Purpose: Reverse shoulder arthroplasty (rTSA), once reserved for elderly low-demand patients, is increasingly used in younger adults despite concerns regarding complication rates and longevity.This systematic review and meta-analysis evaluate contemporary evidence on primary rTSA in patients aged 65 years.Methods: Following PRISMA guidelines, PubMed, Scopus, and CENTRAL databases were searched to October 2025.Studies reporting outcomes of primary rTSA in patients 65 years with 2 years of follow-up were included.Data on indications, functional outcomes, range of motion (ROM), patient-reported outcomes (PROMs), complications, revisions, and implant survival were recorded and synthesized.Subgroup analyses based on patients' age and comparisons with older rTSA cohorts were also performed.Results: Thirteen studies met our inclusion criteria.Cuff tear arthropathy (27.29%), massive cuff tears (23.39%), and glenohumeral osteoarthritis (22.34%) accounted for most indications.rTSA resulted in significant improvements in ROM and all major PROMs.The overall complication rate was 14.23%, and the revision rate was 2.92%, with instability and infection responsible for 64.2% of revisions.Mid to long-term implant survival exceeded 85%.When compared with older patients, younger adults demonstrated equivalent ROM outcomes.Concerning PROMs younger patients demonstrated inferior ASES (MD=-6.43,p=0.01),VAS (MD=0.93,p<0.01),Constant score (MD=-4.98,p<0.01),UCLA (MD=-2.07,p<0.01) and SPADI index (MD=13.56,p<0.01), whereas SST (MD=-0.7,p=0.19) did not differ between the two groups.Moreover, younger patients presented a higher revision risk (RR=2.21,p<0.01). Conclusion:Primary rTSA provides substantial and predictable improvements in pain and shoulder function among young adults, with acceptable early to mid-term durability.Nevertheless, younger age remains associated with higher revision risk and modestly lower subjective outcomes, likely reflecting greater functional demands and postoperative expectations.These findings highlight the importance of nuanced surgical decision-making and patient counseling as RSA use continues to expand in this demographic.
Stamiris et al. (Sun,) studied this question.