Total Shoulder Arthroplasty For Primary Osteoarthritis Research Articles

The association of alcohol use disorder with revision rates and post-operative complications in total shoulder arthroplasty

Background Alcohol use disorder (AUD) is the most prevalent substance use disorder in the United States. However, the current literature on AUD as a preoperative risk factor for Total Shoulder Arthroplasty (TSA) outcomes is limited. The purpose of this study was to identify the association of AUD with revision rates and 90-day postoperative complications in TSA. Methods A retrospective study was conducted using the PearlDiver database. Patients diagnosed with AUD were identified. Patients in remission or with underlying cirrhosis were excluded. Outcomes included 2-year revision, 90-day readmission, 90-day emergency, and 90-day post-operative medical complications. Analysis was performed with univariate chi-squared tests followed by multivariable logistic regression. Results A total of 59,261 patients who underwent TSA for osteoarthritis were identified, with 1522 patients having a diagnosis of AUD. Multivariable logistic regression showed that patients with AUD were more likely to undergo 2-year all-cause revision (OR = 1.49, p = 0.007), 2-year aseptic revision (OR = 1.47, p = 0.014), 90-day hospital readmission (OR = 1.57, p = 0.015), and 90-day transient mental disorder (OR = 2.13, p = 0.026). Conclusions AUD is associated with increased rates of 2-year revision surgery, as well as 90-day readmission and 90-day transient mental disorder following primary TSA for osteoarthritis. These findings may assist orthopedic surgeons in counseling patients with AUD during the pre-operative course.

Cannabis use disorder is not a risk factor for thrombotic events or medical complications following total shoulder arthroplasty

BackgroundIn recent years, there has been an increase in utilization of cannabis. Existing studies have found cannabis use disorder (CUD) to be associated with increased incidence of perioperative complications in lower extremity arthroplasty. However, studies examining CUD following total shoulder arthroplasty (TSA) are limited. The aim of this study was to evaluate the effect of comorbid CUD on 2-year revision and 90-day postoperative outcomes in primary TSA for osteoarthritis. MethodsA retrospective cohort analysis was conducted using the PearlDiver database. Current Procedural Terminology, ICD-9, and ICD-10 codes were used to identify patients undergoing TSA for the indication of osteoarthritis and were divided into a CUD and control group. The primary outcomes of interest were 2-year all-cause revision, 90-day hospital readmission, and 90-day emergency department (ED) visit. Surgical perioperative complications included prosthetic joint infection, periprosthetic fracture, aseptic loosening, articular bearing surface wear, broken prosthesis, and prosthetic dislocation. Univariate analysis and multivariable logistic regression were conducted to analyze the data. ResultsA total of 205,792 patients undergoing TSA were identified. The CUD cohort contained 2058 patients, and the control cohort contained 203,734 patients. After controlling for comorbidities, there were statistically significant differences in 2-year revision outcomes. Multivariable results also showed no association with 90-day medical or surgical complications, with the exception of convulsions, 90-day presentation to an eED, and readmission. Discussion and ConclusionOur study showed that patients with CUD have an increased risk of 2-year all-cause revision, readmission, and ED presentation after undergoing TSA. However, CUD was not found to be an independent risk factor for adverse 90-day medical complications, deep vein thrombosis, or length of stay. The results of this research expand the literature on TSA and comorbid substance use. Further, our findings can assist orthopedic surgeons in counseling patients regarding CUD as a risk factor for complications of TSA.

Comparison of patient-demographics, causes, and costs of 90-day readmissions following primary total shoulder arthroplasty for glenohumeral osteoarthritis

IntroductionReadmissions following orthopaedic surgery are associated with worse outcomes and increased healthcare costs. Studies investigating trends, causes, and costs of readmissions following primary total shoulder arthroplasty (TSA) for the indication of glenohumeral osteoarthritis (OA) are limited. The objective was to compare: 1) patient-demographics of those readmitted and not readmitted within 90-days following primary TSA for OA; 2) causes of readmissions and 3) associated costs. MethodsA retrospective query from 2005 to 2014 was performed using a nationwide administrative claims database. The study group consisted of patients readmitted within 90-days following primary TSA for glenohumeral OA, whereas patients not readmitted served as controls. Causes of readmission were stratified into the following groups: cardiovascular, hematological, endocrine, gastrointestinal (GI), musculoskeletal (MSK), neoplastic, neurological, pulmonary, infectious, renal, and miscellaneous causes. Patient demographics were compared, in addition to the frequency of the causes of readmissions, and their associated costs. Chi-square analyses compared demographics between groups. Analysis of variance was utilized to determine differences in 90-day costs for the causes of readmission. A p-value less than 0.001 was significant. ResultsThe overall 90-day readmission rate was 2.4% (3432/143,878). Patients readmitted following primary TSA were more likely to be over the age of 75, female, and higher prevalence of comorbid conditions, including psychiatric and medical conditions. Readmitted patients had a higher overall comorbidity burden per mean Elixhauser-Comorbidity Index (ECI) scores (10 vs. 7,p < .0001). The leading cause of readmissions were due to MSK (17.34%), cardiac (16.28%), infectious (16.26%), and gastrointestinal (11.64%) etiologies. There were differences in the mean 90-day costs of care for the various causes of readmissions, with the leading cost of readmissions being cardiac causes ($10,913.70) and MSK ($10,590.50) etiologies. ConclusionPatients with greater comorbidities experienced increased incidence of readmission following TSA for glenohumeral OA. Cardiac and MSK etiologies were the primary cause of readmissions. Level of evidenceIII.