Anatomic Total Shoulder Arthroplasty Indications, Outcomes, and Survivorship in Patients Younger Than 50 Years of Age: A Systematic Review.

Abstract

Although prior studies have raised concern regarding the longevity of anatomic total shoulder arthroplasty (aTSA) in young and active patients, it remains an effective treatment option for this population commonly presenting with multifactorial etiologies of shoulder arthritis. The purpose of this study was to perform a systematic review evaluating aTSA indications, outcomes, and implant survivorship in young and active patients aged 50 years or less. A systematic review of the literature from 1980-2024 evaluating outcomes following aTSA in patients less than 50 years of age was preformed according to the PRISMA guidelines. Patient demographics, indications for aTSA, and number of prior shoulder surgeries was recorded when available. Outcomes included implant survivorship, revision and complication rates, indications for revision, pre- and postoperative range of motion (ROM), as well as patient reported outcomes scores. The literature search identified 814 articles and 9 studies met final inclusion criteria following full-text review. A total of 173 patients (184 shoulders) were assessed across the included studies, and mean age ranged from 33.3 to 44.2 years old. Average duration of clinical and radiographic follow-up ranged from 2.3 to 22.0 years. The most common indications for aTSA were glenohumeral osteoarthritis (OA)(37.5%) and rheumatoid arthritis (RA)(35.8%), followed by post-traumatic arthritis (8.5%), chondrolysis (7.4%), avascular necrosis (6.3%), and other (4.5%). Revision rate ranged from 3.8% (1/26 at 2.3yrs) to 41.2% (7/17 at 14.5yrs). Implant survivorship ranged from 80-100%, 95 to 100% at 0-10yrs, 71% to 84% at 11-15yrs, and 61% to 64% at > 15yrs. The most commonly reported outcomes scores were the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and the Visual Analogue Scale (VAS) for pain. Forward flexion (FF) increased by a mean 32° (range, 12° to 51°), abduction (ABD) increased by 41° (range, 26° to 64°), and external rotation (ER) increased by 22° (range, 14° to 26°) at final follow-up. In young patients under the age of 50 years-old, aTSA is a reliable option for restoring shoulder function and ROM with low revision rates and high implant survivorship at short- to mid-term follow-up. The most common indications for aTSA were glenohumeral OA and RA. Compared to older patients, those under 50 may expect moderately inferior functional outcomes and long-term component survivorship secondary to increased activity demands and more complex underlying medical causes of their arthritis.