Comorbidity-specific long-term complication risks on postoperative outcomes in total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Arthroplasty Outcomes
• Comorbidity Analysis

Background:

• Total shoulder arthroplasty (TSA) is a common procedure for end-stage glenohumeral arthritis.
• Complications like fractures, infections, and loosening necessitate revision surgery.
• A comprehensive analysis of the collective impact of comorbidities on TSA outcomes is lacking.

Purpose of the Study:

• To systematically evaluate the 10-year complication risks associated with common comorbidities following TSA.
• To provide a practical reference for shoulder surgeons regarding comorbidity-specific risks.
• To identify specific comorbidities that increase the likelihood of TSA complications.

Main Methods:

• Retrospective analysis of the PearlDiver national database (2010-2020).
• Inclusion of TSA patients with one of 19 predefined comorbidities; exclusion of multiple comorbidities.
• Utilized Cox proportional hazards models to calculate hazard ratios (HRs) for complications, with Bonferroni correction (P≤.00026).

Main Results:

• Depression (HR: 2.85) linked to increased irrigation and débridement.
• Systemic lupus erythematosus (SLE) (HR: 17.98) associated with higher spacer placement rates.
• Stroke (HR: 3.25) increased need for relocation/reduction; Asthma (HR: 11.63) heightened revision risk for dislocation.
• Chronic back pain (HR: 3.55) and SLE (HR: 51.21) linked to increased revision for rotator cuff tears.

Conclusions:

• This study is the first to systematically analyze long-term TSA complication risks across multiple comorbidities.
• Asthma, depression, stroke, chronic back pain, and SLE significantly increase the risk of specific TSA complications.
• Findings aid surgeons in assessing patient-specific revision risks for improved planning and outcomes.