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Scientific Articles   |    
Early Follow-up of Reverse Total Shoulder Arthroplasty in Patients Sixty Years of Age or Younger
Stephanie J. Muh, MD1; Jonathan J. Streit, MD1; John Paul Wanner, BS2; Christopher J. Lenarz, MD1; Yousef Shishani, MD2; Douglas Y. Rowland, PhD1; Clay Riley, MD3; Robert J. Nowinski, DO4; T. Bradley Edwards, MD3; Reuben Gobezie, MD2
1 Case Shoulder and Elbow Service (S.J.M. and C.J.L.), and the Departments of Orthopaedics (J.J.S.) and Epidemiology & Biostatistics (D.Y.R.), Case Western Reserve University School of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106
2 Cleveland Shoulder Institute, University Hospitals of Cleveland, 5885 Landerbrook Drive, Suite 150, Mayfield Heights, OH 44124.
3 Fondren Orthopedic Group, 7401 South Main Street, Houston, TX 77030
4 OrthoNeuro, 5040 Forest Drive, Suite 300, New Albany, Ohio 43054
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  • Disclosure statement for author(s): PDF

Investigation performed at University Hospitals of Cleveland, Mayfield Heights, Ohio, Fondren Orthopaedic Group, Houston, Texas, and OrthoNeuro, New Albany, Ohio



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1877-1883. doi: 10.2106/JBJS.L.10005
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Abstract

Update 

The print version of this article has an error that has been corrected. The doi number for the paper, which was given as “doi:10.2106/JBJS.L.00005,” has been corrected and is now given as “doi:10.2106/JBJS.L.10005.”

Background: 

Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of shoulder arthritis and rotator cuff deficiency. Concerns over the longevity of the prosthesis have resulted in this procedure being reserved for the elderly. There are limited data in the literature with regard to outcomes in younger patients. We report on the early outcomes of RSA in a group of patients who were sixty years or younger and who were followed for a minimum of two years.

Methods: 

A retrospective multicenter review of sixty-six patients (sixty-seven RSAs) with a mean age of 52.2 years was performed. The indications included rotator cuff insufficiency (twenty-nine), massive rotator cuff disorder with osteoarthritis (eleven), failed primary shoulder arthroplasty (nine), rheumatoid arthritis (six), posttraumatic arthritis (four), and other diagnoses (eight). Forty-five shoulders (67%) had at least one prior surgical intervention, and thirty-one shoulders (46%) had multiple prior surgical procedures.

Results: 

At a mean follow-up time of 36.5 months, mean active forward elevation of the arm as measured at the shoulder improved from 54.6° to 134.0° and average active external rotation improved from 10.0° to 19.6°. A total of 81% of patients were either very satisfied or satisfied. The mean American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) score for pain improved from 40.0 to 72.4 and 7.5 to 3.0, respectively. The ability to achieve postoperative forward arm elevation of at least 100° was the only significant predictor of overall patient satisfaction (p < 0.05) that was identified in this group. There was a 15% complication rate postoperatively, and twenty-nine shoulders (43%) had evidence of scapular notching at the time of the latest follow-up.

Conclusions: 

RSA as a reconstructive procedure improved function at the time of short-term follow-up in our young patients with glenohumeral arthritis and rotator cuff deficiency. Objective outcomes in our patient cohort were similar to those in previously reported studies. However, overall satisfaction was much lower in this patient population (81%) compared with that in the older patient population as reported in the literature (90% to 96%).

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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