Doing an arthroplasty on the opposite (second) side - don't rush it!

The relationship of bilateral shoulder arthroplasty timing and postoperative complications

These authors investigated the effect of time between bilateral shoulder arthroplasties on the complication rate using two insurance databases.

 From 2005-2016, a total of 1764 patients (6.3%) underwent bilateral shoulder arthroplasty out of 27,962 shoulder arthroplasties

Of the bilateral patients, 49.1% waited more than 1 year before their second shoulder arthroplasty.

Patients waiting less than 3 months between surgeries comprised 4.9% of the total number of staged bilateral surgeries. 

Overall, implant complications were higher in patients with surgeries less than 3 months apart compared to controls, including revision arthroplasty, loosening/lysis, and periprosthetic fracture. There were no significant increases in any implant-related complications when surgeries were staged by 3 months or more compared to controls. 

Venous thromboembolism and blood transfusion occurred at a significantly higher rate in patients with less than 3 months between surgeries compared with controls. There were no differences in any medical complications when surgeries were staged by 3 months or more compared with controls.

Comment: Shoulder arthritis is often a bilateral condition. For a variety of reasons, patients and physicians may wish to have the second side arthroplasty done soon after the first. One of these reasons is to have the surgeries in the same calendar year so that a second deductible payment is not needed.  

This study indicates that if the second arthroplasty is performed within 3 months, the complication rate essentially doubles: 

revision arthroplasty -11.6% vs. 5.4%, 

loosening/lysis - 8.1% vs. 3.5%

periprosthetic fracture -  4.7% vs. 1.2%

venous thromboembolism - 8.1% vs. 2.2%

blood transfusion - 9.3% vs. 1.7%

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