Complications and implant survivorship following primary reverse total shoulder arthroplasty in patients younger than 65 years: a systematic review

Authors:

Peter J. Millett, MD, MSc, Brandon T. Goldenberg, BA, Brian T. Samuelsen, MD, MBA, James D. Spratt, MD, MS, and Grant J. Dornan, MS

Abstract:

Background

Concerns exist regarding the complication rates and implant survivorship of reverse total shoulder arthroplasty (RTSA) in younger patients.

Methods

A systematic review of the literature regarding the existing evidence on RTSA in patients younger than 65 years was performed using the CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases on June 9, 2019. Articles published between 1995 and 2019 with combinations of the following keywords were identified: “reverse shoulder arthroplasty” and “65,” “60,” and/or “55.” Complications, reoperations, and revisions were recorded. Reoperation-free survival and implant survival rates were grouped at 2, 5, and 10 years. Range of motion and clinical outcomes, along with postoperative radiographic results, were recorded.

Results

Data from 7 studies with a total of 286 shoulders were obtained for quantitative analysis. The mean patient age was 58.4 years (mean age range, 48.9-60.4 years), and the mean follow-up period was 4.7 years (mean follow-up range, 3.0-7.8 years). The overall rate of complications was 18.6%; reoperations, 14.4%; and revisions, 11.2%. The reoperation-free survival rate was 97% at 2 years, 88%-90% at 5 years, and 76% at 10 years. The implant survival rate was 99% at 2 years, 91%-98% at 5 years, and 88% at 10 years. Active abduction, forward elevation, and external rotation significantly improved from preoperatively to postoperatively. All clinical outcome measures significantly improved from preoperatively to postoperatively, with no decline seen over time. The overall rate of infrascapular notching was 22.7% at final follow-up.

Conclusion

RTSA is safe and effective in patients younger than 65 years. Complication, reoperation, and revision rates were similar to those seen in older patient cohorts, without an increase in revisions owing to aseptic loosening. Clinical outcome scores showed significant and lasting improvements.

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Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!