medwireNews: Study findings published in The BMJ suggest that the risk for serious adverse events following shoulder replacement surgery is greater than previously considered, and the likelihood of requiring revision surgery is elevated in younger patients.
Richard Craig and colleagues from the University of Oxford in the UK analyzed data from 51,895 patients aged 50 years or older (mean 72.2 years) who underwent 58,054 elective primary shoulder replacement procedures in England between 1998 and 2017 and were followed up for an average of 5.6 years.
The majority (69%) of patients underwent shoulder replacement due to osteoarthritis or rotator cuff tear arthropathy, while the remaining procedures were carried out due to inflammatory or other conditions, previous trauma, or osteonecrosis.
In all, 3.5% of patients experienced serious adverse events – including lower respiratory tract infection (1.50%), urinary tract infection (1.02%), and death (0.10%) – within 30 days of shoulder replacement, while 45.0% experienced serious adverse events within 90 days of the procedure.
Craig and team say that “[t]hese risks are higher than previously considered, and for some could outweigh any potential benefits.”
The risk for serious adverse events increased with older age and was highest among men aged 85 years or older, with rates of 17.4% at 30 days and 21.2% at 90 days. The corresponding rates in men aged 50–64 years were 1.6% and 2.1%. Age, sex, and comorbidities were all identified as significant predictors of adverse events in a logistic regression analysis.
“The alarmingly high rates of adverse events in elderly patients with comorbidities suggests that better approaches to patient selection, preparation, and postoperative care might be required” in this patient group, write the study authors.
The researchers also estimated lifetime risks for revision surgery, finding that overall rates of revision-free implant survival were 90.0% at 10 years after the original procedure and 87.8% at 18 years, with the greatest risk for revision seen during the first 5 years after shoulder replacement.
They say the risk for revision surgery was “much higher in younger patients, particularly men.” For example, 15-year revision rates among men were 20.6% for those aged 50–54 years, and 4.4% for those aged 85 years or older. The corresponding rates in women were 19.9% and 3.3%.
Craig and colleagues say the elevated risk for revision surgery among younger people was “due to more than simply increased time at risk,” because younger patients also had “considerably higher” rates of revision surgery within the first 5 years of the original procedure than older individuals.
“All younger patients, particularly men, need to be aware of the high likelihood of early failure of their implant and the need for further and more complex revision replacement surgery,” the team concludes.
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