title: Primary reverse shoulder arthroplasty in patients aged 65 years or younger.
abstract: BACKGROUND
  Reverse total shoulder arthroplasty (RTSA) has classically been reserved for patients older than 65 years with rotator cuff arthropathy, pseudoparalysis, and severe pain. This investigation assessed outcomes in a consecutive series of patients aged 65 and younger undergoing primary RTSA.
  
  
  METHODS
  There were 63 patients (67 shoulders; 40 women, 27 men) with a mean age of 60 years (range, 50-65 years). Indications were cuff tear arthropathy (CTA) in 51, severe glenohumeral arthritis in 15, and osteonecrosis in 1. The primary end point was revision-free implant survival. Pain scale, motion, strength, and radiographic outcomes were also studied.
  
  
  RESULTS
  At a mean follow-up of 3 years (range, 2-8 years), the 2-year and 5-year revision-free survival was 99% and 91%, and reoperation-free survival was 97% and 90%, respectively. Complications occurred in 9%. Smoking increased the risk for revision, reoperation, and complications (P < .03). Patients experienced improvements in pain (P < .0001), active abduction (57.5° vs. 132.4°, P < .0001), and active external rotation (20.1° vs. 39.4°, P < .001). At the most recent follow-up, 90% patients were satisfied with their result, and 85% felt they were better or much better than before surgery. There was an 18% incidence notching, 3% incidence of dislocation, and no loosening.
  
  
  CONCLUSIONS
  At both 2 and 5 years, RTSA is a reliable operation in patients aged younger than 65 years. Patients gain significant improvements in pain level, range of motion, and strength, without a large number of early failures. Long-term follow-up is needed to understand late component mechanical problems and loosening.
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: samuelsen.brian@mayo.edu.
authors: Brian T
authors: BT
authors: Samuelsen
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Eric R
authors: ER
authors: Wagner
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Matthew T
authors: MT
authors: Houdek
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Bassem T
authors: BT
authors: Elhassan
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Joaquín
authors: J
authors: Sánchez-Sotelo
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Robert
authors: R
authors: Cofield
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: John W
authors: JW
authors: Sperling
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint; D016896:Treatment Outcome
keywords: reverse; shoulder; shoulder arthroplasty; smoking; survival; young patients