Outcomes and complications of shoulder arthroplasty in patients with rheumatoid arthritis: A large insurance claims matched cohort analysis.

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation, pain, and stiffness, often progressing to joint erosion and deformity. Shoulder arthroplasty is a reliable treatment for alleviating severe arthritic pain in RA patients. This study examines the outcomes and complications of shoulder arthroplasty in individuals with RA. A retrospective cohort study using the PearlDiver national insurance claims database identified patients over 18 who underwent primary shoulder arthroplasty, including anatomic, reverse, and hemiarthroplasty, between 2010 and 2020. Patients with preoperative RA were matched 1:2 with healthy controls by age and gender. Primary outcomes included revision arthroplasty and rotator cuff repair (RCR), while 90-day complications such as infections, wound disruption, and medical conditions were secondary outcomes. Statistical significance was assessed using multivariate and Chi-square analyses. Of 33,282 patients, 11,431 (34.3 %) had preoperative RA. The RA group exhibited significantly higher rates of 90-day complications, including infections (OR 4.4, p < 0.001), ED visits (OR 3.0, p < 0.001), cardiac arrhythmias (OR 3.0, p = 0.015), deep vein thrombosis (OR 1.3, p = 0.045), and pulmonary embolism (OR 4.2, p < 0.001). However, no significant differences were observed in revision or RCR rates between groups. Patients with RA undergoing shoulder arthroplasty face increased risks of postoperative complications compared to controls, highlighting the need for tailored perioperative strategies to optimize outcomes in this high-risk population.