Shoulder replacement in younger patients

[mtomaino]

This week I saw a 48 yo patient who had undergone a Bristow procedure for recurrent shoulder instability 25 years ago. He has been dealing with shoulder pain for years, and finally decided to have it checked out. Although his motion is still functional, almost any kind of activity is accompanied by pain. I shared with him that his "story" is not at all unusual, and that I have indeed seen patients like him before who, over the years, have developed arthritis t the glenohumeral joint. I have attached xray pics before and after resurfacing arthroplasty in a 53 yo patient who had undergone the same "Bristow" procedure several years ago.

The patient I saw this week is not yet at the point where we need to proceed with a replacement; however, he may get some relief from removal of his screw, as it seems to be penetrating the joint.

An October 2010 article in the Journal of Bone and Joint Surgery addresses the issue of replacement in younger patients and acknowledges that the etiology of the arthritis in patients less than 50 is often post traumatic arthritis or chondrolysis, which can potentially be associated with an increased risk of complications.

The patient whose xrays I have attached is now 1 year out and is back weight lifting without pain. We elected a resurfacing arthroplasty because of his interest in going back to this type of activity. You can see the article I mention above if you click on the Shoulder page of this website and see the article re Arthroplasty in younger patients. This can be found under the Popular shoulder topics section entitled Anatomic Shoulder Arthroplasty Options for Arthritis.

[mtomaino]

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) on the shoulder page of this web site.
Visit this link:
http://www.rearmyourself.com/article/Shoulder-Replacement-in%20Younger-Patients

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. As this information becomes available, I will share it.