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Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

  • Symposium: Controversies in Orthopaedics
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older.

Questions/purposes

We asked whether perioperative complications and mortality, transfusion requirements, inpatient length of stay, and discharge disposition after total shoulder arthroplasty were similar in patients 80 years and older compared with those in younger patients.

Methods

We retrospectively compared the 90-day complications, mortality, and other perioperative variables after total shoulder arthroplasty in 40 patients (43 shoulders) aged 80 years and older (Group A; mean age, 82 years) with 46 patients (47 shoulders) younger than 70 years (Group B; mean age, 61 years).

Results

We found no differences in complication rates between Group A and B, including systemic (26% versus 11%) and local (5% versus 9%) complications or major (7% versus 2%) and minor (23% versus 17%) complications. There were no deaths in either group. Group A had an increased transfusion requirement (16% versus 2%) and a decreased number of direct to home discharges (67% versus 98%). Presence of systemic complications predicted increased length of stay in patients overall and in Group A patients.

Conclusions

Total shoulder arthroplasty can be performed in patients 80 years and older with rates of perioperative complications and mortalities comparable to those of younger patients, although these older patients may require a longer period of institutional care before return to home and may be more likely to require a blood transfusion.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Ashish Joshi, MD, MPH, for his contribution to the statistical analysis in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Eric T. Ricchetti MD, Matthew L. Ramsey MD & Gerald R. Williams Jr MD

  2. 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, PA, USA

    Joseph A. Abboud MD

  3. Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Andrew F. Kuntz MD & David L. Glaser MD

Authors
  1. Eric T. Ricchetti MD
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  2. Joseph A. Abboud MD
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  3. Andrew F. Kuntz MD
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  4. Matthew L. Ramsey MD
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  5. David L. Glaser MD
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  6. Gerald R. Williams Jr MD
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Corresponding author

Correspondence to Gerald R. Williams Jr MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Pennsylvania, Philadelphia, PA, USA.

Appendix 1 (Additional description of patient complications)

Appendix 1 (Additional description of patient complications)

All three major local complications were intraoperative fractures that necessitated additional surgical procedures (two in Group A, one in Group B). In Group A, an 80-year-old man undergoing a primary right total shoulder arthroplasty had a greater tuberosity fracture that required suture fixation, whereas another 80-year-old man undergoing a primary right total shoulder arthroplasty had a nondisplaced proximal humeral metaphyseal fracture that required the humeral stem to be converted from uncemented to cemented fixation. In Group B, a 64-year-old woman undergoing a primary right total shoulder arthroplasty had a long, oblique humeral shaft fracture that required cerclage cable fixation and conversion to a long-stem humeral component. The remaining fracture in Group B was in a 59-year-old man who fell 6 weeks after surgery and sustained a nondisplaced humeral shaft fracture distal to the tip of the humeral stem that healed with nonoperative management.

The remaining two local complications in Group B occurred in the same patient, a 52-year-old woman undergoing right total shoulder arthroplasty with removal of a screw from a prior Bristow procedure. She underwent intraoperative nerve monitoring for her procedure because of a history of shoulder surgery and a substantial loss of motion preoperatively. Axillary nerve potentials decreased intraoperatively and did not return to baseline at the conclusion of the case. An electromyogram postoperatively confirmed a persistent axillary nerve injury, but the patient never demonstrated any clinical deficit and no additional treatment was required. She also developed a small, superficial wound infection after surgery that resolved with 1 week of oral antibiotics.

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Ricchetti, E.T., Abboud, J.A., Kuntz, A.F. et al. Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?. Clin Orthop Relat Res 469, 1042–1049 (2011). https://doi.org/10.1007/s11999-010-1582-3

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  • DOI: https://doi.org/10.1007/s11999-010-1582-3

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