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Osteoporosis and Implant-Related Complications After Anatomic and Reverse Total Shoulder Arthroplasty

Casp, Aaron J. MD; Montgomery, Samuel R. Jr BS; Cancienne, Jourdan M. MD; Brockmeier, Stephen F. MD; Werner, Brian C. MD

Journal of the American Academy of Orthopaedic Surgeons: May 29, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-18-00537
Research Article: PDF Only

Introduction: Osteoporosis is a widespread and growing medical condition, with significant orthopaedic implications. However, the effect of osteoporosis on outcomes after total shoulder arthroplasty (TSA) is not well understood. The goal of the present study was to characterize the incidence of osteoporosis in patients undergoing shoulder arthroplasty and to examine whether patients with osteoporosis undergoing anatomic and reverse TSA are at an increased risk of prosthetic-related complications.

Methods: Complication rates were calculated for patients with osteoporosis who underwent anatomic and reverse TSA as separate cohorts within 2 years of surgery including loosening/osteolysis, periprosthetic fracture, periprosthetic dislocation, and revision shoulder arthroplasty and compared using a multivariable logistic regression analysis to control for patient demographics and comorbidities during comparisons, including the indication for reverse TSA.

Results: The prevalence of an osteoporosis diagnosis at the time of surgery was 14.3% for anatomic TSA patients and 26.2% of reverse TSA patients. Anatomic TSA patients with osteoporosis experienced significantly higher rates of periprosthetic fracture (odds ratio [OR], 1.49; P = 0.017) and revision shoulder arthroplasty (OR, 1.21; P = 0.009) within 2 years of surgery compared with matched controls without osteoporosis. Patients in the reverse TSA group with osteoporosis also had significantly higher rates of periprosthetic fracture (OR, 1.86; P = 0.001) and revision shoulder arthroplasty (OR, 1.42; P = 0.005) within 2 years of surgery compared with matched controls.

Discussion: A significant number of patients undergoing both anatomic and reverse TSA have a concurrent diagnosis of osteoporosis. Osteoporosis represents a significant independent risk factor for periprosthetic fracture and revision shoulder arthroplasty within 2 years of surgery, regardless of the type of implant. Patients with osteoporosis should be counseled on their increased risk of complications after shoulder arthroplasty.

From the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Casp, Dr. Cancienne, Dr. Brockmeier, and Dr. Werner), and the University of Virginia School of Medicine, Charlottesville, VA (Mr. Montgomery).

Correspondence to Dr. Werner: BCW4X@virginia.edu

Dr. Brockmeier or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex, Zimmer Biomet, and Exactech; serves as a paid consultant to Arthrex, Zimmer Biomet, and Exactech; has received research or institutional support from Arthrex and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Mid-Atlantic Shoulder and Elbow Society. Dr. Werner or an immediate family member has received research or institutional support from Arthrex, Zimmer Biomet, and Integra LifeSciences and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine and American Shoulder and Elbow Surgeons. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Casp, Mr. Montgomery, and Dr. Cancienne.

© 2019 by American Academy of Orthopaedic Surgeons
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