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Updated: Jun 7, 2026
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.
Background:
The optimal timing between staged bilateral reverse total shoulder arthroplasty (rTSA) is unknown. Here we sought to identify the association between interprocedural time and risk of surgical complications.
Methods:
The Premier Healthcare Database was retrospectively queried for patients in the United States undergoing primary rTSA between 2016 and 2020 and divided into those who underwent staged bilateral surgery and those who underwent unilateral surgery. These patients were propensity score matched 1:3, and staged patients were further split into <6-month, 6-12-month, and >12-month intervals. The primary outcome assessed was a composite of 90-day surgical complications. Multivariable models were generated to evaluate the association between surgical timing and outcomes to account for residual confounding. In a subanalysis treating the interprocedural interval as a continuous variable, the Metropolis-Hastings algorithm was used to identify a changepoint time interval beyond which complication risk attenuates.
Results:
A total of 3,152 staged rTSAs were matched to 9,456 unilateral rTSAs. After adjusting for confounding, patients who underwent staged rTSA at <6 or 6-12 months after their first rTSA experienced 2.4 (95% confidence interval [CI] 1.6-3.6) and 1.8 (95% CI 1.2-4.8) greater adjusted odds of composite surgical complications, respectively, when compared with unilateral rTSA. No significant differences were observed between the unilateral cohort and those staged >12 months. This difference in complications was largely driven by increased risk of fracture and infection. On evaluation of the relationship between time from first rTSA to second and odds of composite surgical complications, an approximated interval threshold of 390 days was determined, beyond which surgical risk becomes nonsignificant.
Conclusion:
Staged bilateral rTSA performed within approximately 1 year of the index procedure is associated with significantly increased early surgical complications, whereas delaying contralateral surgery beyond 12 months is associated with a similar risk to that of unilateral rTSA.
