When is the right time to do something is a question we face throughout our lives. With shoulder replacement for treatment of arthritis, one of the most common questions I am asked is “When is the right age?” The fact is, there is no one single answer for this question. I believe the answer to this question is case specific and should be made in an informed manner using 4 additional questions/points.
What is the implant survival by age
The overall “implant survival” rate for a total shoulder replacement is 90% at 10 years. This means that 90% of the replacements are still in place 10 years after surgery. Interestingly, the survival rate increases with age. According to a Mayo Clinic study the 10 year survival is just under 95% for individuals over the age of 70 and about 89% for individuals between the ages of 60 and 70. The reason? Likely the implant lasts longer in older individuals because activity demands decrease, leading to less wear of the components. So in terms of survival, the outcomes are actually better with age. However, even for individuals under 60, the same study demonstrated a survival rate of about 88% at 10 years and still above 75% at 20 years.
What are my options if the implant wears out?
Historically, revision (repeat replacement) was difficult following a shoulder replacement. This was because implants were often cemented which is difficult to remove and the humeral components were longer. Modern implants, however, are more bone-preserving. They are placed without cement in the humerus (arm bone) and are shorter in length. This not only minimizes invasiveness at the initial surgery, but also provides the option for revision IF it is necessary.
What are the consequences of waiting?
First, it has been shown that arthritis progresses with time and leads to more severe deformity with time. As arthritis progresses the socket or glenoid can wear down, leading to bone loss and instability. Second, it has been demonstrated the more severe deformity leads to less predictable outcomes. In other words, waiting too long can lead to a compromised outcome for a shoulder replacement.
How severe is the impact on my quality of life?
This to me, is actually the most important question to ask. If the pain is controllable with activity modification and one’s range of motion allows him or her to perform desired activities, then conservative treatment is most likely appropriate. If the pain is severe (affects sleep or daily activities) and/or range of motion is limited, then regardless of age, a shoulder replacement can be reasonable. Multiple studies have demonstrated that shoulder replacement can have a substantial improvement on quality of life. At the same time, we all know that life is unpredictable at times. Given this, in many cases, despite a “young age” I think it is reasonable to choose quality of life now rather than waiting. This isn’t to say that shoulder replacement should be performed for minimal arthritis. Certainly, I always try to maximize conservative carewhen appropriate. Yet given the data noted above, and in light of modern implants, if quality of life is affected then I may suggest having the surgery sooner rather than later to help get you back to thriving in your life once again.Dr. Patrick Denard has been voted one of the top 20 Shoulder Surgeons in North America, and is the most widely published shoulder specialist in Oregon. Dr.Denard is committed to providing the highest level of Orthopedic care to his patients. Dr. Denard has advanced arthroscopy training and is able to perform the vast majority of shoulder procedures in a minimally invasive fashion, including all types of rotator cuff repairs and instability repair. These techniques allow him to repair tears that some consider “irreparable.” Providing every patient with advanced medicine and compassionate care each and every time.