Revision Surgeries Rise with Shoulder Replacements

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Shoulder replacement in arthritis patients has increased in recent decades, but research shows that more replacements fail than previously thought, requiring more revision surgeries.

Study results published in the British Medical Journal revealed men and women experience higher incidence of replacement failures and more post-surgery adverse events. These findings show, investigators said, patients, particularly younger ones, should evaluate shoulder replacement risks prior to surgery.

“These risks are higher than previously considered, and, for some, could outweigh any potential benefits,” they said. “Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients.”

Researchers analyzed 58,054 post-surgical results in 51,895 patients over age 50 between 1998 and 2017. The average age at surgery was 72.2 years, and most procedures (72 percent) were performed on women. Osteoarthritis, rotator cuff tear arthropathy, inflammation, previous trauma, and osteonecrosis were the most common indications for surgery. Patients with acute shoulder trauma or bone tumor were excluded.

Results showed the estimated lifetime revision surgery risk is highest in younger, male patients-approximately 25 percent of men age 59 and younger will require another procedure. However, all younger patients face a greater risk-patients age 55-59 have a four-fold risk compared to those over age 85.

Despite previous research showing low serious side effect rates, this study disagreed. Data analysis revealed 3.5 percent of patients experienced a problem within 30 days, and 4.6 percent did so within 90 days with incidence rates being highest in older patients and men. The most common adverse events were lower respiratory tract infections (1.9 percent), urinary tract infections (1.4 percent), and acute kidney injury (1.0 percent). Others included pulmonary embolism and myocardial infarction, both 0.3 percent.

Researchers suggested these findings could be used to better assess which patients should proceed with shoulder replacement surgery.

“Patients need to be informed of these [risk] levels and carefully counseled about the potential risks of serious adverse events,” they said. “The alarmingly high rates of adverse events in elderly patients with co-morbidities suggests that better approaches to patient selection, preparation, and postoperative care might be required.”

REFERENCE

Craig R, Lane, J, Carr A, Furniss D, Collins G, Rees J, Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England. British Medical Journal (2019), doi: 10.1136/BMI.1298