Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty

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BackgroundReverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela. MethodsA nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant. ResultsPatients developing a PJI had higher mean ECI (8 vs. 6; p < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81–2.43, p < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45–2.17, p < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49–2.06, p < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21–1.88, p = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13–1.54, p = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09–1.46, p = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06–1.43, p = 0.001). ConclusionsThe greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.