There is no minimum age and no maximum age for a shoulder replacement. Most of my patients are between sixty and eighty, but I operate on patients of forty for a necrosis and on patients of ninety for a fracture. What decides is not the date of birth, it is the pain, the condition of the tendons and the quality of the bone.
The age on your identity card and the age of a joint do not always match. Two shoulders of sixty-five can be in radically different states depending on the patient's history, their job, their sports and their genetics.
There are four criteria that really count.
The first is the effect of the pain on daily life and on sleep. A shoulder that wakes you every night and makes it impossible to get dressed on your own justifies surgery, whatever your age.
The second is the condition of the rotator cuff tendons. It is this that determines the type of implant, anatomic if the cuff is intact, reverse if it is torn.
The third is the quality of the bone, in particular on the glenoid side, which governs how well the implant holds over time.
The fourth is general health and fitness for anaesthesia, assessed at the pre-anaesthetic consultation.
Here we are talking about patients under sixty, sometimes under fifty. The reasons are different from those in the older patient: avascular necrosis of the humeral head, the after-effects of a fracture, post-traumatic osteoarthritis and, more rarely, early primary osteoarthritis.
The question that arises is how long the implant will last. A patient of fifty has several decades of use ahead of them, which makes revision surgery likely at some point. That is not a reason to refuse, it is something to factor into the decision and to explain clearly.
In the younger patient I therefore favour three things. First, exhausting the alternatives to a replacement where they exist: arthroscopic debridement, treating the cause, tendon repair. Then, if a replacement is chosen, preferring a short-stem or stemless anatomic shoulder replacement, which preserves bone stock and makes any later revision easier. Finally, not detaching the muscles, which leaves a shoulder whose anatomy remains complete for the future.
I have published work on this subject comparing comprehensive arthroscopic management with a replacement in patients under fifty with primary glenohumeral osteoarthritis. It can be read in my publications.
Passing eighty closes no doors. It is in fact the age group in which a shoulder replacement changes life the most, because shoulder pain there takes away independence: washing, dressing, reaching a cupboard.
Two things argue in favour of surgery in the older patient. The question of how long the implant will last barely arises any more. And the absence of immobilisation after the operation, which follows from not detaching the muscles, avoids the loss of independence caused by three to six weeks in a sling in an elderly person.
The limiting factor is not age, it is general health. Severe heart or lung disease, very poorly controlled diabetes or malnutrition weigh far more heavily than ten years more or less. The pre-anaesthetic consultation settles this point.
In the older patient whose cuff is torn, which is common after seventy-five, it is a reverse shoulder replacement that is indicated.
This is the question I am asked most often, and the answer is not the same in both directions.
Waiting has a real cost. Osteoarthritis that progresses wears the glenoid, hollows it out and deforms it, which makes the implant harder to place and worsens the result. A cuff that tears later on shifts the choice from an anatomic replacement, which gives better range of movement, to a reverse replacement. And a shoulder that has been painful for years stiffens up, which lengthens rehabilitation.
Operating too early also has a cost: bringing forward the date of the first revision in a patient who could have lived reasonably well with their own shoulder for a few more years.
The right moment lies between the two, and one simple sign points to it: the day when night pain becomes a nightly event and medical treatment, injections and physiotherapy are no longer enough. From that point on, waiting gains you very little.
The average time between the first consultation and surgery is one month.
Not having surgery is a legitimate option, and it is open to discussion. An arthritic shoulder that is left alone carries on wearing: the pain increases, movement decreases, the glenoid becomes deformed.
What you need to know is that this process is not dangerous. There is no emergency in operating on an arthritic shoulder, and nobody loses their arm by waiting. What is lost is comfort, sleep and mobility, and part of what is lost cannot be fully regained.
The decision is yours. My role is to give you the facts: what you stand to gain, what you are risking, and what waiting costs in your particular case.
There is no minimum age. Avascular necrosis of the humeral head or the after-effects of a fracture can lead to a shoulder replacement before fifty. In a younger patient we first exhaust the alternatives to a replacement and then choose an implant that preserves bone stock.
No. The limiting factor is not age but general health and fitness for anaesthesia. Having no sling after the operation is a particular advantage in an older person, because it avoids the loss of independence that immobilisation brings.
Most patients are between sixty and eighty, but the real range is much wider.
No, not indefinitely. Waiting lets the osteoarthritis deform the glenoid, which makes the implant harder to place, and lets the shoulder stiffen, which lengthens rehabilitation. The right moment is when night pain becomes a nightly event and medical treatment is no longer enough.
It is likely if it is fitted at fifty, given the number of decades of use. That is why in a younger patient we favour an implant that preserves bone and a technique that does not cut the tendons, so as to keep every option open for a possible revision.
Yes, but not on the same day. We operate on the more painful side first, then allow time for rehabilitation before considering the second, which lets you keep one fully working arm during recovery.
One month on average, the time needed for the CT scan, the MRI if one is required, the pre-anaesthetic consultation and the planning of the implant.
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