Hypothyroidism may be associated with increased medical, implant complications after TSA
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Key takeaways:
- Hypothyroidism may be associated with increased perioperative and implant complications after shoulder arthroplasty.
- Results were compared with a matched cohort of patients without hypothyroidism.
According to results published in the Journal of Shoulder and Elbow Surgery, patients with hypothyroidism may be at an increased risk for medical and implant-related complications after total shoulder arthroplasty vs. controls.
“Thyroid function is crucial for bone metabolism and immune regulation. While the impact of hyperthyroidism on bone quality is well-documented, the more prevalent hypothyroidism has been largely overlooked in shoulder surgery,” Jad J. Lawand, MS, medical student from the John Sealy School of Medicine at the University of Texas Medical Branch, told Healio. “Our study identified an association between hypothyroidism at the time of total shoulder arthroplasty and an increased risk of revisions.”
Lawand and colleagues performed a propensity-matched, retrospective cohort study of data from patients who underwent primary anatomic or reverse TSA between October 2015 and March 2022 with minimum 2-year follow-up.
Lawand and colleagues compared 90-day medical complications and 2-year implant-related complications between matched cohorts of 7,716 patients who had a preoperative diagnosis of comorbid hypothyroidism within 3 months of surgery and 7,716 patients without hypothyroidism.
At 90 days postoperatively, patients with hypothyroidism had significantly higher rates of sepsis (1.3% vs. 0.6%), infection (0.8% vs. 0.3%), pulmonary embolism (1.6% vs. 0.6%), stroke (2.2% vs. 1.1%), readmission (7.8% vs. 1.8%), anemia (13.6% vs. 5.2%), pneumonia (2.6% vs. 1.1%), renal failure (3.9% vs. 1.8%) and increased blood transfusion requirements (1.3% vs. 0.3%) compared with control patients.
At 2 years postoperatively, patients with hypothyroidism had significantly higher rates of periprosthetic fractures (1.4% vs. 0.6%), periprosthetic joint infection (1% vs. 0.4%), dislocation (1.7% vs. 0.8%), revision arthroplasty (2.7% vs. 1.3%) and mechanical prosthesis loosening (1.8% vs. 1%) compared with control patients.
“These findings highlight the need for further research to confirm this relationship, explore preoperative treatment strategies and evaluate whether hypothyroidism can be addressed as a modifiable risk factor to improve surgical outcomes,” Lawand said.
Perspective
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Hypothyroidism has been shown to be associated with increased postoperative complications in both total knee and total hip arthroplasty. In this study, the authors documented similar concerns about the complication profile of patients with hypothyroidism who had total shoulder arthroplasty. In performing a matched cohort analysis comparing hypothyroid vs. normal thyroid patients (with more than 7,000 patients in each cohort), the authors reported higher complications across multiple organ systems in the hypothyroid cohort. These included higher rates of infection, pulmonary embolism, stroke, postoperative anemia, pneumonia, renal failure and hospital readmission during the first 90 days post-surgery.
At longer follow up, a higher incidence of periprosthetic fracture, dislocation, mechanical loosening and revision surgery was also noted in the hypothyroid cohort. This work brings to light the importance and ramifications of a preoperative hypothyroid diagnosis, and the potential for possible postoperative adverse events. The study indicates further preoperative counseling and education of the risks may be required when hypothyroid patients consider the decision to undergo total shoulder arthroplasty.
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