Metabolic syndrome can increase complication rate after reverse shoulder arthroplasty
Click Here to Manage Email Alerts
Results showed patients with metabolic syndrome were more likely to have complications after reverse shoulder arthroplasty, despite no increase in complications, reoperation or revision surgery in primary shoulder arthroplasty.
Bradley S. Schoch, MD, and colleagues collected and classified data on 4,635 adults who underwent primary shoulder arthroplasty based on the presence or absence of metabolic syndrome, defined as the existence of type 2 diabetes mellitus and a minimum of two of the following diagnoses: hyperlipidemia, hypertension and BMI of 30 kg/m2 or greater within 1 year of surgery. Researchers compared demographics, complications, reoperation and revision surgery among patients with (n=714) vs. without (n=3,921) metabolic syndrome.
Results showed 9.4% and 8.7% of patients with and those without metabolic syndrome, respectively, sustained at least one postoperative complication after primary shoulder arthroplasty. Researchers identified rotator cuff failure as the most common complication in 1.8% of cases overall, as well as in both patients with and those without metabolic syndrome. Infection was the second most common complication in 1.2% of cases, according to results.
Researchers found rotator cuff failure was the most common complication for anatomic total shoulder arthroplasty, while periprosthetic fracture was the most common complication for RSA. Patients with metabolic syndrome who underwent RSA had significantly higher rates of deep infection, instability and deep vein thrombosis/pulmonary embolism vs. patients without metabolic syndrome. Results showed reoperations and revisions occurred in 5% and 4.2% of patients with metabolic syndrome, respectively, compared with 4.3% and 3.2% of patients without metabolic syndrome. Both groups had equal Kaplan-Meier 5-year survivorship free from reoperation, revision and prosthetic joint infection, according to results.
“As orthopedic surgeons, our job is to educate patients on the risks, potential benefits and alternative treatment options for their condition. In this study, we showed that metabolic syndrome in patients treated with reverse shoulder arthroplasty were twice as likely to sustain a deep infection after surgery, which is a devastating complication for any patient,” Schoch, of the Mayo Clinic in Jacksonville, Florida, told Healio Orthopedics. “As orthopedic surgeons, we need to consider the whole health of our patients and advocate for optimization and modification of correctable health conditions which lower the risks of adverse postoperative complications. This type of data is now being incorporated into predictive algorithms, which can quickly outline patients’ risk for various complications following elective shoulder arthroplasty and help both patients and providers make informed medical decisions.”
Perspective
Back to Top
I enjoyed reading this article. Metabolic syndrome is an increasing problem in our patient population. In this study, 15.4% of patients undergoing primary shoulder arthroplasty had metabolic syndrome. Shoulder arthroplasty is a large operation with inherent surgical and medical risks. In this study, approximately 9% of all patients had sustained at least one postoperative complication at mean follow-up. That is significant. Knowing the extra risk involved with treating patients with metabolic syndrome is helpful. Fortunately, in looking at this group as a whole having metabolic syndrome did not significantly alter the rate of postoperative complication, survivorship free from reoperation or revision surgery.
However, in the reverse shoulder arthroplasty group, deep infection, instability, and DVT were found to be significantly higher in patients with metabolic syndrome compared to those without it. Additionally, the reverse shoulder arthroplasty group had a higher rate of complications when compared to anatomic shoulder arthroplasty group. Knowing this information when making decisions for surgery is helpful.
Collapse
Read more about
Click Here to Manage Email Alerts