The influence of prior shoulder surgery on implant survival and patient-reported outcomes of shoulder arthroplasty as analyzed by the Dutch Arthroplasty Register (LROI).

Abstract

Shoulder arthroplasty effectively treats various degenerative and traumatic shoulder conditions, but outcomes can be compromised by complications, limited mobility, and persistent pain. The impact of previous non-arthroplasty surgery on functional outcomes remains unclear. Therefore, the purpose of this study is to determine if a history of prior non-arthroplasty shoulder surgery is associated with worse functional outcomes after primary shoulder arthroplasty. This registry study with data sourced from the Dutch Arthroplasty Register (LROI) includes adult patients who underwent primary arthroplasty between 2014 and 2022, with or without a history of prior non-arthroplasty shoulder surgery. Prior surgeries were divided in the following categories: osteosynthesis, stabilization, rotator cuff, subacromial decompression, and other shoulder surgeries. The outcomes of the study include revision rate, shoulder function and shoulder pain. 25,188 shoulder arthroplasty procedures were recorded in the registry between 2014 and 2022. Of the procedures, 18,160 (72.1%) were reverse total shoulder arthroplasty, 4,772 (18.9%) anatomic total shoulder arthroplasty, and 2,256 (9.0%) hemi shoulder arthroplasty. A total of 4,203 patients (16.7%) underwent prior shoulder surgery, while 20,985 (83.3%) did not. From 2017 onwards, completion rates of PROMs ranged from 21.2% to 30.0%. Prior shoulder surgery was associated with higher chance of revision surgery (HR (95%CI) = 1.48 (1.31 to 1.68), n=25,188). Prior surgery was associated with less improvement in shoulder function (regression coefficient (95%CI) = -2.84 (-3.83 to -1.84), n=3,206), less improvement in pain score at rest (regression coefficient (95%CI) = -0.57 (-0.77 to -0.37), n=3,325) and less improvement in pain during activity (regression coefficient (95%CI) = -0.64 (-0.88 to -0.41), n=3,318) after 12 months. Patients with a history of osteosynthesis (HR (95%CI) = 1.58 (1.31 to 1.91)) or rotator cuff repair (HR (95%CI) = 1.47 (1.18 to 1.83)) had lower prosthesis survival compared to those without such interventions. A history of non-arthroplasty shoulder surgery is associated with higher revision rates and poorer patient-reported outcomes after primary shoulder arthroplasty. These findings highlight the importance of surgical history in preoperative counseling and risk stratification.