2015 ISAKOS Biennial Congress Paper #0

Shoulder Replacement In The Elderly, Anatomic Versus Reverse Total Prothesis? A Prospective 2-Year Follow-Up Study

Maciej Jk Simon, MD, PhD, Kiel GERMANY
Jennifer Coghlan-Bell, Brighton, VIC AUSTRALIA
Simon Bell, fracs, Brighton, Victoria AUSTRALIA
Melbourne Shoulder and Elbow Centre; Monash University, Melbourne, AUSTRALIA

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Mathys, Affinis Short

Summary: This study of older patients (>75 years) demonstrated that an aTSR for a judiciously selected patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than a rTSR.

Abstract:

Purpose

In older patients, with an intact rotator cuff, requiring a total shoulder replacement (TSR) there is, at present, uncertainty whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same age patients aims to assess clinical and radiological outcomes of older patients (> 75 years) who received either an aTSR or a rTSA.

Methods

Consecutive patients with a minimum age of 75 years who received an aTSR (n=44) or rTSR (n=51) were prospectively studied. Pre- and postoperative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with a rTSR.

Results

Postoperative improvement for ROM and all clinical assessment scores for both groups was found. Patient reported outcome scores (PROMs) were significantly better in the aTSR group compared with the rTSR patients (p<0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR patients and acromioclavicular joint pain for both groups.

Conclusions

This study of older patients (>75 years) demonstrated that an aTSR for a judiciously selected patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than a rTSR.