Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

This really gets me but both my gramma and me are having the same shoulder surgery (shoulder replacement) on the same day by the same surgeon. She's 75 and I'm 45. But the funny thing is the doc thinks she's likely to have a better result than me. Why is that? I've got her beat by 30 years! And I figure as a male I'm stronger so that should count for something!

Answer:

Studies show that patients who are 50 and younger just don't have as good of results as patients over 50 with this procedure. For a long time, we thought it was really just the age difference. Younger patients are more active and more likely to stress the implant more than a quiet, fairly inactive grandmother might. But there's new evidence that it may not be age as much as the underlying cause of the shoulder problem. It turns out that younger patients with shoulder pain and loss of function severe enough to warrant replacing the joint is more often due to capsulorrhaphy arthropathy than degenerative joint disease. Capsulorraphy arthropathy refers to arthritis that occurs after a previous surgery on the shoulder. That surgery might have been to repair a torn rotator cuff or relocate a dislocated shoulder. Degenerative joint disease is age-related osteoarthritis more common in older adults. The surgeon may have been referring to age as the major difference between the two of you -- more so than the differences between men and women. It is true that studies have showed that women tend to report worse outcomes than men in the months to years after shoulder replacement. Perhaps women just have a different idea of what is a successful surgery compared with men. Younger patients seem to have more complex pathologies (e.g., loss of blood to the joint, post-traumatic arthritis) compared with older adults. The vast majority of older adults who need a shoulder replacement suffer from osteoarthritis. And the greater involvement of the surrounding soft tissues with capsulorraphy arthropathy can complicate surgery and follow-up rehab program. Your surgeon may have some other reason(s) to suggest a difference in results between you and your grandmother. There can be complicating factors such as previous injury and/or surgery to the shoulder. And it's entirely possible the surgeon was teasing you as a way to encourage you both to get the best results possible. You'll never know unless you ask for a clarification of that prediction! Matthew D. Saltzman, MD, et al. Comparison of Patients Undergoing Primary Shoulder Arthroplasty Before and After Age of Fifty. In Journal of Bone and Joint Surgery. January 2010. Vol. 92-A. No. 1. Pp. 42-47.

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