Reverse Total Shoulder Arthroplasty in Patients Who Exceeded Their Life-Expectancy: A Retrospective Study

Abstract

Background: Reverse total shoulder arthroplasty (RTSA) has become an established treatment for cuff arthropathy, severe osteoarthritis and in certain fracture cases. Due to the increasingly aging population, patients who have already exceeded their life-expectancy pose a significant challenge to the shoulder surgeon. Methods: Patients older than 83 years who received a RTSA were included. Elective cases were compared to fracture cases. Patient demographics, hospital stay length, complication rate, functional outcome, patient reported outcome scores and mortality were assessed retrospectively. Results: We included 110 cases, 48 in the elective group and 62 in the fracture group. The average age at time of surgery was 86.6 ± 3.5 years. Mean follow-up was 30 months. Elective cases had a significant shorter hospital stay length (P =.014). Functional outcome scores showed better results for the elective group with ASES 79 ± 12 vs 69 ± 19 (P =.07), QuickDASH 29 ± 16 vs 37 ± 21 (P =.22), subjective shoulder value 86 ± 14 vs 75 ± 19 (P =.04*) and VAS.7 ± 1.5 vs 2.1 ± 2.5 (P =.02*). There was no significant difference in ROM and mean quality-adjusted-life-years (QALY) with 3.2 ± 1.8 vs 3.5 ± 2.5 years (P =.69). The complication rate requiring surgical intervention was 2.4% in the elective and 6.5% in the fracture group. The 1-year mortality was 3 (6%) respectively 9 (15%). Conclusion: RTSA in elderly patients can be successful with good functional outcomes. Age should not be a contraindication. Instead, the patient’s activity level and quality of life should be taken into account. Elective RTSA show better functional outcome scores and lower complication rates compared to RTSA in proximal humeral fractures.