Reverse total shoulder arthroplasty in patients of varying body mass index

Body mass index (BMI) is an independent predictor of complications after hip and knee arthroplasty. Whether similar trends apply to patients undergoing reverse total shoulder arthroplasty (RTSA) is unknown.

A retrospective review of primary RTSAs with a minimum 90-day follow-up were included. Complications were classified as major or minor and medical or surgical. Patients were classified into 3 groups: normal BMI (BMI <25 kg/m(2)), overweight or mildly obese (BMI 25-35 kg/m(2)), and moderately or severely obese (BMI >35 kg/m(2)).

Of the 119 patients met our inclusion criteria, 30 (25%) had a BMI of less than 25 kg/m(2); 65 (55%) had a BMI of 25 to 35 kg/m(2), and 24 (20%) had BMI exceeding 35 kg/m(2). Complications occurred in 30 patients (25%), comprising major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%). Patients with a BMI exceeding 35 kg/m(2) had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P = .05) than the other groups. Patients with BMI of less than 25 kg/m(2) had a greater overall complication rate than those with a BMI of 25 to 35 kg/m(2) (P < .05). Multivariate regression analysis demonstrated BMI was the only significant determinant of overall complication rates and medical complication rates (P < .05).

Patients with a BMI exceeding 35 kg/m(2) (severely obese) or a BMI of less than 25 kg/m(2) have higher rates of complication after RTSA.