Shoulder hemiarthroplasty for OA linked with increased 30-day complication rates vs. TSA

Matthew J. DiPaola, MD

This is a retrospective propensity-matched analysis of a large cohort of patients who underwent TSA or hemiarthroplasty during a 10-year period. The chief finding was that hemiarthroplasty was associated with a higher 30-day overall complication rate in this dataset.

The authors are to be commended for including a large number of variables that were previously reported to influence early complication rate after shoulder arthroplasty. What sets this study apart is that the authors also controlled to ensure that the patients were all indicated for the same diagnosis: glenohumeral OA.

However, one should caution against drawing the conclusion that hemiarthroplasty was the true causative factor responsible for the higher complication rate. In fact, the authors themselves note, “The higher rate of 30-day complications observed in this study may have been influenced by the surgeon selection of candidates for [hemiarthroplasty] HA vs. TSA more than the procedure itself.”

Indeed, after propensity matching, factors such as morbidity probability, mortality probability, BMI and dependent functional status were noted to be significantly different between groups. In addition, length of stay, a factor noted by Matthew Kim, BA, and colleagues, to be independently associated with increased postoperative complication risk after TSA, was noted to be significantly increased in the hemiarthroplasty group compared to TSA group.

It does not appear that depression, another known risk factor for complications after TSA, was evaluated in this study. Nor does this dataset illuminate whether the surgeons performing these operations were high-volume shoulder arthroplasty surgeons or low-volume shoulder arthroplasty surgeons, yet another factor that has been shown to correlate with overall complication rate after shoulder arthroplasty.

Large datasets are good. Propensity matching can help even out some demographic factors when comparing surgical procedures. But a randomized, prospective study design or a deeper understanding of individual surgeon preoperative decision-making would give readers better insight as to whether the operative intervention (hemiarthroplasty vs. TSA) truly influenced the overall complication rate.

In my opinion, it would be unlikely for hemiarthroplasty, a lower complexity and time-consuming surgery than TSA, to increase the complication rate. The true causative factor of the increased complication rate noted in patients who underwent hemiarthroplasty is likely not the difference in replacing the glenoid.

References:

Hammond JW, et al. J Bone Joint Surg Am. 2003;doi:10.2106/00004623-200312000-00008.

Kim M, et al. JSES Int. 2023;doi:10.1016/j.jseint.2023.07.011.

Lunati MP, et al. J Shoulder Elbow Surg. 2021;doi:10.1016/j.jse.2020.04.015.