Total Shoulder Arthroplasty in Patients Aged 80 Years and Older: A Systematic Review.

BACKGROUND: Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older.

METHODS: A literature search of Embase, PubMed, Medline, and Cochrane databases was performed according to PRISMA guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis.

RESULTS: A total of 15 studies evaluating 1,685 primary aTSAs, 1,170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. Postoperative active forward flexion and external rotation ranged from 138˚-150˚ and 45˚-48˚ following aTSA and 83˚-139˚ and 16˚-47˚ following RSA, respectively. Postoperative VAS pain scores ranged from 0-1.8 following aTSA and 0-1.4 following RSA. Ninety-day mortality ranged from 0-3% and perioperative complications ranged from 0-32%. Late complications ranged from 5.6-24% for aTSA patients and 3.5-29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0-18%) and rotator cuff tear (5.6-10%) following aTSA and scapular notching (0-40%) and scapular fracture (4-9.4%) following RSA. Reoperation rates ranged from 0-6% following aTSA and 0-13% following RSA.

CONCLUSIONS: aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.