Body mass index does not increase risk of complications after reverse total shoulder arthroplasty.

Abstract

As obesity rates continue to rise in the United States, understanding the long-term impact of body mass index (BMI) on outcomes following reverse total shoulder arthroplasty (rTSA) is increasingly important. While prior studies have yielded conflicting results, limited data exist on functional outcomes beyond five years postoperatively. We conducted a retrospective study of 50 shoulders that underwent primary rTSA by a single surgeon, with a mean follow-up of 6.7 years. Patients were stratified into two groups based on BMI: <30 (n = 37) and ≥30 (n = 13). Demographics, range of motion (ROM), patient-reported outcome measures (PROMs), and implant survival were compared between groups. Statistical analyses included t-tests, χ² tests, Pearson correlations, and Kaplan-Meier survival estimates. Both BMI cohorts experienced significant improvements in ROM and PROMs postoperatively. Forward elevation improved from 81.3° to 133.5° (p < .01), and VAS pain scores decreased from 6.1 to 1.7 (p < .01). There were no statistically significant differences between BMI groups in final ROM, ASES, SST, or VAS scores. Implant survival was similar between groups. No significant correlations were found between BMI and long-term functional outcomes. BMI does not significantly affect long-term clinical or functional outcomes following rTSA. Despite higher BMI posing potential perioperative challenges, obese patients can achieve comparable improvements in pain, ROM, and quality of life. These findings support the efficacy of rTSA across BMI categories when appropriate perioperative care is provided.