Racial and Socioeconomic Disparities in Risk and Reason for Revision Total Shoulder Arthroplasty

Background: With the rise of total shoulder arthroplasty (TSA), revision TSA is also becoming more prominent. However, there is a paucity of literature on potential racial, ethnic and socioeconomic disparities regarding revision TSA. The purpose of this study is to determine the risk and reason for revision TSA between racial, ethnic and socioeconomic groups.

Methods: The National Inpatient Sample (NIS) was queried from 2016 to 2020 to identify all patients who underwent primary TSA and revision TSA. The risk of revision was calculated for each racial, ethnic and socioeconomic group between 2016 and 2020 using the total number of revision and primary TSA. Reason for revision was also compared between cohorts.

Results: Hispanic patients were 13% less likely to undergo revision TSA than white patients following primary TSA (odds ratio [OR]=0.87). Black and Asian/Pacific Islander patients demonstrated similar risks of revision to white patients. Black and Hispanic patients were 48% and 63% less likely to have mechanical complications as the cause of revision than white patients, respectively (OR=0.52 and OR=0.37), and black patients were five times more likely to require revision due to osteolysis (OR=4.8). Risk of revision TSA was similar between socioeconomic groups. Patients of lower socioeconomic status were less likely to require revision due to mechanical complications or osteolysis than patients in the highest income quartile.

Conclusion: Racial, ethnic and socioeconomic disparities exist in revision TSA, though not to the extent that has previously been investigated in lower extremity total joint arthroplasty. Race was predictive of the reason for revision TSA with black patients undergoing revision for different reasons on average than white patients. The reasons for revision also differed across income quartiles with lowest income quartile patients differing from those in the highest income quartile. Raising awareness and emphasizing the reduction of variability could aid in further decreasing these disparities and alleviating the impact of social determinants of health on revision TSA.