PROGNOSTIC FACTORS (AGE)
Moderate evidence supports that older age at the time of surgery is associated with lower revision rates.

Rationale

One moderate quality study (Robinson et al 2018) and two low quality studies (Odquist et al 2018, Rispoli et al 2006) have evaluated the outcomes of patients who underwent hemiarthroplasty for the treatment of glenohumeral joint osteoarthritis. All three of these studies were retrospective reviews of hemiarthroplasty patients of institutional (Robinson et al, Rispoli et al) or national (Odquist et al) database registries. All three studies used Cox proportional hazards regression model to determine the factors associated with survival defined as time from the index procedure free from any revision surgery. The findings of all three studies demonstrate that older age was associated with a decreased risk of revision surgery. The study by Odquist et al had a minimum follow-up of 5 years after the index procedure and the Robinson et al study, which was a continuation of the same patient cohort as the Rispoli et al study which was published at an earlier time point, had a mean follow-up duration of 17 years. The most common reason for revision surgery in the study by Robinson et al was due to glenoid arthrosis and glenoid erosion was cited as one of the most common reasons for revision in the study by Odquist et al.

 

Strength of Evidence (quality of evidence): Moderate

 

Benefits & Harms:
There are no known harms associated with implementing this recommendation.

 

Outcome Importance:
The reader should understand that this association between older age and lower revision rate was identified in only 3 studies all of moderate to low quality and is in reference to patients undergoing hemiarthroplasty for the treatment of glenohumeral joint osteoarthritis. In addition, the surgeon should understand that multiple studies have shown an association between better patient reported outcomes and total shoulder arthroplasty over hemiarthroplasty for glenohumeral joint osteoarthritis.

 

Future Research:
Further prospective studies are needed to determine the effect of age on survivorship after shoulder arthroplasty in not only the setting of hemiarthroplasty but total and reverse shoulder arthroplasty.


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