Keywords

1. Reverse Shoulder Arthroplasty
2. Glenohumeral Osteoarthritis Treatment
3. Shoulder Surgery Outcomes
4. Reverse Shoulder Arthroplasty Study
5. Aging and Shoulder Arthroplasty

Introduction

A recently published study in the Journal of Shoulder and Elbow Surgery has evaluated the outcomes of reverse shoulder arthroplasty (RSA) in patients suffering from glenohumeral osteoarthritis (GHOA) with an intact rotator cuff across different age groups. The comprehensive analysis suggests that age, particularly the benchmark of 70 years, should not act as a deterrent or deciding factor in the selection of patients for RSA procedures. This is significant, considering the reluctance in the orthopaedic community towards performing the operation on younger, more active patients due to perceived higher functional demands.

The Research

The study titled “Outcomes After Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis in Patients Under and Over 70 Years of Age: A Propensity Score-Matched Analysis” was conducted by a team of researchers led by Efremov Kristian K along with Glass Evan A, Swanson Daniel P, Bowler Adam R, Le Kiet K, Kirsch Jacob M, and Jawa Andrew from the Department of Orthopaedic Surgery at the New England Baptist Hospital, Boston, MA, USA. The study used advanced statistical methods, specifically propensity score matching, to draw comparisons between patients below 70 years of age (U-70) and those over 70 (O-70) regarding their post-operative outcomes after RSA.

Methodology

The research involved a retrospective review leveraging prospectively collected data from an institutional registry. A 1:1 ratio of patients under 70 matched with those over 70 was established based on sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, active forward elevation (FE), Walch classification, and American Society of Anesthesiologists comorbidity score. The data captured included preoperative and a minimum of two years postoperative clinical outcomes measured via Visual Analog Scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE) score, ASES score, and active range of motion including active (FE), internal rotation, and external rotation.

After matching, each cohort contained 66 patients, with similar mean follow-up periods; 28.1±7.5 months for the U-70 group versus 27.4±7.5 months for the O-70 group. Importantly, the mean age for the U-70 cohort was 66.2±3.3, while the O-70 group was 75.3±3.8. Descriptive statistics and univariate analyses were conducted to compare the two cohorts.

Findings

Notably, both age groups demonstrated significant improvement across all measured parameters: VAS for pain, SANE, ASES scores, and active range of motion metrics. The study reveals that younger patients achieved slightly greater postoperative FE compared to their older counterparts (143±16° versus 136±15°; P=.017), but both cohorts showed similar degrees of improvement when comparing baseline to postoperative forward elevation (50±29° for the U-70 cohort versus 43±29° for the O-70 cohort, P=.174).

The Implications

The study’s implications are profound for orthopaedic surgery, especially for those patients under the shadow of apprehension based on age-related concerns. As the research showed no significant differences in clinical outcomes between the younger and older patient groups after RSA, it directly challenges the preconceived notion that patients aged 70 or above might not benefit as much from the procedure.

DOI and References

The study, “Outcomes After Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis in Patients Under and Over 70 Years of Age: A Propensity Score-Matched Analysis,” published in the Journal of Shoulder and Elbow Surgery, can be accessed via the digital object identifier (DOI): 10.1016/j.jse.2023.11.022.

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In conclusion, the research offers a new lens through which the orthopaedic community can evaluate the viability of reverse shoulder arthroplasty. As the demographic shift continues and the populace ages, reassessing treatment strategies to suit older patients is paramount to improving their quality of life. This study confirms that RSA is an effective procedure for patients with glenohumeral osteoarthritis, dispelling the myth that age is a major factor in RSA outcomes. Patients and surgeons alike stand to benefit from these insights, potentially leading to broader RSA adoption across a spectrum of ages. The findings of this study underscore the necessity for individualized patient care, rather than a rigid adherence to age-based criteria, in the decision-making process for shoulder arthroplasty.