Is it worth the risk? Clinical and radiographic outcomes 24 months after reverse shoulder arthroplasty in an advanced geriatric population.

BACKGROUND

The application of reverse shoulder arthroplasty (RSA) has risen in the past decades especially due to its excellent long-term outcomes. With this positive trend, the indications for RSA have gradually extended to a broader age spectrum. The objective of this study was to identify the benefits of primary RSA in an advanced geriatric population with considerable comorbidity burden and higher perioperative risk.

METHODS

For this observational study using data collected from our local RSA register, we identified 73 patients (77% female) with a minimum age of 85 years (range: 85-93 years) at the time of surgery and a complete 24-month postoperative follow-up. Clinical evaluations of pain, Subjective Shoulder Value, Constant score, Shoulder Pain and Disability Index, quality of life (European Quality-of-Life 5-Dimension 5-Level utility), and patient satisfaction were made. Radiographic evaluation followed an international consensus core set. Adverse events were documented according to a core event set.

RESULTS

Preexisting medical conditions categorized following the American Society of Anesthesiologists physical status classification system indicated only 22% of patients with mild comorbidities (American Society of Anesthesiologists I-II), whereas severe (American Society of Anesthesiologists III-IV) comorbidities were common (78%). Indications for surgery were rotator cuff deficiency (72%), post-traumatic conditions (18%), and primary arthrosis (10%). There was significant improvement in all clinical evaluations up to 24 months post RSA: mean pain levels decreased from 6.2 to 1.6 points, where 0 indicates no pain ( < .001) and Subjective Shoulder Value, Constant score, Shoulder Pain and Disability Index, and European Quality of Life 5 Dimensions 5 Level increased from 36% to 76%, 26 to 61 points, 29 to 74 points, and 0.58 to 0.79, respectively ( < .001). Most patients (88%) opted in favor of undergoing the same surgery again based on their personal outcome. There were no signs of early loosening, migration or dislocation at 24 months postsurgery. However, 6 periprosthetic fractures were identified, 5 of which were treated conservatively. Adverse events were reported for 39% of patients, yet rarely led to the need for revision surgery (1.8%) or hospital readmission (3.6%).

CONCLUSION

Despite an advanced age over 85 years and numerous associated comorbidities, our geriatric population showed a distinct clinical improvement in their daily activities with high rates of patient satisfaction. Radiographic analysis at 24 months after surgery identified adequate implant stability. RSA is a safe procedure, even in these elderly patients, with an acceptable risk of unfavorable medical and surgical events.