Often a patient will ask, “how old do you have to be to get a shoulder replacement?” Usually, and each situation is different, shoulder replacements are recommended to people between the ages of sixty and eighty.

At any age, the the choice to have shoulder replacement will usually be made following a long course of conservative care, non-surgical treatments that failed to reduce or eliminate the person’s  consistent pain, ability to work or continue in sport, and for many the inability to sleep.

At ten years follow up in 17% of patients,  the implant did not last

An April 2024 study (1) of 50 patients (25 male, 25 female) who underwent anatomic total shoulder replacement  under the age of 60 with minimum 5 years follow-up, found significant improvements in active range of motion and functional strength scores. The 5-year and 10-year implant survival rates were found to be 98.0 % and 83.3 %, respectively. (At ten years in 17% of patients,  the implant did not last). Five patients underwent revision shoulder arthroplasty at an average of 6.5 years after the initial procedure.

A June 2022 paper (2) examined the long-term clinical and radiographic outcomes of total shoulder replacement in patients under age 60 years old. The research team had hypothesized meaningful improvements in shoulder functionality and pain with total shoulder replacement and an acceptably low rate of prosthesis complications and revisions.

  • In this study 29 patients (34 shoulders) undergoing total shoulder replacement before the age of 60 years were followed up a minimum 10 years after the surgery. Shoulder range of motion, functionality, and pain were evaluated. Radiographs were assessed for lateral humeral offset, the acromiohumeral interval, and glenoid loosening.

Results:

  • The average age of the patients was 54.4  years  old – the youngest being 35.5. In patients under 60, total shoulder replacement significantly improved forward elevation, external rotation , and internal rotation. Complications occurred in 6 patients (17.6%), all of which were cases of aseptic glenoid loosening. Ultimately, 4 patients underwent conversion to a reverse total shoulder replacement and 2 underwent arthroscopic glenoid removal. The rate of prosthesis survivorship was 97.1% at 10 years, 85.4%  at 15 years, and 80.1%  at 20 years.

This research is in agreement with a 2017 paper (3) which stated: “Although there is concern with periprosthetic radiolucency and glenoid loosening in the young patient ( under 65 years old) undergoing total shoulder replacement, overall low revision rates and high implant survivorship are reported in the current literature. Whereas the patient-reported outcomes are inferior to those of the overall total shoulder replacement population, there is significant improvement from baseline levels in young patients with glenohumeral arthritis.”

The problems of internal rotation

An August 2024 study (6) assessed the restoration of internal rotation after reverse shoulder replacement in patients younger than 60 years of age. Two subgroups of patients who underwent primary reverse shoulder replacement were analyzed separately with respect to active internal rotation with the elbow at the side (AIR1): “difficult AIR1” and “easy AIR1.”

  • The study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active internal range of motion. Accordingly, significant improvement in active internal rotation was observed for fracture, primary osteoarthritis, and rheumatoid arthritis, whereas no statistically significant improvement in internal rotation was observed for tumor, revision, and cuff-tear arthropathy.

A 2018 study (4) suggests that young or active individuals with a total shoulder replacement have good return rates to sports. Hemiarthroplasty and reverse shoulder arthroplasty, when compared with total shoulder replacement , have lower but also reasonable return rates to sports.

At an average follow-up of 47 months, primary Reverse total shoulder arthroplasty patients under age 60 years had worse clinical outcomes compared to those aged 60-79 years

A March 2022 study (5) examined patients younger than 60 years old had previous reverse total shoulder arthroplasty. The results showed at an average follow-up of 47 months, primary Reverse total shoulder arthroplasty patients under age 60 years had worse clinical outcomes compared to those aged 60-79 years, with lower outcome scores, increased pain, lower function scores and less patient satisfaction. Patients younger than 60 years of age had higher rates of previous surgery, inflammatory arthropathy, and post-traumatic arthritis, while those aged 60-79 had higher rates of rotator cuff tear arthropathy. While complications were similar, younger patients had three times the risk of revision reverse total shoulder arthroplasty.

1 Barry LW, Katayama ES, Barnett JS, Henderson BL, Patel AV, Cvetanovich GL, Bishop JY, Rauck RC. Functionality, complications, and survivorship of total shoulder arthroplasty in patients under 60 years old. Journal of Orthopaedics. 2024 Sep 1;55:59-63.
2 Brochin RL, Zastrow RK, Patel AV, Parsons BO, Galatz LM, Flatow EL, Cagle PJ. Long-term clinical and radiographic outcomes of total shoulder arthroplasty in patients under age 60 years. Journal of Shoulder and Elbow Surgery. 2022 Jun 1;31(6):S63-70.
3 Roberson TA, Bentley JC, Griscom JT, Kissenberth MJ, Tolan SJ, Hawkins RJ, Tokish JM. Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review. Journal of Shoulder and Elbow Surgery. 2017 Jul 1;26(7):1298-306.
4 Christensen J, Brockmeier S. Total shoulder arthroplasty in the athlete and active individual. Clinics in Sports Medicine. 2018 Oct 1;37(4):549-58.
5 Neel GB, Boettcher ML, Eichinger JK, Friedman RJ. Clinical and Radiographic Outcomes Following Reverse Total Shoulder Arthroplasty in Patients 60 Years of Age and Younger. Journal of Shoulder and Elbow Surgery. 2022 Mar 26.
6 Berhouet J, Samargandi R, Jacquot A, Favard L, Boileau P, Gauci MO. Restoration of Internal Rotation After Reverse Shoulder Arthroplasty May Vary Depending on Etiology in Patients Younger Than 60 Years Old: A Multicenter Retrospective Study. Journal of ISAKOS. 2024 Jun 6.