The impact of prior ipsilateral arthroscopy on infection rates after shoulder arthroplasty

Wright-Chisem, Joshua; Apostolakos, John; Dines, Joshua S.; Dines, David M.; Gulotta, Lawrence V.; Taylor, Samuel A.; Werner, Brian C.

doi:10.1016/j.jse.2020.09.019

Cited by 18 publications

(24 citation statements)

References 43 publications

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“…This is consistent with the infection risk associated with prior shoulder surgery as reported by others, including Malik et al 26 and Wright-Chisem et al. 7 , 22 , 27 This statistically significant finding cautions against using nonarthroplasty surgery as a temporizing option before primary RTSA.…”

Section: Discussionsupporting

confidence: 89%

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Nezwek¹,

Dutcher²,

Mascarenhas³

et al. 2021

JSES International

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Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular surgery for patients with rotator cuff arthropathy, unreconstructible proximal humeral fracture, and end-stage glenohumeral arthritis. The increased annual volume of RTSAs has resulted in more postoperative complications and revision rates between 3.3% and 10.1%. Postoperative infection is one of the most common complications requiring revision surgery after primary RTSA. This study assesses patient-specific risk factors for development of early infection after primary RTSA in a single high-volume shoulder arthroplasty institution. Methods From 2014 to 2019, 902 consecutive primary RTSAs were performed for surgical treatment of rotator cuff arthropathy, glenohumeral arthritis, inflammatory arthropathy, and/or dislocation. Excluding proximal humeral or scapula fractures, 756 cases met the inclusion criteria and had a minimum of 3-month follow-up. All surgeries were performed using the same surgical technique and received similar antibiotic prophylaxis. Age, patient demographics, medical history, smoking history, and prior ipsilateral shoulder treatment and/or surgery were recorded. Multivariable logistic regression analysis was used to determine risk factors associated with development of postoperative shoulder infection. Results Thirty-five patients did not meet minimum follow-up criteria and were lost to follow-up. Overall, of 721, 22 patients (3%) developed a postoperative ipsilateral shoulder infection. Previous nonarthroplasty surgery and history of rheumatoid arthritis were significantly associated with the development of postoperative shoulder infection. Amongst 196 patients who had previous nonarthroplasty shoulder surgery, there were 12 postoperative shoulder infections (6%) compared with those without previous shoulder surgery (10 of 525, 2%) ( P = .003). Among 58 patients with rheumatoid arthritis, there were 5 postoperative shoulder infections (9%) compared with patients without rheumatoid arthritis (17 of 663, 3%) ( P = .010). Patient age, gender, smoking status, history of diabetes mellitus, history of cancer/immunosuppression, and prior cortisone injection did not demonstrate significant associations with the development of postoperative infection. Conclusion Prior nonarthroplasty shoulder surgery and/or rheumatoid arthritis are independently associated with the development of postoperative infection after primary RTSA. Patients who demonstrate these risk factors should be appropriately evaluated and preoperatively counseled before undergoing primary RTSA. Strong consideration should be given to avoid minimally invasive nonarthroplasty surgery as a temporizing measure to delay definitive RTSA.

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Section: Discussionsupporting

confidence: 89%

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Nezwek¹,

Dutcher²,

Mascarenhas³

et al. 2021

JSES International

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“…On the contrary, younger age (<64 years) could statistically be determined as a risk factor of PRCs. To a great extent, this is consistent with previous studies which identi ed younger age as an independent predictor of PJI, failure or revision after shoulder arthroplasty [6, 10,11,14,17,24,28,30]. The etiology underlying this nding is unclear, but this can be used to educate patients, inform surgeons when counseling younger patients regarding their risks, and serve as an impetus for further investigation [24].…”

Section: Discussionsupporting

confidence: 87%

“…However, it was found that patients with history of PSA were risky to PRCs after TSA, similar to our prior nding that prior knee arthroscopy conferred high risk of PRCs after TKA [38]. Furthermore, PSA has also been reported to be associated with a higher risk of infection after shoulder arthroplasty [17]. On the basis of this association, surgeons should proceed with increased caution before performing an arthroplasty procedure in a patient with a history of PSA, and consider a lower threshold to rule out infection as well as the perioperative usage of antibiotic [17].…”

Section: Discussionsupporting

confidence: 85%

“…Consistently, AN has been associated with a signi cantly increased risk for postoperative infection, dislocation, fracture, and revision surgery after TSA [16]. Despite our authors previously reported that RA was associated with in-hospital PRCs following THA, it was rstly found in this study that patients RA undergoing TSA were risky to experience in-hospital PRCs [39] Arthroscopic intervention for shoulder osteoarthritis has been used as a measure to temporize pain or mechanical symptoms in order to delay joint arthroplasty and expedite time to return to recreational activities and physically demanding jobs [17]. However, it was found that patients with history of PSA were risky to PRCs after TSA, similar to our prior nding that prior knee arthroscopy conferred high risk of PRCs after TKA [38].…”

Section: Discussionmentioning

confidence: 88%

“…Therefore, with the purpose of optimizing postoperative outcomes and reducing the requirement for revision procedures after TSA, it is imperative to determine preoperatively whether patients are at high risk of early PRCs. Numerous risk factors for the above complications have been reported by prior studies [7,[9][10][11][12][13][14][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Yang

Xie

Liu

et al. 2021

Preprint

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BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

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Preventing Infection in Revision Shoulder Arthroplasty

Khan,

Fares,

Abboud

2023

Revision Shoulder Arthroplasty

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The impact of prior ipsilateral arthroscopy on infection rates after shoulder arthroplasty

Cited by 18 publications

References 43 publications

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Preventing Infection in Revision Shoulder Arthroplasty

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