title: Shoulder arthroplasty in patients 59 years of age and younger.
abstract: BACKGROUND
  While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients.
  
  
  METHODS
  This is a retrospective cohort study of shoulder arthroplasties performed within a statewide integrated healthcare system between 2005 and 2010. Patients were stratified into 2 groups based on age at time of index replacement procedure: younger patients (≤59 years) and older patients (>59 years).
  
  
  RESULTS
  There were 2981 primary arthroplasties followed for a median time of 2.2 years (interquartile range, 1.0-3.8), 90 (3.0%) of which required revisions. After adjusting for procedure type and diagnosis, younger patients had a two times higher risk (95% CI 1.2-3.5, P = .007) of revision than older patients. When looking at the risk of revision in younger and older patients separately, the risk of revision in hemiarthroplasty (RR = 4.5 vs RR = 1.7) and reverse total shoulder arthroplasty (RR = 33.6 vs RR = 3.0) compared to total shoulder arthroplasty were higher in younger patients compared to older patients.
  
  
  CONCLUSIONS
  This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. The higher risk of revision in younger patients receiving hemiarthroplasty may support the use of total shoulder arthroplasty in patients 59 years of age and younger.
authors.affiliation: The Permanente Medical Group, Sacramento, CA, USA. Electronic address: Mark.T.Dillon@kp.org.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dillon
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
authors.forename: Mary F
authors.initials: MF
authors.lastname: Burke
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Navarro
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yian
mesh_terms: D000367:Age Factors; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Level III; Retrospective Cohort Design; Shoulder arthroplasty; Treatment Study; glenoid loosening; hemiarthroplasty