Increased revision rates in shoulder arthroplasty following shoulder arthroscopy

Introduction: Total shoulder arthroplasty (TSA) and reverse TSA (rTSA) are successful treatments for end-stage shoulder arthritis. However, it is unknown whether prior arthroscopy is associated with an increased risk for revision surgery. This study investigates if undergoing a shoulder arthroscopy in the year prior to primary arthroplasty increases risk of revision surgery within 2 years.

Methods: Patients who underwent TSA or rTSA between 2005 and 2017 were identified in a natinal claims database and stratified into two cohorts: (1) individuals with a history of shoulder arthroscopy prior to arthroplasty and (2) individuals with no documented history of arthroscopy prior to arthroplasty. These cohorts were propensity matched based on demographic and comorbidity factors. Univariate analysis was used to determine differences in revision rates, aseptic loosening, periprosthetic fracture, and infection between the two cohorts.

Results: Seven hundred and eighty-eight patients were successfully matched from the two cohorts. Revision surgery (3.4% vs. 1.4%, p = 0.001) and aseptic loosening (2.2% vs. 0.8% p = 0.021) were significantly more common in the arthroscopy cohort. Periprosthetic fracture and periprosthetic infection were not found to be significantly different between cohorts.

Discussion: Shoulder arthroscopy in the year prior to shoulder arthroplasty is associated with an increased risk of complications, including revision and aseptic loosening.