Shoulder Replacement Surgery For Elderly

Risks for Patients Under Age 60

What is the average age for a shoulder replacement?

How long does it take to recover from a shoulder replacement?

What is the success rate for shoulder replacement surgery?

Who is a candidate for shoulder replacement surgery?

Shoulder replacement surgery for elderly

Total shoulder replacement for osteoarthritis in patients 80 years of age and older.

This study was performed to review the safety and outcome of total shoulder replacements in patients who are > or = 80 years of age. A total of 50 total shoulder replacements in 44 patients at a mean age of 82 years (80 to 89) were studied. Their health and shoulder status, the operation and post-operative course were analysed, including pain, movement, patient satisfaction, medical and surgical complications, radiographs, the need for revision surgery, and implant and patient survival.

A total of 27 patients had an ASA classification of III or IV and medical abnormalities were common. Of the 13 shoulders with bony deficiency of the glenoid, nine required grafting. The duration of hospital stay was prolonged and blood transfusions were common. There were no peri-operative deaths. The mean follow-up was for 5.5 years (2 to 12). Pain was significantly reduced (p < 0.001) and movement improved in active elevation and both external and internal rotation (p < 0.001)

Using the Neer scale for assessing outcome, 40 (80%) shoulders had an excellent or satisfactory result. There were medical or surgical complications in 17 cases. Four shoulders developed radiological evidence of loosened glenoid components, and three of these had a poor outcome.

Three other shoulders required revision, two for instability. By the time of this review 39 of the patients had died from unrelated causes at a mean of 7.5 years (0.8 to 16.4) after surgery. Total shoulder replacement is a relatively effective treatment in this elderly group of patients. However, there is a requirement for more intense patient care in the peri-operative period, and non-fatal medical or surgical complications are common. Most of these elderly patients will have a comfortable functional shoulder for the rest of their lives.

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Age and Weight Requirements

Advanced age or obesity alone does not rule out shoulder replacement surgery. Experts believe patients aged 85 or older who are in good general health can still have shoulder replacement surgery. Likewise, there is no upper weight limit for those who can have the surgery.

While there are no age and weight limits, advanced age and obesity do tend to increase the risk for post-surgical complications such as infection. If appropriate, a doctor may encourage a patient to lose weight before surgery.

Risks for Patients Under Age 60

Patients under age 60 tend to have a higher rate of revision surgery than older patients It may be that younger patients tend to be more active and therefore are harder on their new shoulders.

Because of the extra post-surgical risk, younger patients are sometimes encouraged to postpone shoulder replacement surgery and consider other less invasive treatment. However, arthroscopic surgery for shoulder arthritis has not been that successful.

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What is the average age for a shoulder replacement?

The typical age group for a shoulder replacement patient is 60-80 years old. I have performed shoulder replacements on patients as old as 88 and as young as the mid-40s.

How long does it take to recover from a shoulder replacement?

Shoulder replacement surgery is a major operation, so you’ll likely experience pain during your recovery. You might be given pain medications by injection right after your procedure.

A day or so following the surgery, your doctor or nurse will give you oral drugs to ease the discomfort.

Rehabilitation is started right away, usually on the day of surgery. Your healthcare staff will have you up and moving as soon as possible.

After a couple of days you’ll be discharged from the hospital. When you leave, your arm will be in a sling, which you’ll wear for about 2 to 4 weeks.

You should be prepared to have less arm function for about a month after surgery. You’ll need to be careful not to lift any objects that are heavier than 1 pound. You should also avoid activities that require pushing or pulling.

In general, most people are able to resume gentle daily living activities within two to six weeks. You might not be able to drive for about six weeks if the surgery was done on your right shoulder for people who drive on the right side of the road, or your left shoulder for those that drive on the left side of the road.

It’s important to perform all home exercises that your healthcare provider recommends. Over time, you will gain strength in your shoulder.

It will take about six months before you can expect to return to more vigorous activities, such as golfing or swimming.

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What is the success rate for shoulder replacement surgery?

Total shoulder replacement is a very successful operation and the 10 year survival rate is up to 90 percent. Many patients end up with extremely functional shoulders and are able to return to the activities of daily living and low impact sports without pain.

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Who is a candidate for shoulder replacement surgery?

You may want to consider surgery if the shoulder joint damage causes significant pain and interferes with daily activities despite treatment.

Your doctor may decide that you are a good candidate for shoulder replacement if:

• Your shoulder joint damage is caused by a medical condition, such as osteoarthritis, rheumatoid arthritis, or osteonecrosis (dead bone caused by poor blood flow to the bone).
• Your shoulder joint damage is caused by an injury or fracture.
• Physical therapy, anti-inflammatory medications, and cortisone injections don’t relieve your pain well enough or improve arm and shoulder movement.
• A previous shoulder replacement surgery failed.

You may not be a good candidate if:

• You can manage your houlder painwith medications and exercise. 
• You have loss or paralysis of both rotator cuff and deltoid muscles.
• You have an active infection.
• You have a progressive disease of the nervous system that has affected the shoulder joint. 

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