Results of anatomic total shoulder arthroplasty with the Arthrex EclipseTM stemless humeral implant in patients over 70 years of age

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 using a multicenter shoulder arthroplasty registry was performed evaluating all patients over 70 years of age 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 and younger. Outcome scores were obtained preoperatively and at 2 years postoperatively using the 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 Minimal Clinically Important Difference (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 no statistical difference between the 2 groups in regard to baseline scores or range of motion. At 2-year follow-up, older patients were noted to have significantly better visual analog scale, ASES, WOOS, and Constant-Murley scores than younger patients (P < .05). For the ASES, all patients over the age of 70 years achieved MCID compared with 84% of those 65 years and younger (P = .011), whereas for the WOOS, 100% of older patients achieved MCID compared with 86% of those in the control group (P = .022). Postoperative range of motion was generally not different between the 2 groups, although older patients had better active internal rotation at 90° of abduction (P = .002). Partial calcar resorption was noted in 1 patient in each age group. Radiolucent lines were noted in 2 patients over the age of 70 years and 1 patient 65 years or younger.

Discussion

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