Background: Osteoarthritis may be caused by or concurrent with diseases such as rheumatoid arthritis or systemic lupus erythematosus, which rely on chronic corticosteroids regimens for treatment. If a total knee or hip arthroplasty is needed, this chronic treatment method has been associated with poorer surgical outcomes. Methods: A retrospective analysis of data collected by the American College of Surgeons National Surgical Quality Improvement Program was conducted. The Current Procedural Terminology codes were used to identify 403,566 total knee arthroplasty and total hip arthroplasty patients who were then stratified by the use of chronic corticosteroids for univariate analysis. Results: Forteen thousand seven hundred seventy-four of the patients identified were prescribed chronic corticosteroid regimens. A statistically significant difference was observed in perioperative complications for patients prescribed with corticosteroids, including higher rates of surgical site infection ( P = 0.0001), occurrence of deep incisional surgical site infection ( P < 0.0001), occurrences of organ space surgical site infection ( P < 0.0001), wound dehiscence ( P < 0.0001), general would infection ( P < 0.0001), pneumonia ( P < 0.0001), occurrences of unplanned intubation ( P = 0.0002), urinary tract infection ( P < 0.0001), and readmission ( P < 0.0001). No statistically significant difference was observed in the 30-day mortality between the 2 groups (0.63), venous thromboembolic event (0.42), cerebrovascular accident (0.12), myocardial infarction (0.49), cardiac arrest (0.098), deep vein thrombosis (0.17), or sepsis (0.52). Conclusion: Many of the notable differences in complications may be directly attributed to the immunosuppressive nature of corticosteroids. With increased knowledge of which perioperative complications to monitor, surgeons can tailor treatment strategies to this population that reduce morbidity and improve outcomes.

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Background: Superior capsular reconstruction (SCR) has been gaining popularity as a treatment for irreparable rotator cuff tears (RCTs), especially in younger patients. This biomechanical study aimed to investigate how SCR affects functional abduction force, humeral head migration, and passive range of motion following an irreparable RCT. We hypothesized that SCR will restore these parameters to nearly intact shoulder levels. Methods: Six fresh-frozen cadaveric shoulders were evaluated using a custom biomechanical testing apparatus. Each shoulder was taken through 3 conditions: (1) intact (control); (2) irreparable, complete supraspinatus (SS) tear; and (3) SCR. Functional abduction force, superior humeral head migration, and passive range of motion, including axial shoulder rotation, were measured in static condition at 0 , 30 , and 60 of glenohumeral abduction. Data were analyzed using the paired Student t test or Wilcoxon signed rank test, depending on the results of normality testing. Results: The irreparable SS tear resulted in significantly lower functional abduction force at 30 of abduction (P ¼ .01) and a trend toward a decrease (P ¼ .17) at 60 compared with the intact configuration. SCR shoulders produced greater functional force at 0 compared with the tear configuration (P ¼ .046). Humeral head migration was significantly increased by 4.4 and 3.0 mm at 0 and 30 of abduction, respectively, when comparing the intact vs. SS tear configurations (P ¼ .001). SCR decreased superior migration down to levels of intact shoulders at 0 and 30 of abduction (P ¼ .008 and P ¼ .013, respectively) and was not significantly different from the intact configuration at any angle. SCR decreased passive shoulder extension compared with the tear configuration and increased abduction compared with the intact configuration (P ¼ .007 and P ¼ .03, respectively). The overall arc of axial rotation was not significantly different between SCR and the intact configuration at any angle. Conclusions: In the setting of an irreparable SS tear, SCR restores key biomechanical parameters of the shoulder to intact levels. SCR should be considered for qualifying patients with irreparable RCTs.