Postoperative complication rates following total shoulder arthroplasty (TSA) vs. reverse shoulder arthroplasty (RSA): A nationwide analysis

Abstract

BackgroundHistorically, anatomic total shoulder arthroplasty (TSA) has been the gold-standard of care for patients with glenohumeral osteoarthritis refractory to nonoperative treatment. With expanding indications, utilization of reverse total shoulder arthroplasty (RSA) has been rapidly increasing. The purpose of this study was to use a nationwide patient database with contemporary data to identify and compare joint and systemic complication rates following primary TSA and RSA. MethodsPatients records of patients receiving TSA or RSA were queried from PearlDiver (Fort Wayne, IN), a commercially available administrative claims database, using International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9/ICD-10) and Current Procedural Technology (CPT) codes. Incidences of postoperative joint complications were measured at 90-days and 1-year post-discharge. Incidences of systemic complications were measured at 90-days post-discharge. Complication rates were compared using logistic regression. Demographic data was also compared using chi-square analysis. ResultsFrom 2007 to 2017, a total of 17,681 patients received primary total shoulder arthroplasty: 8,846 (50%) received TSA and 8,835 (50%) received RSA. A greater proportion of patients that underwent RSA were female (p < 0.001), over the age of 80 (p < 0.001), and had a higher average Charlson comorbidity index (2.49 vs. 1.99, p < 0.001). At 90-days post-discharge, patients that received RSA were more likely to have prosthetic joint infection (OR 1.66; 95% CI 1.30–2.70), periprosthetic fracture (OR 4.01; 95% CI 3.32–4.87), prosthetic dislocation (OR 2.10; 95% CI 1.57–2.85), and adjacent local scapular/acromion fractures (OR 3.58; 95% CI 2.05–6.71). At 1-year, these patients still had a higher association with periprosthetic fracture (OR 3.66; 95% CI 3.08–4.38), prosthetic dislocation (OR 1.40; 95% CI 1.12–1.75), and local fractures (OR 3.10; 95% CI 2.10–4.73). Patients that underwent TSA were more likely to have prosthetic loosening (OR 0.64; 95% CI 0.45–0.90) and prosthetic stiffness (OR 0.91; 95% CI 0.84–0.99). Additionally, patients that underwent RSA exhibited higher rates of DVT (OR 1.29; 95% CI 1.03–1.62), anemia (OR 1.42; 95% CI 1.25–1.62), acute renal failure (ARF) (OR 1.35; 95% CI 1.13–1.61), pneumonia (OR 1.23; 95% CI 1.02–1.48), and respiratory failure (OR 1.81; 95% CI 1.46–2.26). ConclusionPatients undergoing RSA exhibited higher rates of joint complications at both 90-days and 1-year post-discharge. These patients also experienced higher rates of systemic complications in the 90-day postoperative period, likely due to overall poorer health status. Level of evidenceLevel III; Treatment Study