It is tempting to assume that relationships in orthopadics are linear, for example "more active elevation of the arm gives proportionally better function"; however, the function of shoulders with active elevation of 10 degrees is not much different than those with active elevation of 40 degrees, and the function of shoulders with active elevation of 140 degrees is not much different than those with active elevation of 170 degrees.
Similarly, it may seem that the risk of complications after shoulder arthroplasty (TSA) would increase proportionally with increase in the body mass index (BMI).
However, the authors of The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty found that this was not the case. They reviewed data on 31,755 TSAs and found that 4.5% experienced medical complications. The relationship between complication risk and BMI was not linear: the lowest risk was in patients with a BMI between 30 and 35 kg/m2.
The probability of medical complications increased with age and was greater for female patients.
showing that underweight patients had the highest rates of transfusion and return to the operating room after shoulder arthroplasty.
More information on the relationship of body mass index to shoulder arthroplasty outcomes can be found at the links below:
Anatomic and reverse total shoulder arthroplasty: over one third of patients are obese - does this matter?
Underweight Patients Are the Greatest Risk Body Mass Index Group for 30-Day Perioperative Adverse Events After Total Shoulder Arthroplasty
The not infrequent complications after reverse total shoulders - influence of body mass index
Total shoulder arthroplasty - relationship of complications to obesity
Total shoulder - a low BMI more than doubles the rate of complications
Total shoulder outcomes: are they related to obesity?
Complications of shoulder arthroplasty - body mass index matters
Underweight Patients Are the Greatest Risk Body Mass Index Group for 30-Day Perioperative Adverse Events After Total Shoulder Arthroplasty
The not infrequent complications after reverse total shoulders - influence of body mass index
Total shoulder arthroplasty - relationship of complications to obesity
Total shoulder - a low BMI more than doubles the rate of complications
Total shoulder outcomes: are they related to obesity?
Complications of shoulder arthroplasty - body mass index matters
And importantly, bariatric surgery does not reduce the risk of complications and may, in fact, increase the risk.
Comment: It may be that nutritional status, rather than BMI, should be our focus. Individuals with low serum albumin, poor wound healing, or other manifestations of poor nutrition deserve a workup to determine the cause and consultation for optimizing management prior to elective surgery.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
