Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

Abstract

Background Indications for reverse total shoulder arthroplasty (RTSA) have expanded. The purpose of this retrospective cohort study was to evaluate national trends in shoulder arthroplasty utilization and to compare national perioperative complication rates for hemiarthroplasty (HA), total shoulder arthroplasty (TSA), and RTSA in a matched cohort. Methods The National Inpatient Sample was queried from 2011-2013 to identify patients who underwent HA, TSA, or RTSA. Age, sex, race, insurance type, Elixhauser comorbidity index, and perioperative complications were identified. A coarsened exact matching algorithm was used to match RTSA patients with TSA and HA patients to compare medical and implant-related perioperative in-hospital complications. Multivariable logistic regression analysis was performed on unmatched data to identify risk factors for development of perioperative complications. Results Overall, 42,832 shoulder arthroplasties were identified (44% TSAs, 34% RTSAs, 19% HAs). After matching, RTSAs had 6.2 times the odds of a perioperative implant-related complication ( P < .001) and 2 times the odds of a red blood cell transfusion compared with TSAs ( P < .001). The logistic regression model showed that prior shoulder arthroplasty (odds ratio [OR], 15.1; P < .001), younger age (OR, 0.98; P = .006), earlier year of index surgery (OR, 0.83; P = .002), history of illicit drug use (OR, 6.2; P = .008), and depression (OR, 2.3; P = .003) were risk factors for development of in-hospital implant-related complications after RTSA. Conclusion The perioperative implant-related complication rate and postoperative transfusion rate of RTSAs were significantly higher than those of TSAs. In addition, prior shoulder surgery, younger age, earlier year of index surgery, history of illicit drug use, and depression were risk factors for implant-related complications after RTSA. However, the perioperative RTSA implant-related complications did decline each year, suggesting a growing national proficiency with performing RTSA.

Return to work following shoulder arthroplasty: A systematic review

“…In patients with end-stage glenohumeral arthritis and an intact rotator cuff, TSA has shown to be a highly effective treatment with high rates of functional recovery[ 5 ]. While the original indication for rTSA was rotator cuff arthropathy, the indications for rTSA have expanded to include conditions such as TSA and HA implant failures, complex proximal humerus fractures, asymmetric glenoid wear, posterior humeral head subluxation in patients with intact rotator cuffs, and irreparable rotator cuff tears in the absence of arthritis[ 38 - 40 ]. Similarly, the indications for TSA have also expanded to now include a more diverse and active patient population[ 41 ].…”

The Impact of Preoperative Anemia on Complications After Total Shoulder Arthroplasty

“…It has been suggested that reverse TSA may have higher perioperative transfusion rates for anemia compared with anatomic TSA. 35 Moreover, the etiology of each individual patients' anemia was also not available in the ACS NSQIP for analysis. Further research investigating the relationship between specific etiologies of anemia and their impact on postoperative complications after TSA would further elucidate this topic of interest.…”

Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

“…By shifting the center of rotation (COR), the Grammont design and the more recent reverse shoulder prosthesis designs achieve an improvement of the abductor lever arm of the deltoid muscle, therefore compensating for deficiencies of the cuff or loss of the tuberosities [5,9,10]. Although reverse prostheses are used in growing numbers, they are accompanied by high rates of complications of up to 60% [2,3,11]. Besides infections, periprosthetic fractures, and loosening, a common cause of failure of reverse prostheses is instability [5,13,15].…”