The role age plays in the outcomes and complications of shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery Vol. 26; no. 9; pp. 1573 - 1580
• Main Authors: Wagner, Eric R., MD, Houdek, Matthew T., MD, Schleck, Cathy, BS, Harmsen, William S., MS, Sánchez-Sotelo, Joaquin, MD, PhD, Cofield, Robert, MD, Elhassan, Bassem T., MD, Sperling, John W., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; arthroplasty; Arthroplasty, Replacement, Shoulder - adverse effects; complications; Female; Humans; Male; Middle Aged; old; Orthopedics; Proportional Hazards Models; Prosthesis Failure; Reoperation - statistics & numerical data; shoulder; Shoulder Joint - surgery; Shoulder Prosthesis - adverse effects; Thromboembolism - etiology; Time Factors; Treatment Outcome; young; Young Adult; Treatment Study; Level IV; complications; young; Case Series; arthroplasty; old; shoulder; Age
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2017.01.020

Background This investigation used age as a continuous variable to estimate implant survival and the risk of complications. Methods Prospectively collected data were used to analyze 5494 consecutive shoulder arthroplasties performed from 1970 to 2012. Patients were a mean age of 67 years. The association between the age at the index procedure and the risk for each outcome was assessed using Cox regression and smoothing spline analysis. Results Older age was associated with a decreased risk of revision surgery, revision for mechanical failure, and reoperation but with a higher risk for thromboembolic events. Reoperation rates also decreased in a linear fashion with older ages ( P  < . 001). The risk of revision surgery decreased in a linear fashion between the ages of 40 and 85, with a 3% decreased risk of revision per 1-year increase in age ( P  < . 01). This association held true in a multivariate model and when specific procedures were separated out. Compared with patients aged <50 years, patients aged from 50 to 65 years ( P  < . 001) and those >65 years ( P  < . 001) have decreased risks of revision surgery. The risk of a revision surgery in a patient aged >50 years was significantly decreased (~13% reduction in risk for each year; P  < . 001). There was a subtle association between older age and decreased rates of infection ( P  = .01). Conclusions There is a strong association between older age and decreased rates of revision surgery and reoperation after shoulder arthroplasty, with a striking association with decreased rates of mechanical failure. These are important considerations when counseling younger patients regarding their risks.