Summary

Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent complications and reduced clinical improvement compared to primary shoulder arthroplasty patients.

Abstract

Background

Patients who undergo total shoulder arthroplasty (TSA) typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty performed at a single institution.

Methods

Retrospective chart review was conducted for patients who underwent revision shoulder arthroplasty between January 2015 and May 2021 (N=152, 126 reverse TSA, 26 TSA). Relevant procedures included surgery for component exchange, single-stage or two-stage revision, debridement, antibiotics, and implant retention (DAIR), conversion of anatomic to reverse TSA, or conversion of hemiarthroplasty to TSA. A cohort of patients who underwent primary TSA (126 reverse TSA, 26 TSA) in the same period was generated by matching 1:1 for implant type (anatomic or reverse), age, and surgery date. Demographic data, patient reported-outcomes, surgical details, complications, and reoperations were collected for both cohorts (N=304). Univariate analyses were performed to analyze patient factors and outcomes. Categorical variables were analyzed using chi-square and Fisher's exact tests, where appropriate. Continuous variables were analyzed using a two-sample t-test or Mann-Whitney test, where appropriate.

Results

The revision cohort experienced a higher rate of complications than the primary cohort (N=58, 38.2% vs. N=22, 14.5%; P<.0001). Reverse TSA had 14.3% and 37% complication rate and TSA had 15.4% and 42.3% complication rate in primary and revision cohorts, respectively . The distribution of complication types differed significantly between the primary and revision cohorts (P = .018). Revision patients reported less improvement in Single Assessment Numeric Evaluation (SANE) score from baseline to two-years follow-up compared to primary patients (post-pre scores 33.9±35.9 vs. 52.3±32.5; P=.036). Patients in the primary cohort who underwent a previous shoulder surgery prior to their shoulder arthroplasty were more likely to experience complications than those who did not (P<.001). The two most common complication types in the revision cohort were persistent pain (N=20) and periprosthetic joint infection (N=10), and in the primary cohort were persistent pain (N=6) and instability (N=4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision cases (120±68 min) than primary cases (94±31 min; P<.0001). 72.7% of primary patients who experienced complications were male, while 44.6% of those who did not experience complications were male (P=.020). Patients in the revision cohort who experienced complications had higher estimated blood loss during surgery (165±110 cc) than those without complications (125±83 cc; P=.049). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (P=.043).

Conclusions

Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent complications and reduced clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.