Total shoulder arthroplasty deemed safe, effective for patients aged 80 years and older
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Key takeaways:
- Researchers found low rates of perioperative mortality and reoperation after anatomic and reverse TSA for these patients.
- Mortality and complication rates were similar to those of the general population.
Patients aged 80 years and older had low rates of perioperative mortality and reoperation after anatomic and reverse total shoulder arthroplasty, according to results published in the Journal of Shoulder and Elbow Surgery.
Researchers used Embase, PubMed, Medline and Cochrane databases to perform a systematic review of 15 studies that evaluated 1,685 primary TSAs, 1,170 primary RSAs and 45 revision RSAs in patients aged 80 years or older.
Researchers found low rates of 90-day perioperative mortality, ranging from 0% to 3%, and perioperative complication rates that ranged from 0% to 32%. They also found low rates of reoperation, ranging from 0% to 6% after TSA and 0% to 13% after RSA, and “excellent” VAS pain scores, ranging from 0 to 1.8 after TSA and 0 to 1.4 after RSA.
Researchers noted “satisfactory” range of motion outcomes as postoperative active forward flexion ranged from 138 to 150 after TSA and 83 to 139 after RSA, while external rotation ranged from 45to 48 after TSA and 16 to 47 after RSA.
According to the study, common complications included glenoid loosening after rotator cuff tear after TSA and scapular notching and scapular fracture after RSA. Researchers concluded the overall durability of the prosthesis exceeded patient longevity in this cohort.
“Octogenarians were found to demonstrate a higher risk of certain perioperative complications, including blood transfusion and a longer hospital stay,” the researchers wrote in the study. “However, the overall perioperative mortality and surgical complication rate appear to be relatively low and similar to that of the general population, so that, overall, [shoulder arthroplasty] is safe in patients who are 80 years older,” they concluded.
Perspective
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The rate of shoulder replacement has increased steadily in the past 2 decades. One of the many reasons that can be attributed to this increase is a population that is, thankfully, living longer. But with longevity comes new challenges. One challenge, in particular, is how well shoulder replacement works in individuals aged 80 years or older. The article Dennis A. DeBernardis, DO, and colleagues addresses this important concern.
In their manuscript, the authors perform a systematic review gathering 15 different studies. Those studies examined more than 2,500 shoulder replacement procedures performed in individuals 80 years or older. They carefully examined the data looking at how well the shoulders functioned, how much pain was alleviated and how safe the procedures were. Encouragingly, the data analyzed demonstrated good return of shoulder function, meaning the ability to raise and rotate the shoulder. Pain scales after surgery were also reassuring with low scores for both common types of shoulder replacement procedures. Finally, the data demonstrated shoulder replacement to be a safe operation. Thus, overall, this manuscript supports shoulder replacement as a safe and effective option for individuals aged 80 years or older.
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