These authors reviewed patients from two insurance databases who underwent staged bilateral shoulder arthroplasty (either anatomic or reverse) between 2005 and 2016. Patients with prior infection, those undergoing hemiarthroplasty, arthroplasty for a diagnosis of proximal humerus fracture and revision shoulder arthroplasty were all excluded. Patients were then stratified by elapsed time between surgeries into four study groups: (1) less than three months, (2) 3-6 months, (3) 6-9 months, and (4) 9-12 months.
Surgical and perioperative medical complications of these patient cohorts were compared to a control group that underwent bilateral shoulder arthroplasty with greater than a one-year interval between surgeries.
From 2005-2016, 1,764 patients (6.3%) underwent bilateral shoulder arthroplasty out of 27,962 shoulder arthroplasties performed in the two databases.
From 2005-2016, 1,764 patients (6.3%) underwent bilateral shoulder arthroplasty out of 27,962 shoulder arthroplasties performed in the two databases.
Of the bilateral patients, 49.1% waited more than one year before their second shoulder arthroplasty.
Patients waiting less than three months between surgeries comprised 4.9% of the total number of staged bilateral surgeries.
Implant complications were higher in patients with surgeries less than 3 months apart compared to controls, including revision arthroplasty (11.6% vs 5.4%), loosening/lysis (8.1% vs 3.5%) and periprosthetic fracture (4.7% vs 1.2%).
Implant complications were higher in patients with surgeries less than 3 months apart compared to controls, including revision arthroplasty (11.6% vs 5.4%), loosening/lysis (8.1% vs 3.5%) and periprosthetic fracture (4.7% vs 1.2%).
There were no significant increases in any implant-related complications when surgeries were staged by 3 months or more compared to controls.
Venous thromboembolism (8.1% vs 2.2%) and blood transfusion (9.3% vs 1.7%) occurred at a significantly higher rate in patients with less than 3 months between surgeries compared to controls.
There were no differences in any medical complications when surgeries were staged by 3 months or more compared to controls.
Comment: Patients may be eager to have the "second side done", often because of the desire to minimize insurance deductibles by having both procedures done in the same year. This article provides useful information regarding the risks of the second surgery within 3 months.
While it is not specifically addressed in this study, the data suggest that any major surgical procedure during the preoperative 3 months may increase the risk or surgical and medical complications from shoulder arthroplasty.
It is worth noting that complications after shoulder arthroplasty are not rare, even in the control group: 5.4% revision, 3.5% loosening/lysis, 1.2% periprosthetic fracture, 2.2% venous thromboembolism and 1.7% blood transfusion.
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A respected colleague emailed:
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While it is not specifically addressed in this study, the data suggest that any major surgical procedure during the preoperative 3 months may increase the risk or surgical and medical complications from shoulder arthroplasty.
It is worth noting that complications after shoulder arthroplasty are not rare, even in the control group: 5.4% revision, 3.5% loosening/lysis, 1.2% periprosthetic fracture, 2.2% venous thromboembolism and 1.7% blood transfusion.
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A respected colleague emailed:
"This type of study gives us information but does not interpret it.
Is it possible that surgeons who are willing to agree to do bilateral shoulder arthroplasties with short time interval are more likely to cause surgical or implant related complications. How about the potential psychosocial aspects of patients who are in a rush to have elective treatment?"
The point is that the decision to "rush" to have the second side done may reflect characteristics of the surgeon and of the patient.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
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