Primary Reverse Total Shoulder Arthroplasty in Patients older than 80 years of age: Clinical and Radiological Outcome Measures.

BACKGROUND: The use of reverse total shoulder arthroplasty (RTSA) spreads worldwide due to an expansion of indications and an aging society. The value of RTSA for very old patients is rarely analyzed. This study was conducted to investigate the outcome of primary RTSA in patients older than 80 years of age.

METHODS: We identified 171 shoulders (159 patients), treated with a RTSA at an age of more than 80 years between January 2005 and March 2018. The primary outcome parameters were Subjective Shoulder Value (SSV) and the Constant-Murley Scores, mortality, complications, and reoperation rates. Secondary outcomes were adverse radiographic outcomes. A minimum follow-up of 1 year was accepted in 14 patients (8%) because of the high patients' age.

RESULTS: We included 171 cases (159 patients; 120 females) with a mean age of 84 +- 3 (80.1 to 94) years. The main indication for RTSA was Cuff Tear Arthropathy (43%), isolated Rotator Cuff Tear (22%) and Fracture (21%). 136 (79%) were eligible for a physical examination with a mean follow-up of 41 +- 25 (12 to 121) months. Relative Constant Scores improved significantly from 39% ± 19% to 77% ± 16% and Subjective Shoulder Value from 31% ± 18% to 74% ± 22%. The range of motion and force improved significantly as well. The surgical site complication rate was 30% with a reoperation rate of 8% (13 patients) mainly due to fracture and glenoid loosening. The overall mortality was 16% with a mean time to death of 53 +- 31 (15; 120) months, thereby no higher than the age-adjusted, expected mortality rate without this procedure.

CONCLUSION: Despite a quite high postoperative complication rate, RTSA is a valid therapeutic option in patients older than 80 years of age, with an unexpectedly low medical complication rate and a good to excellent improvement of shoulder function and pain.