How Young is too Young for RTSA? THOMAS (QUIN) THROCKMORTON, MD - - PowerPoint PPT Presentation

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How Young is too Young for RTSA? THOMAS (QUIN) THROCKMORTON, MD - - PowerPoint PPT Presentation

Nov 10, 2022 697 likes •885 views

How Young is too Young for RTSA? THOMAS (QUIN) THROCKMORTON, MD PROFESSOR SHOULDER AND ELBOW SURGERY UNIVERSITY OF TENNESSEE- CAMPBELL CLINIC DEPARTMENT OF ORTHOPAEDIC SURGERY C AMPBELL C LINIC O RTHOPAEDICS I (and/or my co-authors) have

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CAMPBELL CLINIC ORTHOPAEDICS

THOMAS (QUIN) THROCKMORTON, MD PROFESSOR SHOULDER AND ELBOW SURGERY UNIVERSITY OF TENNESSEE- CAMPBELL CLINIC DEPARTMENT OF ORTHOPAEDIC SURGERY

How Young is too Young for RTSA?

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CAMPBELL CLINIC ORTHOPAEDICS CAMPBELL CLINIC ORTHOPAEDICS

I (and/or my co-authors) have something to disclose.

Detailed disclosure information is available via: “My Academy” app; Printed Final Program; or AAOS Orthopaedic Disclosure Program on the AAOS website at http://www.aaos.org/disclosure

My Academy

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CAMPBELL CLINIC ORTHOPAEDICS

Indications

A non-functional rotator cuff

  • Cuff tear arthropathy
  • 3 or 4 part proximal humerus fractures
  • Proximal humerus non-unions
  • Massive rotator cuff tears with

pseudoparalysis

  • Failed cuff repairs
  • Tumor resection
  • Failed shoulder arthroplasty
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CAMPBELL CLINIC ORTHOPAEDICS

Indications

A non-functional rotator cuff

  • Cuff tear arthropathy
  • 3 or 4 part proximal humerus fractures
  • Proximal humerus non-unions
  • Massive rotator cuff tears with

pseudoparalysis

  • Failed cuff repairs
  • Tumor resection
  • Failed shoulder arthroplasty
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CAMPBELL CLINIC ORTHOPAEDICS

Complications

Initially, a reported 50% complication rate and 33% reoperation rate Then 17% complication rate Now 6% Follows experience of other total joint replacements

  • 87% survival at 15 years

Werner CM, JBJS-A, 2005 Frankle MA, JBJS-A, 2006 Cuff D, JBJS-A, 2008 Walch, ASES, 2016

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Population

Literature focuses on ages 55-65 as cutoff for “young” versus “old”

  • Does not account for physiologic age

One consensus statement placed “minimum” age at 65 for RTSA However, demand projections for shoulder arthroplasty predict a significant increase in patients under 55

  • 333% from 2011-2030

Kwaees, Orthop Traumatol Rehabil, 2014 Padegimas, CORR, 2015

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CAMPBELL CLINIC ORTHOPAEDICS

Activity Levels

Conventional thinking suggests younger patients will be…

  • More active
  • Place more stress on components
  • Have earlier mechanical failure

Multiple studies indicate RTSA patients return to medium and high level activity

  • Includes sporting activities
  • None of these studies stratified patients

by age

Lawrence, JSES, 2012 Bulhoff, Arch Orthop Trauma Surg, 2016 Garcia, Am J Sports Med, 2015 Fink-Barnes, Am J Orthop, 2015

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CAMPBELL CLINIC ORTHOPAEDICS

Activity Levels

Patients under 65 reported similar activity levels as older patients after RTSA

  • 47% vs 44% high demand activities
  • 24% vs 37% moderate activities

Younger patients more likely to require narcotics and be disabled

  • Self-regulated their activities to

minimize pain and maximize daily functions

Walters, JSES, 2016

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Outcomes

Multiple studies demonstrate satisfactory outcomes in younger patients

  • Maximum ages vary from 59-65 years
  • Follow up ranges from 2-15 years
  • Improved function, pain, and strength
  • Gains maintained at 10 years in one study

Muh, JBJS, 2013 Samuelsen, JSES, 2016 Sershon, JSES, 2014 Dillon, JSES, 2013 Ek, JSES, 2013

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Outcomes

Inferior patient satisfaction

  • 81% vs 90-96%

75% satisfactory results by ASES score 38% complication rate reported Higher revision rate

  • Relative risk 3.0 vs older patients
  • 25% at average 93 months follow up

Muh, JBJS, 2013 Sershon, JSES, 2014 Dillon, JSES, 2013 Ek, JSES, 2013

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Why?

This is a revision population

  • 67-83% of patients with at least one

prior operation

  • 46% with muliple prior operations
  • Average of 2.5 prior operations

Muh, JBJS, 2013 Sershon, JSES, 2014

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Salvage

Similar outcomes for RTSA after failed prior arthroplasty

  • Improved pain and function
  • VAS 1.4

SSV 60%

  • Worse than age matched patients undergoing

primary RTSA

  • Complication rate 28%

Black, JSES, 2014

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CAMPBELL CLINIC ORTHOPAEDICS

Conclusions

RTSA in younger patients is a viable treatment option

  • More difficult population
  • Higher revision and complication rates
  • Limited goals

Younger patients not necessarily more active after RTSA

  • Due to salvage nature of their condition
  • Self-regulation of activities

Long-term outcomes still in process

  • Mechanical failure still a concern over time
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CAMPBELL CLINIC ORTHOPAEDICS

Conclusions

How young is too young… Combine understanding of…

  • Pathology
  • Physiologic age
  • Activity level
  • Comfort with revision surgery
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CAMPBELL CLINIC ORTHOPAEDICS

Thank You