Anatomic and reverse shoulder arthroplasty in patients 70 years of age and older: A comparison cohort at early to mid-term follow up.

Abstract Background Reverse shoulder arthroplasty (RSA) has gained popularity in elderly patients due to its limited reliance on rotator cuff function and high survivorship rates. However, while there are theoretical advantages of RSA over anatomic total shoulder arthroplasty (TSA) in elderly patients, there is little data to guide surgeons on implant selection in this population. Methods Patients were identified from our prospectively collected shoulder arthroplasty registry. We included patients between the age of 50 and 89 years who underwent primary TSA for osteoarthritis with intact rotator cuff or primary RSA for cuff tear arthropathy. The minimum and mean clinical follow-up was 2 and 3.1±1.3 years, respectively. Four patient groups were formed for analysis: [1] TSA aged 50-69 years (n=274), [2] TSA aged 70-89 years (n=208), [3] RSA aged 50-69 years (n=81), and [4] RSA aged 70-89 years (n=104). We evaluated age group differences in pain, Constant score, ASES score, patient satisfaction, complications and revisions. Results All groups showed significant improvements from preoperative to final follow-up for all outcome measures (p .05), however older RSA patients reported better function during activities of daily living (p=.020) than their younger counterparts. Patients undergoing TSA had a lower revision rate of 3.9% compared to 8.1% in the RSA group (p=.043). Conclusions TSA and RSA are reliable procedures for patients older than 70 years of age, and have comparable results to their respective patient cohorts less than 70 years of age. While some surgeons anecdotally advocate for RSA in patients over 70 years old with primary osteoarthritis and an intact rotator cuff, we found no difference in outcomes for TSA based on our age cutoff. Given satisfactory results following TSA in patients 70 years of age and older, we do not routinely perform reverse total shoulder arthroplasty for primary osteoarthritis with an intact rotator cuff solely based on age. Further studies and longer follow-up are needed to determine the optimal implant selection for elderly patients with primary osteoarthritis.