Patients with prior anterior shoulder instability have a higher risk of prosthetic dislocation and revision surgery after total shoulder arthroplasty: a cohort study.

Abstract

Patients with a history of anterior shoulder instability (ASI) can develop glenohumeral arthritis, and often require total shoulder arthroplasty (TSA). The purpose of this study was to compare complications following TSA in patients with and without a history of ASI. The PearlDiver Mariner database was queried to identify all patients who underwent primary TSA with and without prior ASI from 2010 to 2020 using CPT codes for TSA and laterality-specific ICD-10 codes for ASI. After 1:1 propensity score matching was performed, postoperative mechanical complications, including periprosthetic fracture, prosthetic dislocation, prosthetic joint infection, mechanical loosening, superficial and deep surgical site infection, emergency department (ED) visits, readmissions, and revision surgery were evaluated within 30 days, 90 days and 1 year following TSA. Each cohort consisted of 594 patients after propensity matching. Patients with prior ASI had a statistically significant higher rate of ED visits within 30 days postoperatively. Within 90 days and at 1 year following TSA, patients with prior ASI had a statistically significant higher odds of prosthetic dislocation, revision surgery, and ED visits. Kaplan-Meier analysis demonstrated 1-year dislocation-free and revision-free survivorship rates of 96.5% and 95.8%, respectively, in patients with prior ASI surgery. Patients who underwent TSA with a history of prior ASI had a significantly increased risk of prosthetic dislocation and revision surgery within 90 days and at 1 year postoperatively. Awareness of this risk profile is essential for surgical planning, patient counseling, and optimizing postoperative management in this population. III.