Enhanced risk of 90-day medical and 2-year implant-related complications in total shoulder arthroplasty patients with osteoporosis

Background: As the average age of patients undergoing shoulder arthroplasty (SA) increases, the frequency of SA patients with osteoporosis is expected to rise. While the effects of osteoporosis have been described in the broader orthopedic literature, it is presently unclear how osteoporosis affects SA postoperative medical and implant-related outcomes.

Methods: A multicenter database TriNetX was queried for patients between 2011 and 2021 who underwent SA with and without osteoporosis. Patients with less than 2 years of follow-up and those with a prior shoulder hemiarthroplasty were excluded. Primary outcomes included 2-year periprosthetic joint infection, prosthesis dislocation, periprosthetic fracture, and revision surgery. Secondary outcomes included 90-day medical complications and readmissions. Osteoporotic and control patient cohorts were propensity matched in a 1:1 ratio.

Results: Seven thousand eight hundred forty-two patients were included after matching in each cohort. Baseline demographic variables were similar between groups, except osteoporotic patients had a lower body mass index (28.6 vs. 31.0 kg/m²; P < .001). Osteoporotic patients undergoing SA were more likely to experience wound disruptions, stroke, pulmonary embolism, deep vein thrombosis, myocardial infarction, anemia, pneumonia, renal failure, transfusion, and readmission within 90 days after surgery. At 2 years postoperative, osteoporotic SA patients experienced an elevated risk of mechanical loosening, periprosthetic joint infection, dislocation, periprosthetic fracture, and required revision surgery at a higher rate than control patients.

Conclusions: Osteoporotic patients undergoing SA are at greater risk for medical complications within the 90 days perioperative period as well as implant-related complications within 2 years of surgery. Patients and surgeons should be aware of the potential higher risk of complications in osteoporotic patients following SA, and further investigation into benefits of preoperative management and treatment of osteoporosis is necessary.