Results of Anatomic Total Shoulder Arthroplasty with the Arthrex Eclipse Stemless Humeral Implant in Patients Over 70.

Abstract

Background: Anatomic total shoulder arthroplasty (aTSA) is a well described technique for addressing glenohumeral osteoarthritis. Little has been written on outcomes for newer stemless humeral implants in older patients, with none looking specifically at an implant relying on screw fixation. The purpose of this study is to evaluate the clinical and radiographic outcomes for patients over 70 years of age undergoing aTSA with the Eclipse (Arthrex Inc., Naples, FL, USA) stemless humeral component.

Methods: A retrospective review utilizing a multicenter shoulder arthroplasty registry was performed evaluating all patients over 70 who underwent aTSA with a stemless humeral implant for a diagnosis of glenohumeral osteoarthritis and had a minimum follow-up of 2 years. Thirty-seven patients met the study criteria and were matched for comparative analysis to 37 patients 65 years of age and younger. Outcome scores were obtained preoperatively and at 2 years postoperatively using the VAS (Visual Analog Scale), Constant-Murley, American Shoulder and Elbow Surgeons (ASES) and Western Ontario Osteoarthritis Index (WOOS) scores. The percentage of patients in each group who exceeded the MCID for the ASES and WOOS was reported. When available, postoperative radiographs were evaluated for the presence of radiolucent lines and calcar resorption.

Results: There was a statistically significantly higher preoperative WOOS score in the older patient group, otherwise there was not statistical difference between the two groups in regards to baseline scores or range of motion. At two-year follow-up, older patients were noted to have significantly better VAS, ASES, WOOS, and Constant-Murley scores when compared to younger patients (p < .05). All patients over the age of 70 achieved MCID for the ASES compared to 84% of those 65 and younger (p=0.011), while for the WOOS 100% of older patients achieved MCID compared to 86% of those in the control group (p=0.022). Postoperative range of motion was not significantly different between the two groups, although older patients had better active internal rotation at 90 degrees of abduction (p=.002). Partial calcar resorption was noted in one patient in each age group. Radiolucent lines were noted in two patients over the age of 70 and one patient in under 65.

Discussion: Patients over the age of 70 with glenohumeral osteoarthritis undergoing aTSA with a stemless humeral component have equivalent, if not better, outcomes when compared to younger patients. Age alone does not appear a limitation for stemless aTSA.