Selman Farah, Moreira Brett, Perry Nicholas P J, Kriechling Philipp, Gressl Maximilian, Wieser Karl
Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
Orthopaedic Department, University Hospital Geelong, Geelong, Victoria, Australia.
JSES Int. 2025 Feb 6;9(3):815-822. doi: 10.1016/j.jseint.2025.01.006. eCollection 2025 May.
Previous studies have found varied outcomes for elderly patients following reverse total shoulder arthroplasty (rTSA). Results for very old patients are rare. The purpose of this study was to analyze functional and radiographic outcomes after rTSA in patients aged 85 years and older and to compare them to a younger population.
Of 1460 patients treated with rTSA from 2005 to 2020, 5% (n = 74) were ≥85 years. 32 patients were excluded due to travel difficulties, death, refuse to participate and lost to follow-up. 42 patients with a minimum follow-up of 2 years were included and matched for sex, body mass index, American Society of Anesthesiologists Score, surgical indication, smoking, alcohol consume, and follow-up time to a younger population with a mean age of 69.5 ± 9 years. Statistical analysis was performed based on preoperative and postoperative range of motion (ROM), pain scores and patient satisfaction. Postoperative X-rays were evaluated for notching, radiolucency, bone formation and resorption, implant migration and periprosthetic fractures.
42 cases with a mean age of 87 ± 2 years were included, 71% female. Indications for rTSA were rotator cuff (RC) tear with arthritis (36%), RC arthropathy (17%), RC tear without arthritis (17%), primary arthritis (17%), proximal humeral fracture (10%), failed osteosynthesis (7%), and instability (2%). Mean follow-up was 47 ± 22 months. Except for age, there were no significant differences in the matching cohort. In the elderly cohort, relative Constant-Murley Score (CMS) improved postoperative significantly from 41 ± 20 to 83 ± 11 and subjective shoulder value from 38 ± 20 to 80 ± 19. All aspects of ROM, except for external rotation, improved significantly. Abduction force and pain improved as well. Radiolucency around the glenoid (21%), bone formation (4.9%) and implant migration (4.9%) were significantly associated with poorer outcome in the absolute CMS ( = .013, = .002 and = .008). One patient (1/42, 2.4%) suffered multiple shoulder dislocations and needed a revision. No other reoperations were performed. Comparison between patients over 85 years and the younger matched control group showed no significant differences in relative CMS, subjective shoulder value, and ROM at final follow-up.
Patients aged 85 years and older can expect significant improvement in shoulder function and significant reduction of pain after rTSA. Overall clinical outcome is comparable to a younger population. Complication and revision rates are low. Age should not be a limiting factor when considering rTSA.
既往研究发现，老年患者接受反式全肩关节置换术（rTSA）后的结果各不相同。关于高龄患者的结果报道较少。本研究的目的是分析85岁及以上患者接受rTSA后的功能和影像学结果，并与年轻人群进行比较。
在2005年至2020年接受rTSA治疗的1460例患者中，5%（n = 74）年龄≥85岁。32例患者因出行困难、死亡、拒绝参与和失访而被排除。纳入42例至少随访2年的患者，并在性别、体重指数、美国麻醉医师协会评分、手术指征、吸烟、饮酒和随访时间方面与平均年龄为69.5±9岁的年轻人群进行匹配。基于术前和术后的活动范围（ROM）、疼痛评分和患者满意度进行统计分析。对术后X线片进行评估，观察有无切迹、透亮区、骨形成和吸收、植入物移位及假体周围骨折。
纳入42例平均年龄为87±2岁的患者，71%为女性。rTSA的指征包括伴有关节炎的肩袖（RC）撕裂（36%）、RC关节病（17%）、无关节炎的RC撕裂（17%）、原发性关节炎（17%）、肱骨近端骨折（10%）、骨合成失败（7%）和不稳定（2%）。平均随访时间为47±22个月。除年龄外，匹配队列中无显著差异。在老年队列中，相对Constant-Murley评分（CMS）术后显著从41±20提高到83±11，主观肩关节评价值从38±20提高到80±19。ROM的所有方面，除了外旋，均有显著改善。外展力和疼痛也有所改善。肩胛盂周围透亮区（21%）、骨形成（4.9%）和植入物移位（4.9%）与绝对CMS较差的结果显著相关（P = .013、P = .002和P = .008）。1例患者（1/42，2.4%）发生多次肩关节脱位，需要翻修。未进行其他再次手术。85岁以上患者与年轻匹配对照组在最终随访时的相对CMS、主观肩关节评价值和ROM方面无显著差异。
85岁及以上患者接受rTSA后，肩关节功能有望显著改善，疼痛显著减轻。总体临床结果与年轻人群相当。并发症和翻修率较低。在考虑rTSA时，年龄不应成为限制因素。
