JSES - 2026-05-01 - Journal Article; Systematic Review; Review
Anatomic total shoulder arthroplasty indications, outcomes, and survivorship in patients younger than 50 years of age: a systematic review.
Peebles LA, Akamefula RA, Weinerman J, DeFoor MT, Dekker TJ
Topics
Key Takeaway
In patients under 50, aTSA achieves 95–100% implant survivorship at 0–10 years, but survivorship drops to 61–64% beyond 15 years, with revision rates ranging from 3.8% to 41.2% across included studies.
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Summary
This systematic review evaluated indications, outcomes, and survivorship of aTSA in patients ≤50 years using 9 studies published 1980–2024. The most common indications were glenohumeral OA (37.5%) and rheumatoid arthritis (35.8%). Implant survivorship was 95–100% at 0–10 years but declined to 61–64% beyond 15 years, with forward flexion improving a mean 32° and external rotation improving 22° at final follow-up.
Key Limitation
The pooled cohort of only 184 shoulders across 9 heterogeneous studies spanning four decades prevents controlling for implant generation, glenoid type, or surgical technique, making survivorship estimates imprecise.
Original Abstract
BACKGROUND
Although prior studies have raised concern regarding the longevity of anatomic total shoulder arthroplasty (aTSA) in young and active patients, it remains an effective treatment option for this population commonly presenting with multifactorial etiologies of shoulder arthritis. The purpose of this study was to perform a systematic review evaluating aTSA indications, outcomes, and implant survivorship in young and active patients aged 50 years or less.
METHODS
A systematic review of the literature from 1980 to 2024 evaluating outcomes following aTSA in patients less than 50 years of age was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient demographics, indications for aTSA, and the number of prior shoulder surgeries were recorded when available. Outcomes included implant survivorship, revision and complication rates, indications for revision, preoperative and postoperative range of motion, as well as patient-reported outcome scores.
RESULTS
The literature search identified 814 articles, and 9 studies met the final inclusion criteria following full-text review. A total of 173 patients (184 shoulders) were assessed across the included studies, and the mean age ranged from 33.3 to 44.2 years old. Average duration of clinical and radiographic follow-up ranged from 2.3 to 22.0 years. The most common indications for aTSA were glenohumeral osteoarthritis (37.5%) and rheumatoid arthritis (35.8%), followed by post-traumatic arthritis (8.5%), chondrolysis (7.4%), avascular necrosis (6.3%), and other (4.5%). Revision rate ranged from 3.8% (1/26 at 2.3 years) to 41.2% (7/17 at 14.5 years). Implant survivorship ranged from 80 to 100%, 95 to 100% at 0-10 years, 71% to 84% at 11-15 years, and 61% to 64% at >15 years. The most commonly reported outcome scores were the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and the visual analog scale for pain. Forward flexion increased by a mean 32° (range, 12° to 51°), abduction increased by 41° (range, 26° to 64°), and external rotation increased by 22° (range, 14° to 26°) at the final follow-up
CONCLUSION
In young patients under the age of 50 years, aTSA is a reliable option for restoring shoulder function and range of motion with low revision rates and high implant survivorship at short- to mid-term follow-up. The most common indications for aTSA were glenohumeral osteoarthritis and rheumatoid arthritis. Compared to older patients, those under 50 may expect moderately inferior functional outcomes and long-term.