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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Operative timing predicts postoperative complications after staged reverse total shoulder arthroplasty
Julian Wier1, Cory K Mayfield1, Anthony C Mouchawar1
1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Journal of Shoulder and Elbow Surgery
|June 5, 2026
Summary
Optimal timing for staged bilateral reverse total shoulder arthroplasty (rTSA) is crucial. Undergoing the second rTSA within one year increases surgical complication risks; delaying beyond 12 months is safer.
Area of Science:
- Orthopedic Surgery
- Biostatistics
- Health Services Research
Background:
- The optimal interval between staged bilateral reverse total shoulder arthroplasty (rTSA) remains undefined.
- Understanding this timing is critical for minimizing surgical risks.
Purpose of the Study:
- To investigate the association between the time interval of staged bilateral rTSA and the risk of early surgical complications.
- To identify an optimal time threshold for contralateral surgery to mitigate adverse outcomes.
Main Methods:
- Retrospective analysis of the Premier Healthcare Database (2016-2020) for patients undergoing primary rTSA.
- Propensity score matching comparing staged bilateral rTSA (split by <6, 6-12, >12 months) with unilateral rTSA.
- Multivariable models and changepoint analysis to assess complication risks.
Main Results:
- Staged bilateral rTSA performed <6 or 6-12 months after the first surgery showed significantly higher odds of 90-day complications (2.4x and 1.8x, respectively) compared to unilateral rTSA.
- Increased risks were primarily driven by fracture and infection.
- A changepoint analysis suggested that complication risk becomes non-significant beyond approximately 390 days.
Conclusions:
- Performing staged bilateral rTSA within one year of the initial surgery is linked to increased early surgical complications.
- Delaying contralateral surgery beyond 12 months results in complication risks comparable to unilateral rTSA.
