Shoulder arthroplasty in patients with multiple sclerosis: complications stratified by arthroplasty type

Abstract

BackgroundDespite the prevalence of osteoarthritis in patients with multiple sclerosis (MS) being equivalent to that of the general population, very little research exists on outcomes and complications following shoulder arthroplasty in patients with this condition. MethodsPatients with MS who underwent anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) were identified in a national insurance database. The following cohorts were then created for analysis: (1) patients with MS who underwent TSA, (2) patients with MS who underwent RSA for a diagnosis other than fracture, and (3) patients with MS who underwent RSA for a diagnosis of fracture. Patients who underwent TSA, RSA, and RSA for fracture without a diagnosis of MS were then identified and matched to study cohorts in a 5:1 manner for demographics and comorbidities for comparison purposes. Each cohort was then assessed for surgical complications (revision surgery, periprosthetic joint infection, prosthetic dislocation) and numerous medical complications. Comparisons were made with logistic regression analyses to control for confounders. ResultsOne thousand seventy seven patients with MS who underwent shoulder arthroplasty were identified, including 386 who underwent anatomic TSA, 570 who underwent RSA for a nonfracture diagnosis, and 121 who underwent RSA for acute or chronic fracture. These were compared to 1930 TSA controls, 2850 RSA controls, and 605 RSA for fracture controls without MS. Overall, the rates of surgical complications were similar between MS patients and their respective matched controls as well as between prosthesis types for MS patients, without any statistically significant differences. Patients with MS had significantly higher rates of urinary tract infections compared to controls for both TSA (odds ratio [OR] 2.48, P = .001) and RSA (OR 2.42, P < .001). Patients with MS who had an RSA for fracture had right rates of venous thromboembolism compared to controls (OR 4.01, P = .011) and RSA for nonfracture (OR 3.83, P = .016). ConclusionPatients with MS undergoing shoulder arthroplasty have similar rates of surgical complications compared to matched controls without MS and between prosthesis types. Patients with MS have higher rates of some postoperative medical complications, including urinary tract infection and venous thromboembolism. The results of the present study suggest that surgeons should not alter their treatment strategies or implant selection for patients undergoing shoulder arthroplasty with a diagnosis of MS.