I am often asked "How young is too young?" when it comes to having a total shoulder replacement. Historically, joint replacement was something that we hesitated to do unless patients were either "older" or functionally "low demand". Innovation in design and fixation methods have, however, expanded the feasibility of providing these pain-relieving procedures in higher demand and younger patients. Indeed, the rationale of providing better function and less pain during the "active years" of one's life makes sense.
Today more than ever, Shoulder arthroplasty is an option for most patients. At times a glenoid component may not be required; "Resurfacing" of the humerus alone can provide great pain relief. But, when the glenoid disease is advanced, a satisfactory outcome may require a total replacement. The newest types of glenoid components have a central peg that actually allows bone ingrowth. The value proposition is better long-term fixation, and hopefully lower revision rates with time.
The video attestation below provides an example of the extent of functional restoration and pain relief that can result after a total shoulder replacement in a 57 yo patient whose preoperative diagnosis was osteoarthritis. In cases when patients are even younger than 50 the diagnosis may entail a host of additional challenges--injury to the subscapularis, as in the case of previous instability surgery, for example, or altered bony anatomy of the humerus, in the case of post-traumatic arthritis after fracture.
Though such etiologies may not preclude shoulder replacement, the potential complications may be higher, and the outcomes may be slightly compromised. See the recent Journal article that I have attached.
Today more than ever, Shoulder arthroplasty is an option for most patients. At times a glenoid component may not be required; "Resurfacing" of the humerus alone can provide great pain relief. But, when the glenoid disease is advanced, a satisfactory outcome may require a total replacement. The newest types of glenoid components have a central peg that actually allows bone ingrowth. The value proposition is better long-term fixation, and hopefully lower revision rates with time.
The video attestation below provides an example of the extent of functional restoration and pain relief that can result after a total shoulder replacement in a 57 yo patient whose preoperative diagnosis was osteoarthritis. In cases when patients are even younger than 50 the diagnosis may entail a host of additional challenges--injury to the subscapularis, as in the case of previous instability surgery, for example, or altered bony anatomy of the humerus, in the case of post-traumatic arthritis after fracture.
Though such etiologies may not preclude shoulder replacement, the potential complications may be higher, and the outcomes may be slightly compromised. See the recent Journal article that I have attached.
1 comment
mtomaino 2/27/11 at 10:26 am
I have attached the most recent article on the topic of Shoulder arthroplasty in young patients (patients 55yo or younger) with osteoarthritis (J Shoulder Elbow Surgery Jan 2011).
The purpose of the study was to define results, complications, and frequency of revision surgery in this group. Open the PDF above and read the abstract. In a nutshell, Mayo Clinic's Dr Cofield reports favorable outcome in this group, and acknowleges that pain relief, range of motion, and implant survival were better after Total replacement as compared to Hemiarthroplasty.
This is important information because historically surgeons have been inclined to recommend Hemis in younger patients for fear of glenoid loosening. Dr Cofield's findings actually suggest that a Total is a better option--10 year survival was 92% compared to 72% after a Hemiarthroplasty. Moderate to severe glenoid erosion was present in 6 of 13 Hemiarthroplasties.
At least as of 2011, the evidence seems to support Totals rather than Hemi's even in younger patients. Newer, more anatomic designs and better glenoid fixation have been instrumental in improving outcomes---but longer term follow-up will be important. To the extent that pain relief and range of motion gains are primary indications for shoulder arthroplasty, this Jan 2011 study provides valuable informaton.
An ongoing question regarding activity/lifting restrictions in this patient population exists. Visit this link for an article that was published regarding the subject: http://www.rearmyourself.com/article/anatomic-total-shoulder-replacement