Folate deficiency and total shoulder arthroplasty outcomes

Area of Science:

• Orthopedic Surgery
• Nutritional Science
• Biochemistry

Background:

• Folate deficiency is linked to inflammation and severe osteoarthritis.
• Osteoarthritis can complicate shoulder reconstruction and total shoulder arthroplasty (TSA).

Purpose of the Study:

• To investigate the correlation between folate deficiency and complications after TSA.
• To assess the impact of pre-operative folate levels on TSA outcomes.

Main Methods:

• Retrospective cohort analysis using the TriNetX database.
• Identification of patients with low (≤2.5 ng/mL) and normal (≥2.6 ng/mL) folate levels before TSA.
• Comparison of outcomes at 90 days, two years, and four years post-TSA.

Main Results:

• Folate-deficient patients showed higher risks of periprosthetic joint infection, mechanical loosening, periprosthetic fracture, and dislocation at 90 days.
• Significant increases in mechanical complications and instability/subluxation were observed in folate-deficient patients at all time points.
• Long-term risks of dislocation, mechanical complications, and instability/subluxation were elevated in patients with folate deficiency post-TSA.

Conclusions:

• Folate deficiency is associated with a significant increase in short- and long-term orthopedic complications following TSA.
• Pre-operative folate status is a critical factor influencing TSA outcomes.
• Counseling folate-deficient patients on these elevated risks before TSA is recommended.