What is the outcome of reverse shoulder arthroplasty (RSA) in young patients with severe shoulder joint damage?

Outcomes of Reverse Shoulder Arthroplasty in Young Patients

Reverse shoulder arthroplasty (RSA) in young patients with severe shoulder joint damage provides reliable clinical improvements with high implant retention rates, though patients should be counseled about the higher complication rate of up to 17% compared to other shoulder procedures. 1

Indications and Considerations for RSA in Young Patients

• RSA was originally designed for older adults with rotator cuff deficiency but has expanded to younger populations with severe shoulder pathology 2
• Primary indications in younger patients include:
  • Cuff tear arthropathy (CTA) and massive irreparable rotator cuff tears (72% of primary cases) 1
  • Failed previous shoulder arthroplasty (21% of cases) 1
  • Severe glenohumeral arthritis with rotator cuff deficiency 3
  • Fracture sequelae and instability sequelae 4

Clinical Outcomes in Young Patients

Functional Improvements

• Significant improvements in range of motion:
  • Forward elevation increases from 50-57° preoperatively to 105-132° postoperatively 3, 5
  • External rotation improves from 10-20° to 26-39° 3, 5
• Substantial pain relief with visual analog scale (VAS) pain scores decreasing from 6.0-6.1 to 0.6-2.1 6, 4
• Improved functional scores:
  • American Shoulder and Elbow Surgeons (ASES) scores improve from 24-31 to 41-78 points 6, 5, 4
  • Simple Shoulder Test (SST) scores improve from 1.3-1.4 to 3.2-7.0 6, 5

Implant Survival and Complications

• High implant retention rates:
  • 91% implant retention at up to 12 years follow-up 5
  • 2-year and 5-year revision-free survival of 99% and 91%, respectively 3
• Overall complication rate of 17% (range 7%-38%) 1:
  • Most common complications include instability (5%) and infection (4%) 1
  • Scapular notching occurs in approximately 18% of cases 3
  • Dislocation rate of approximately 3% 3
• Reoperation rate of 10-13% at midterm follow-up 1, 5
• Risk factors for complications:
  • Smoking significantly increases risk for revision, reoperation, and complications (P < .03) 3
  • Revision cases have higher complication rates but lower reoperation rates compared to primary RSA 5

Comparative Outcomes Between Age Groups

• Young patients (<65 years) show similar improvements in pain and function compared to older populations 6
• Patients undergoing revision RSA typically begin with worse function than primary RSA patients but can expect similar degrees of improvement 5
• No mechanical failures have been reported in primary RSA in younger patients, with infection being the cause of all revisions in one study 5

Patient Satisfaction and Quality of Life

• 90% of patients under 65 years report satisfaction with their results 3
• 85% of patients feel they are "better" or "much better" than before surgery 3
• Success rates of 75% at 2.8 years have been reported in complex cases under age 60 4

Pitfalls and Considerations

• RSA should be considered a "limited-goals procedure" in young patients, with longer-term studies needed to determine durability 4
• Patients should be counseled about the risk of mechanical complications and potential need for revision surgery 1, 3
• Careful patient selection is crucial, as those with previous surgeries (average 2.5 procedures per patient in one study) may have more complex presentations 4
• The American Academy of Orthopaedic Surgeons notes concerns about performing shoulder arthroplasty in patients <50 years due to potential risks of increased prosthetic loosening and decreased survivorship 2

Conclusion for Clinical Practice

• RSA provides reliable pain relief and functional improvement in young patients with severe shoulder pathology 1, 3, 5
• Despite higher complication rates compared to other shoulder procedures, the benefits in terms of pain relief and improved function make RSA a viable option for carefully selected young patients with severe shoulder joint damage 1, 4
• Patients should be informed about the potential for complications and the possible need for revision surgery in the future 1, 3