Postoperative Complications in Patients With Sickle Cell Disease After Total Shoulder Arthroplasty

Sickle cell disease (SCD) encompasses a spectrum of genetic hematologic disorders characterized by erythrocyte sickling. Patients may experience musculoskeletal manifestations, such as osteonecrosis, which may warrant consideration for total shoulder arthroplasty (TSA). While prior literature suggests patients with SCD more frequently suffer complications after orthopaedic procedures, this is not well characterized for TSA.

Adult TSA patients (older than 18 years) were identified in the 2010 to 2023 PearlDiver M170 database. Patients with SCD were matched 1:4 to patients without SCD based on age, sex, and Elixhauser Comorbidity Index (ECI). Ninety-day postoperative complications, emergency department (ED) visits, and readmissions were identified. Complications were compared for the matched cohorts by univariable analysis and multivariable analysis, controlling for age, sex, and ECI. A Kaplan-Meier survival curve was generated to compare 5-year revision rates by log-rank test.

Among TSA patients, 278 with SCD were identified and compared with 1076 matched control subjects. SCD was associated with greater odds of any aggregate adverse events (OR = 9.41), serious adverse events (OR = 5.96), and minor adverse events (OR = 10.30) (P < 0.001 for all); nearly all individual complications studied; and ED visits (OR = 5.67, P < 0.001). However, 90-day readmissions and 5-year survival to revision surgery did not differ markedly.

After TSA, patients with SCD had markedly elevated odds of many complications. Surgeons should consider this elevated risk with preoperative counseling and patient management. Reassuringly, elevated odds of 90-day postoperative complication did not correlate with increased rates of 5-year revision, although this finding could partially represent hesitancy to reoperate on high-risk patients.