The impact of neurologic disorders on clinical and functional outcomes after shoulder arthroplasty: a systematic review

Background: Patients with pre-existing neurologic disorders present a unique set of challenges for shoulder arthroplasty (SA) surgeons due to the presence of concomitant contractures, muscle weakness, and spasticity, which may affect outcomes and complication rates after SA. The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients pre-existing with neurologic disorders, focusing on complication and reoperation rates.

Methods: This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on outcomes after SA in patients with neurologic disorders. Study demographics and information on outcomes including patient-reported outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the Methodological Index for Nonrandomized Studies scoring system.

Results: Twenty articles published between 1997 and 2023 met inclusion criteria. In total, 13,126 patients with neurologic conditions with 7 different neurologic disorders (Parkinson's disease, epilepsy and seizures, cerebral palsy, poliomyelitis, Charcot neuropathy, cerebrovascular disease, and multiple sclerosis) were included. The mean patient age was 64.3 years (range, 33.0-75.8 years), 51.4% of patients were male, and the mean postoperative follow-up time was 5.1 years (range, 1.4-9.9 years). Parkinson's disease was the most reported neurologic disorder (9 studies, 8033 patients), followed by epilepsy (4 studies, 3783 patients), and multiple sclerosis (1 study, 1077 patients). While these patients did experience improvements in outcomes following SA, high complication and revision rates were noted.

Conclusions: Patients with neurologic disorders demonstrate improvements in pain and function after SA but have higher reported complication and revision rates when compared with patients without neurologic conditions. This systematic review offers valuable data for both the surgeon and patient regarding anticipated clinical results and possible complications from SA in patients with neurologic disorders that may aid in shared decision-making when considering SA.