Folate deficiency and total shoulder arthroplasty outcomes

Folate deficiency is inversely correlated with inflammatory (markers/conditions) and severe osteoarthritis. Osteoarthritis can lead to increased difficulty in shoulder reconstruction and longer operative times in total shoulder arthroplasty (TSA). Our goal is to see if folate deficiency is correlated with complications after TSA.

A retrospective cohort analysis using the TriNetX database was used to identify individuals with low (≤2.5 ng/mL) and normal (≥2.6 ng/mL) folate levels before TSA. Outcomes were compared at 90 days, two years, and four years following TSA.

At 90 days, folate deficient patients had a higher risk of periprosthetic joint infection (11.4% vs 5.9%, RR = 1.944, p = .016), mechanical loosening (3.3% vs 0%, p = .014), periprosthetic fracture (14.4% vs 7.8%, RR = 1.833, p = .011), dislocation (8.5% vs 3.9%, RR = 2.167, p = .021), any mechanical complications (14.1% vs 6.5%, RR = 2.150, p = .002), and instability/subluxation (10.8% vs 5.6%, RR = 1.941, p = .02) when compared to the control group. At the two-year and four-year time points, TSA folate deficient patients had an increased risk of dislocation, any mechanical complications, and instability/subluxation.

Folate deficiency in TSA patients is correlated with significant short- and long-term increase in several orthopedic complications. Folate deficient patients should be counseled on these risks before TSA.