Sex hormone deficiencies may be associated with rotator cuff repair
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According to published results, female patients with estrogen deficiency and male patients with testosterone deficiency have “significantly” higher odds of rotator cuff repair compared with patients without a sex hormone deficiency.
Karch M. Smith, BA, of the department of orthopedic surgery at the University of Utah, and colleagues performed a retrospective analysis on 229,986 patients aged 18 to 64 years who underwent primary rotator cuff repair (RCR) for a rotator cuff tear from Jan. 1, 2008, to Dec. 31, 2017. The researchers also analyzed a control group of 229,986 patients who were matched for age, sex and year of RCR. According to the study, the researchers used data from the Veterans Genealogy Project database and multivariable logistic regression models to estimate relative risk for RCR for patients with and without sex hormone deficiency (SHD).
Overall, 27% of women patients in the RCR group were diagnosed with estrogen deficiency (ED) compared with 20% of women in the control group, while 7% of men patients were diagnosed with testosterone deficiency (TD) compared with 4% of men in the control group. Smith and colleagues found the odds of RCR for women patients with ED were 48% higher (OR = 1.48) than those without ED. Similarly, the odds of RCR for men with TD were 89% higher (OR = 1.89) than those without TD.
After analysis of the Veterans Genealogy Project database, Smith and colleagues determined the RR of ED among patients who underwent RCR was 2.58, while the RR of TD among patients who underwent RCR was 3.05.
“As hypothesized, SHD was associated with a significantly increased incidence of RCR within two independent databases. These results further support the hypothesis that rotator cuff disease is partially secondary to circulating systemic factors,” the researchers wrote in the study.
“Future prospective studies will be necessary to understand the relationship of sex hormones to the pathophysiology of rotator cuff disease,” they added.
Perspective
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The authors have studied the association between SHD (testosterone and estrogen) and rotator cuff disease using a large commercial claims database that represents approximately 161 million patients across a wide demographic. Additionally, a supplemental confirmatory analysis using the Veteran Affairs Genealogy Project database was performed. As such, these large database-mining studies do have inherent selection biases associated with the results as data input is crucial. However, this study design was robust.
There were four subgroups studied. Women with and without estrogen deficiency and men with and without testosterone deficiency. Patients were between 18 and 64 years of age and underwent a RCR for cuff tear (RCT). These were studied against matched controls. The study population was 459,972 patients.
Conclusions were that SHD was associated with a “significantly increased incidence of RCR” in both female and male cohorts. The authors discuss the important role of systemic factors on RCT and RCR healing. As these may be modifiable risk factors, further research must be performed to increase our awareness of these factors and possible interventions to aid in prevention and treatment of rotator cuff disease. The authors should be commended for this important work.
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