Perioperative shingles diagnosis does not influence prosthetic joint infection rates after shoulder arthroplasty.

Abstract

Shoulder arthroplasty (SA) utilization has increased substantially, with a corresponding rise in revision procedures, many driven by periprosthetic joint infection (PJI). Herpes zoster (HZ), or shingles, is increasingly prevalent among older and immunocompromised patients and shares overlapping risk factors with PJI. However, the association between shingles and postoperative complications following SA is unknown. This study evaluated the relationship between peri-operative shingles and postoperative complications after SA. Patient-level claims from adults ≥ 18 years undergoing SA between 2016 and 2022 from a 20% Medicare fee-for-service sample and the IBM^® MarketScan^® Commercial Database were retrospectively collected. Shingles diagnoses from one year preoperatively through one year postoperatively were identified. For postoperative shingles, the diagnosis date was required to precede the earliest censoring event (outcome occurrence, loss to follow-up, end of follow-up) to maintain appropriate temporality of events. Outcomes within one year included revision arthroplasty, irrigation and debridement (I&D), implant removal, or shoulder PJI. Incidence rates (IRs) per 100 person-years and incidence rate ratios (IRRs) were calculated for a composite primary outcome. Associations between shingles and outcomes were evaluated using three Cox regression approaches with covariate adjustment. Among 26,543 patients, 1.4% had shingles preoperatively and 1.0% developed shingles on or after surgery. The IR of the primary outcome was lower in patients with (IR 3.78; 95% CI 2.20-5.36) than without shingles (IR 5.06; 95% CI 4.77-5.35), but without statistical significance (IRR 0.75; 95% CI 0.49-1.14). No analytic approach showed a significant association, and no effect modification was observed. Shingles diagnosed within one year before or after shoulder arthroplasty was not associated with increased risk of revision surgery, I&D, implant removal, or PJI within one year postoperatively.