Infection risk following total shoulder arthroplasty in patients with diabetic foot ulcers

Diabetic foot ulcers (DFU) reflect advanced diabetic microvascular and immunologic dysfunction and are associated with increased postoperative infection risk in lower-extremity arthroplasty. Their impact on total shoulder arthroplasty (TSA) outcomes, however, remains poorly defined. The purpose of this study is to determine the effect of DFU on periprosthetic joint infection (PJI), deep wound infection, and sepsis in diabetic patients undergoing primary TSA.

Using the PearlDiver Mariner database from 2010 to 2023, diabetic patients undergoing primary TSA were identified and stratified by DFU status using ICD-10 codes. Primary outcomes were postoperative sepsis, deep infection, and PJI at 90 days and 1 year. Multivariable logistic regression assessed the association between DFU status and postoperative complications.

Among 56,482 diabetic patients undergoing TSA, 2404 had DFU (4.3%). Compared with diabetics without DFU, DFU patients had significantly higher rates of sepsis at 90 days (1.62% vs 0.86%) and 1 year (5.86% vs 2.30%), PJI at 1 year (1.70% vs 1.09%), and deep infection at 1 year (0.67% vs 0.28%) (all p < 0.01). DFU was independently associated with increased odds of PJI (OR 2.23; 95% CI 1.85-2.67), deep infection (OR 2.99; 95% CI 2.41-3.69), and sepsis (OR 3.93; 95% CI 3.61-4.29).

The presence of DFU was independently associated with increased odds of sepsis, deep infection, and PJI following TSA. DFU may reflect a high-risk diabetic phenotype with impaired immunity and microvascular dysfunction. DFU status should be taken into account during preoperative informed consent and counseling, perioperative optimization, and postoperative surveillance.

Level III-retrospective cohort study.