Outcomes of reverse total shoulder arthroplasty in patients aged under 60 vs. over 60 years

Background

Each year, the incidence of reverse total shoulder arthroplasty (RSA) rises. Although RSA yields positive outcomes in older patients, such as improved range of motion (ROM) and reduced pain with rare occurrences of revision surgery, its application in patients under 60 years of age introduces distinct challenges. As RSA becomes increasingly common in younger patients, it is essential to compare outcomes to an older cohort to balance the advantages of early intervention against potential complications and the long-term durability of implants.

Methods

A retrospective analysis was conducted on a total of 220 patients who underwent primary RSA with a minimum of 2 years of clinical follow-up. The procedures were performed by 7 surgeons at a single institution. These patients were divided into 2 groups: under and over 60 years of age. Demographic and baseline variables were extracted from electronic medical records. Preoperative and postoperative outcomes of ROM and strength were recorded. Patient-reported outcomes were obtained via phone call.

Results

The under-60 group included 50 patients (mean age 56.9 ± 4.6 years) with a mean follow-up of 4.9 ± 2.7 years. The over-60 group included 170 patients (mean age 71.2 ± 6.0 years) with a mean follow-up of 4.5 ± 2.1 years. When compared, the under-60 group had significantly higher postoperative external rotation ROM (<60: 44° ± 25° vs. >60: 39^° ± 12^°, P = .048) and internal rotation ROM (<60: sacrum vs. >60: L5, P = .035). Of the 50 patients in the under-60 cohort, 6 had complications (12.0%), all resulting in revision at an average of 1.7 years after primary RSA. In the over-60 group, 11 patients had 11 complications (6.5%), with 6 undergoing revision surgery. The under-60 cohort had a significantly lower implant survival rate, with a rate of 94.0% at 2 years, 85.9% at 5 years, and 85.8% at 10 years compared with 97.6% at 2 years, 96.7% at 5 years, and 94.9% at 10 years in the over-60 cohort (P = .021).

Conclusion

RSA is safe and effective for patients who are 60 years and younger compared with older patients, although the complication rate is nearly 2 times higher in the younger cohort. An early intervention yields important considerations: younger individuals often have heightened postoperative expectations due to increased demand for arm usage. As the trend toward increasing use of RSA continues, we emphasize the importance of careful patient selection to ensure optimal outcomes.