Ryan Simovitch, MD
The authors conducted a study to measure a subjective questionnaire that reported type of activities, range of motion, pain and strength. The authors looked at patients younger and older than 65 to determine if there was a difference in activity levels and what the functional differences were in these patient populations. They broke activity level down into low, medium and high demand.
The authors bring up a good point for surgeons to think about. Older patients are not necessarily inactive patients. The patient population at my practice in South Florida is older demographically, but those patients still enjoy golfing, swimming, lifting weights, cycling, hunting and other similar activities that place high stresses on shoulder implants.
In my practice, I tend to view physiological age as a more important indicator than chronological age because my experience confirms what the study has above has found.
In this study, the questionnaire separated out low, medium and high demand activities to see if there were was a difference in the activities of older and younger patients. The authors found younger patients and older patients had no significant difference in activities after surgery and concluded that patients self-regulate. A piece that is missing from this study is what the activity levels were prior to surgery.
The authors also point out that the younger cohort included nine patients who had disabilities, which represents 53 percent of the younger cohort and could skew the data points. Younger patients in need of reverse total shoulder arthroplasty (rTSA) and with disabilities may also have more complex disease profiles than the older patients being treated for arthritis.
In my opinion, this study is bringing up the topic and understanding that chronological age is different from physiological age. We published an article in the Journal of Shoulder and Elbow Surgery in 2015 that looked at clinical outcomes of rTSA in the senior athletic population. We found similar results: our older patients were active and wanted to be assured that they could return to an active lifestyle after a reverse shoulder. Our study found that 60 percent of patients (mean age 73 +/- 7.2) who played a sport before rTSa returned to sports after surgery. And, 95 percent of patients who returned to sports indicated that they could play the sport at the same or higher level than before surgery.
In my practice, I tend to view physiological age as a more important indicator than chronological age because my experience confirms what the study has above has found: activity level tends to be adjusted based on the patient’s desire to improve function or reduce pain. In my practice, a combination of patient selection and managing expectations tends to result in a positive patient experience. This does not entirely vindicate us from concerns that rTSA, while reasonable in an active younger patient, may result in truncated survivorship since wear will occur over a longer period of time.
Ryan Simovitch, MD, is president of Palm Beach Orthopaedic Institute, director of Palm Beach Shoulder Institute and chief of the division of orthopaedics at Palm Beach Gardens Medical Center. He completed his residency at Duke University Medical Center and fellowships in Switzerland and at Massachusetts General Hospital. Dr. Simovitch is a design surgeon for the Equinoxe resurfacing and cuff sparing systems.