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

Ross, Bailey J.; Wu, Victor; McCluskey, Leland C.; O’Brien, Michael J.; Sherman, William F.; Savoie, Felix H.

doi:10.1053/j.sart.2020.05.006

Cited by 17 publications

(7 citation statements)

References 28 publications

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“…The 1-year PJI rates for TSA (0.75%) and RSA (0.73%) reported in this study are within the range of expected PJI rates based on current literature. 11 , 15 , 18 , 24 The combined 90-day aseptic reoperation rate after shoulder arthroplasty observed in this study was 1.12% which does not significantly differ from the 0.91% reported in the institutional database study by Streubel et al. 22 Use of the PearlDiver database allowed us to query 96,648 shoulder arthroplasty patients across multiple payer-types and geographic locations.…”

Section: Discussionsupporting

confidence: 41%

“…Previous studies have shown this relationship of increased reoperation rates in the 90-day period after RSA compared with TSA. 18 , 22 The etiology of the increased complication rate is likely multifactorial and related to host factors, surgical technique, implant design, and other factors associated with RSA procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Proper component positioning and restoration of soft-tissue tensions intraoperatively are critical for prevention of postoperative instability. 2 , 18 , 19 Patients who may be at increased risk for postoperative instability should be identified preoperatively to optimize outcomes. Postoperative hematoma has been reported as a common complication after index shoulder arthroplasty procedures, particularly in the RSA literature.…”

Section: Discussionmentioning

confidence: 99%

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Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection

et al. 2021

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Background Despite the success of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), the clinical course of some patients necessitates operative intervention in the acute postoperative period. In this study, we evaluate the risk of subsequent prosthetic joint infection (PJI) in patients who undergo an aseptic reoperation within 90 days of primary shoulder arthroplasty. Method A retrospective review of patients with primary TSA and RSA was performed using a commercially available national database (PearlDiver Inc., Fort Wayne, IN, USA). Queries were performed with use of International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Technology codes. Patients were divided into cohorts based on undergoing aseptic reoperation, reoperation for PJI, or no reoperations within 90 days of index procedure. Primary outcome was subsequent PJI within 1 year of index procedure. Observed PJI rates were compared using chi-square analysis. Risk factors for PJI were compared using logistic regression. Results From 2010 to 2018, a total of 96,648 patients underwent primary shoulder arthroplasty: 46,810 underwent TSA and 49,838 underwent RSA. The rate of aseptic reoperation within 90 days was 0.72% and 1.5% in the TSA and RSA cohorts, respectively. At 1 year postoperatively, patients who underwent an aseptic reoperation within 90 days had an elevated risk of subsequent PJI compared with the overall rate of PJI in the TSA (3.54% vs. 0.75%; P < .001) and RSA (3.08% vs. 0.73%; P < .001) cohorts. On multivariate logistic regression analysis, aseptic reoperation within 90 days was identified as a significant risk factor for subsequent PJI in the TSA cohort (odds ratio, 14.19; P < .001) and RSA cohort (odds ratio, 8.38; P < .001). The most common indication for aseptic reoperation was postoperative prosthetic joint instability in both the TSA (31%) and RSA (49%) cohorts. Conclusion Aseptic reoperation within 90 days of primary TSA or primary RSA was associated with a notably increased risk of subsequent PJI.

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Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection

et al. 2021

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“…Similar to previous studies, the use of ICD procedural codes for the procedures instead of CPT-23472 allowed accuracy in identifying TSA versus RSA during the studied time period. 8 , 21 , 22 A comprehensive list of all ICD and CPT codes used in this study are included in Supplementary Table S1 .…”

Section: Methodsmentioning

confidence: 99%

Trending a decade of proximal humerus fracture management in older adults

et al. 2022

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Background Proximal humerus fractures are the third most common fracture in older adults. Because of the aging population, the incidence of these fractures and their impact will continue to grow. With advancement in treatment options for proximal humeral fractures, the aim of this study was to evaluate the trends in acute management of proximal humerus fractures to determine how definitive treatment has changed over the past decade in patients older than 65 years. Methods Using a commercially available database, patient records were queried from 2010 to 2019 for the incidence of proximal humerus fractures. For each individual year, data were queried to identify the incidence of closed reduction percutaneous pinning (CRPP), hemiarthroplasty (HA), intramedullary nailing (IMN), open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), or nonoperative treatment for acute proximal humeral fractures. A Cochran-Armitage trend test was used to determine significant changes in the trends of proximal humerus fracture management. Logistic regression analyses were performed to generate odds ratios (OR) with associated 95% confidence intervals comparing each individual procedure performed in 2019 to 2010. Results A total of 160,836 patients at least 65 years of age and older were diagnosed with a proximal humerus fracture. Of this total, 28,503 (17.72%) patients received operative treatment and 132,333 (82.28%) received nonoperative treatment. From 2010 to 2019, operative treatment trends of proximal humerus fractures changed such that CRPP decreased by 60.0%, HA decreased by 81.4%, IMN decreased by 81.9%, ORIF decreased by 25.7%, TSA decreased by 80.5%, and RSA increased by 1841.4% (all P < .0001). Overall, nonsurgical management increased from 80% to 85% during the examined study period ( P < .0001). Patients in 2019 were significantly more likely to receive an RSA (OR 22.65) and were significantly less likely to receive CRPP (OR 0.45), HA (OR 0.20), IMN (OR 0.20), ORIF (OR 0.82), and TSA (OR 0.22) than patients in 2010. In addition, patients in 2019 were significantly more likely to receive nonoperative treatment than patients in 2010 (OR 1.10). Conclusion Over the past decade, most of older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. Although CRPP, IMN, HA, ORIF, and TSA have decreased, RSA has recently become more widely utilized, which is consistent with what has been noted in other countries. Continued examination of the mid- and long-term outcomes of the increasing percentages in RSA should be performed in this population.

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“…Similar to prior studies on proximal humerus fractures, this study used only ICD-9 and ICD-10 procedural codes to specifically identify RSA and TSA procedures, given the typical CPT code (CPT-23472) includes both RSA and TSA. 16 , 39 , 42 A comprehensive list of all ICD and CPT codes used in this study is included in Supplementary Tables S1 .…”

Section: Methodsmentioning

confidence: 99%

How age and gender influence proximal humerus fracture management in patients older than fifty years

Patel¹,

Wilder²,

Ofa³

et al. 2022

JSES International

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

Cited by 17 publications

References 28 publications

Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection

Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection

Trending a decade of proximal humerus fracture management in older adults

How age and gender influence proximal humerus fracture management in patients older than fifty years

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