Revision after anatomical total shoulder arthroplasty : the influence of age on outcomes in a large nationwide registry study.

Abstract

Primary anatomical total shoulder arthroplasty (aTSA) is generally the preferred treatment for active young patients with increased functional demands who need a shoulder arthroplasty. There is little information, however, about the survival of this implant in patients aged < 65 years. The aim of this study was to investigate the differences in revision rates after primary aTSA in patients aged < 65 years compared with those aged ≥ 65 years, within ten years, hypothesizing that younger patients would have higher revision rates due to increased functional demands and activity levels. Data on 3,622 primary aTSAs performed between January 2014 and January 2024 were extracted from the Dutch Arthroplasty Register. A total of 1,486 were performed in patients aged < 65 years, and 2,136 in those aged ≥ 65 years. Kaplan-Meier survival and multivariate Cox regression analyses were performed. Within ten years of follow-up, 159 revisions (4%) were required. Significantly more revisions were performed in the younger group (89 (6%)) than in the older group (70 (3%); p < 0.001). The cumulative revision percentages were 11% (95% CI 8 to 14) and 6% (95% CI 4 to 7; p < 0.001), respectively. The most common indications for revision in both groups were cuff rupture, instability, and loosening of the glenoid component. In patients aged ≥ 65 years, both revisions for periprosthetic fracture (8 (11%) vs 2 (2%); p = 0.023) and total revisions were undertaken significantly more often (49 (71%) vs 49 (56%); p = 0.029). In the multivariate Cox regression model, age < 65 years was not associated with worse implant survival (hazard ratio (HR) 1.4 (95% CI 1.0 to 1.9); p = 0.069). Previous surgery on the affected shoulder was associated with significantly worse implant survival in all patients (HR 1.9 (95% CI 1.3 to 2.8); p = 0.002). Patients aged < 65 years had significantly higher revision rates after aTSA, but this was primarily explained by an increased prevalence of previous surgery to the shoulder. After adjustment, age itself was not associated with implant survival.