Anatomic total shoulder arthroplasty in the 7th decade of life demonstrates superior long-term maintenance than in older patients

Background: Anatomic total shoulder arthroplasty (aTSA) is often delayed due to concerns about a more rapid loss of postoperative improvements in younger, more active patients. This retrospective study investigated the effects of patient age on activity-specific functional outcomes at a minimum of 10 years following aTSA. Methods: A retrospective review of a shoulder arthroplasty database was performed. There were two cohorts: Patients who underwent aTSA at 60–70 years of age and patients 70+ years old with Minimum 10 years follow-up. Primary outcomes included range of motion (ROM) and patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) scores. Furthermore, individual survey responses to the ASES Score questionnaire were analyzed. Results: 46 shoulders, 30 shoulders in the 60–70 age cohort and 16 in the 70+ cohort, were included with a mean age of 65.5 ± 3.0 years and 74.2 ± 3.2 years, respectively. Interval from surgery was 15.6 ± 3.9 years in the 60–70 cohort, and 13.1 ± 3.2 years in the 70+ cohort. Postoperatively, scores for the 60–70 cohort versus 70+ respectively included: 141.7° versus 153.1° forward elevation (p = 0.12), 52.4° versus 51.3° external rotation (p = 0.82), L1 versus T11 internal rotation (p = 0.12), 2.1 versus 2.1 VAS (p = 0.94), 75.7 versus 73.8 ASES (p = 0.79), and 7.8 versus 8.8 SST (p = 0.35). Postoperative scores were similar between cohorts. No difference was seen in preoperative responses for any activity listed in the ASES-score questionnaire. However, younger patients showed improvement across all survey responses, while patients above age 70 had long-term improvement in only 5 of 10 activities. Conclusion: Patients who receive surgery earlier may experience sustained improvement long-term, same as those who undergo aTSA at an older age. Patients undergoing aTSA earlier in life benefit from sustained long-term function and activity. Level of evidence: 3.