title: Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review.
abstract: BACKGROUND
  Despite concerns about the longevity of total shoulder arthroplasty (TSA) in young patients, it remains an attractive option because of the absence of superior options.
  
  
  METHODS
  A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. English-language studies were identified with search terms "total shoulder arthroplasty" (title/abstract) or "shoulder replacement" (title/abstract) and "young" (title/abstract) or "under 65 years of age" (title/abstract). Duplicate studies, studies not reporting outcomes, and those using a humeral resurfacing technique were excluded. Outcomes of interest included pain, range of motion, patient-reported outcome scores, patient satisfaction, radiographic changes, complication and revision rates, and implant survival.
  
  
  RESULTS
  Six studies met inclusion criteria. Significant improvements in pain, range of motion, and patient-reported outcomes were found across all studies that reported these measures. At an average of 9.4 years, 17.4% underwent revision and 54% had glenoid lucency. Whereas glenoid loosening is the most common reason for revision (52%), overall implant survivorship was reported at 60% to 80% at 10- to 20-year follow-up. Outcome measures including the Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores were reported, with generally satisfactory but not excellent results between 3 and 10 years from surgery.
  
  
  CONCLUSIONS
  Although there is concern with periprosthetic radiolucency and glenoid loosening in the young patient (<65 years) undergoing TSA, overall low revision rates and high implant survivorship are reported in the current literature. Whereas the patient-reported outcomes are inferior to those of the overall TSA population, there is significant improvement from baseline levels in young patients with glenohumeral arthritis.
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Troy A
authors.initials: TA
authors.lastname: Roberson
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Jared C
authors.initials: JC
authors.lastname: Bentley
authors.affiliation: University of South Carolina School of Medicine, Greenville, SC, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Griscom
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kissenberth
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Tolan
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hawkins
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA. Electronic address: jtokish@ghs.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Tokish
mesh_terms: D000293:Adolescent; D000328:Adult; D001168:Arthritis / Q000150:complications / Q000601:surgery*; D000072228:Arthroplasty, Replacement, Shoulder; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Total shoulder arthroplasty; implant survivorship; outcomes; pain; range of motion; younger patients