-risk fall patients or those with severe osteoporosis should be counseled about the elevated risks of fracture. These data will allow improved patient-surgeon decision making regarding the most effective and safest methods of treatment of rotator cuff arthropathy in this elderly patient cohort.
Perspective
Back to TopHow to treat arthritis in very elderly patients can be a concerning decision to make, but the authors of this article take on this difficult question and provide helpful data. By examining a group of patients older than 80 years old with both degenerative traumatic etiologies, an improvement in standardized outcome scores and function was appreciated following reverse total shoulder replacement. Although the rate of surgical complication was 30%, the rate of medical complication and mortality was relatively low. Thus, what I take away from this paper is further support that arthroplasty can be utilized to treat arthritis in the elderly population.
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