Objectives: Indications for reverse total shoulder arthroplasty (rTSA) for degenerative shoulder conditions continue to expand, including in older populations. However, the safety profile of primary rTSA in patients aged 90 years and older remains poorly defined. This study aims to evaluate the safety and early postoperative complications of rTSA in this age group.

Methods: A retrospective cohort study was conducted on all patients aged 90 years and older who underwent primary rTSA between July 2014 and April 2023 in a single multi-center institution. Patient records were reviewed to assess preoperative demographic characteristics and comorbidities, and early postoperative complications as well as overall patient satisfaction. Patients ≥90 years old undergoing primary rTSA were included. Revision surgeries were excluded.

Results: A total of 31 patients were included, with a mean age of 91.5 ± 1.5 years (range, 90–97 years). The median follow-up was 12 months (IQR, 5.5–22 months; range, 1–71 months). One surgical complication occurred (3.2%): a periprosthetic joint infection requiring irrigation and debridement and placement of an antibiotic spacer. Ninety-day mortality was 0%; one patient died 18 months postoperatively from causes unrelated to the arthroplasty. Satisfaction was documented in 23 patients, of whom 22 (96%) reported being satisfied.

Conclusion: In this study, primary rTSA was associated with one surgical complication and no documented medical complications or 90-day mortality. Although these findings support the feasibility of the procedure in this age group, the limited sample size and variable follow-up duration warrant cautious interpretation, particularly with respect to long-term safety.