title: Early follow-up of reverse total shoulder arthroplasty in patients sixty years of age or younger.
abstract: BACKGROUND
  Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of shoulder arthritis and rotator cuff deficiency. Concerns over the longevity of the prosthesis have resulted in this procedure being reserved for the elderly. There are limited data in the literature with regard to outcomes in younger patients. We report on the early outcomes of RSA in a group of patients who were sixty years or younger and who were followed for a minimum of two years.
  
  
  METHODS
  A retrospective multicenter review of sixty-six patients (sixty-seven RSAs) with a mean age of 52.2 years was performed. The indications included rotator cuff insufficiency (twenty-nine), massive rotator cuff disorder with osteoarthritis (eleven), failed primary shoulder arthroplasty (nine), rheumatoid arthritis (six), posttraumatic arthritis (four), and other diagnoses (eight). Forty-five shoulders (67%) had at least one prior surgical intervention, and thirty-one shoulders (46%) had multiple prior surgical procedures.
  
  
  RESULTS
  At a mean follow-up time of 36.5 months, mean active forward elevation of the arm as measured at the shoulder improved from 54.6° to 134.0° and average active external rotation improved from 10.0° to 19.6°. A total of 81% of patients were either very satisfied or satisfied. The mean American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) score for pain improved from 40.0 to 72.4 and 7.5 to 3.0, respectively. The ability to achieve postoperative forward arm elevation of at least 100° was the only significant predictor of overall patient satisfaction (p < 0.05) that was identified in this group. There was a 15% complication rate postoperatively, and twenty-nine shoulders (43%) had evidence of scapular notching at the time of the latest follow-up.
  
  
  CONCLUSIONS
  RSA as a reconstructive procedure improved function at the time of short-term follow-up in our young patients with glenohumeral arthritis and rotator cuff deficiency. Objective outcomes in our patient cohort were similar to those in previously reported studies. However, overall satisfaction was much lower in this patient population (81%) compared with that in the older patient population as reported in the literature (90% to 96%).
authors.affiliation: Case Shoulder and Elbow Service (S.J.M. and C.J.L.), and the Departments of Orthopaedics (J.J.S.) and Epidemiology & Biostatistics (D.Y.R.), Case Western Reserve University School of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Muh
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Streit
authors.forename: John Paul
authors.initials: JP
authors.lastname: Wanner
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lenarz
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shishani
authors.forename: Douglas Y
authors.initials: DY
authors.lastname: Rowland
authors.forename: Clay
authors.initials: C
authors.lastname: Riley
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nowinski
authors.forename: T Bradley
authors.initials: TB
authors.lastname: Edwards
authors.forename: Reuben
authors.initials: R
authors.lastname: Gobezie
mesh_terms: D000328:Adult; D001168:Arthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome