Total shoulder arthroplasty (TSA) is an increasingly common procedure that improves shoulder pain and function for the arthritic shoulder. Due to the increasing frequency of this procedure, the need and frequency of revision total shoulder arthroplasty (RevTSA) is also increasing. Our aim is to report the rate of complications for primary and revision shoulder arthroplasty.
We conducted a retrospective review of a large commercial insurance database (PearlDiver, USA) between the years 2010-2018. PearlDiver is a publicly available database that captures data on demographics and complications for patients with claims for TSA and RevTSA. Patients who underwent TSA or RevTSA were identified using Common Procedural Terminology (CPT) codes and the appropriate International Classification of Diseases (ICD) codes. Odds ratios were calculated to compare complication rates between primary and revision procedures.
A total of 102,698 patients underwent primary total shoulder arthroplasty between 2010-2018. Data for revision arthroplasty was available 2013-2018, and a total of 4551 had RevTSA, with 1945 having either glenoid or humeral revision and 2891 patients having revision of both components. Of TSA patients, 58% were female and 42% were male, while RevTSA patients consisted of 54% female and 46% male patients. On average, RevTSA patients were older than primary TSA patients (p=0.0172). Odds of surgery related complications within 30 days were significantly more higher in RevTSA than TSA, including surgical site infections (0.62% TSA vs 4.53% RevTSA, OR 7.55, p<0.0001), dislocation (0.96% TSA vs 4.66% RevTSA, OR 5.03, p<0.0001), wound disruption (0.15% TSA vs 0.79% RevTSA, OR 5.49, p<0.0001), and hematoma (0.44% TSA vs 1.30% RevTSA, OR 2.97, p<0.0001). Odds of anemia (0.52% TSA vs 0.83% RevTSA, OR 1.62, p=0.0044), transfusion (1.19% TSA vs 1.51% RevTSA, OR 1.28, p=0.05), acute kidney injury (1.36% TSA vs 1.87% RevTSA, OR 1.38, p=0.0043), and arrhythmia (5.34% TSA vs 6.28% RevTSA, OR 1.19, p=0.0059). There was no difference in 30 day odds of myocardial infarction, congestive heart failure, cardiac arrest, pneumonia, or urinary tract infection between primary and revision surgery.
Using the most recent available data on primary and revision total shoulder arthroplasty, we found that both of the procedures are safe, with infrequent complications. Revision surgery does come with a more frequent incidence of complications, while this population is on average older.