Published 12/17/2025
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Rebecca Araujo
An ePoster presented at the AAOS 2025 Annual Meeting shows improved pain relief and function after reverse total shoulder arthroplasty (RTSA) in patients aged 50 years or younger. The study was led by Piotr Łukasiewicz, MD, PhD, of the Department of Trauma Surgery and Emergency Medicine at the Medical University of Lublin, Poland, and his colleagues from the Johns Hopkins School of Medicine in Baltimore.
“In the past, there have been few surgical options for ‘younger’ patients who have shoulder deformities with or without rotator cuff deficiencies. The evolution of RTSA has changed from precautions that it should be restricted to patients over the age of 70, and the indications have expanded to include osteoarthritis with glenoid deformity and significant bone loss, pseudoparalysis, fracture of the proximal humerus, fracture nonunions, and revision arthroplasty,” Dr. Łukasiewicz told AAOS Now. “As the indications have expanded for RTSA, younger patients with severe shoulder pathologies have increasingly undergone this procedure. There are a few studies that explore results of RTSA in patients that are 60 or even 55 years old, but ours would be the first for a group of patients 50 or younger operated by a single senior surgeon.”
The study included 38 patients who were aged 50 years or younger at the time of RTSA and had at least two years of follow-up. That cohort was matched 2:1 to a group of patients who underwent RTSA at age 65 years or older. Matching was done according to surgical indication, gender, and glenoid morphology (measured via CT).
Radiographs were taken pre- and postoperatively at 10 days, one year, and two years after surgery. Humeral and glenoid component loosening and scapular notching were noted on postoperative radiographs. Patient-reported outcome measures (PROMs) and range of motion (ROM) were also collected.
The most prevalent Walch classifications in both cohorts were A1 and A2, comprising 28.12% and 21.88%, respectively, in the ≤50 group and 18.18% and 40.91%, respectively, in the ≥65 group. Osteoarthritis with significant bone loss was the most common indication in both age groups (≤50 group, 53%; ≥65 group, 70%).
In the younger cohort, at an average follow-up of 61 months, the implant survival rate was 97%, with one case of revision. In the older cohort, the survival rate was 98%, also with one revision.
Dr. Łukasiewicz reported, “Patients aged ≤50 years had significantly improved postoperative satisfaction, pain relief, shoulder ROM, and PROMs for midterm results.
“With matching to a cohort of patients over the age of 65, we found complication rates to be relatively comparable between age groups.” The complication rates were 7.9% (n = 3) and 2.5% (n = 2) in the ≤50 and ≥65 years groups, respectively. Twelve patients (32%) in the younger group demonstrated postoperative notching, compared to 11 patients (14%) in the older group.
Notably, “There were significantly more cases of prior shoulder surgery in the 50 years and younger group,” Dr. Łukasiewicz added. “We were also positively surprised by only one case that had to be revised in our study group, which was due to humeral loosening. This was a much smaller complication rate compared to other studies on patients aged 60 or 55 years and younger.”
The clinical takeaway from this study, according to Dr. Łukasiewicz: “Patients with severe arthritic changes in the shoulder at a young age below 50 years can be successfully improved in terms of pain reduction, satisfaction, ROM, and radiological results with RTSA,” according to their midterm observations.
These findings could be supported by longer-term outcomes in this age group. “Questions arise whether implant longevity would be the same among young patients, who are still in their employment years and want to sustain an active life without limitations in sports and daily activities,” Dr. Łukasiewicz noted. “As mentioned, we only had a single revision for aseptic humeral loosening that occurred at 100 months postoperatively. We checked that the satisfaction rates after RTSA surgery are high, but to see how it might change in time, long-term follow-up is crucial. Since it is still uncommon to use RTSA in younger patients, and the number of cases remains small, a larger multicenter analysis could be the next step.”
The study had several limitations, including its small sample size. To this point, Dr. Łukasiewicz said, “The patient population studied reflects the referral practice of an academic medical center with a diverse patient population.”
Another limitation is that a younger population is often treated for different indications than older patients. “It has previously been shown that certain preoperative indications, such as post-traumatic arthritis, may lead to worse outcomes and reported satisfaction than other RTSA indications,” he said. “Furthermore, many underlying pathologies with severe arthritis, such as Kniest syndrome, achondroplasia, and paraplegic cerebral palsy, make this population of younger patients different from others reported in the literature.” He also added that part of the cohort of patients aged 50 years and younger had arthritis that was associated with surgery performed before RTSA. “While this is not an overt limitation, the influence of prior surgical interventions on the outcomes of RTSA remains debatable,” he said.
He noted, due to the short follow-up period of this study, “Longer follow-up is required before implantation of an RTSA can be recommended.”
Dr. Łukasiewicz’s co-authors of “Outcomes of Reverse Total Shoulder Arthroplasty in Patients Aged 50 and Younger: A Case Control Study” are Sarah Ida Goldfarb; Laurence U. Okeke, BA; and Edward G. McFarland, MD, FAAOS.
Rebecca Araujo is the managing editor of AAOS Now. She can be reached at raraujo@aaos.org.