Advertisement
Journal of Shoulder and Elbow Surgery

The relationship of bilateral shoulder arthroplasty timing and postoperative complications

      Background

      Though several case series have described bilateral shoulder arthroplasty results with range of motion, patient-reported outcomes, and complications, little guidance exists regarding the optimal interval timing between surgeries.

      Methods

      All patients from 2 insurance databases who underwent staged bilateral shoulder arthroplasty between 2005 and 2016 were identified. These patients were then stratified by elapsed time between surgeries into 4 study groups: (1) less than 3 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 a greater than 1-year interval between surgeries.

      Results

      From 2005-2016, a total of 1764 patients (6.3%) underwent bilateral shoulder arthroplasty out of 27,962 shoulder arthroplasties performed in the 2 databases. 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. Demographics and comorbidities were similar between the study groups. Overall, implant complications were higher in patients with surgeries less than 3 months apart compared to controls, including revision arthroplasty (11.6% vs. 5.4%, odds ratio [OR] 2.29, P = .037), loosening/lysis (8.1% vs. 3.5%, OR 2.46, P = .032), and periprosthetic fracture (4.7% vs. 1.2%, OR 4.18, P = .010). There were no significant increases in any implant-related complications when surgeries were staged by 3 months or more compared to controls. Venous thromboembolism (VTE; 8.1% vs. 2.2%, OR 3.95, P = .001) and blood transfusion (9.3% vs. 1.7%, OR 5.82, P < .001) 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.

      Conclusions

      Patients with staged bilateral shoulder arthroplasty who have the second arthroplasty within 3 months have significantly higher rates of revision surgery, loosening/lysis, periprosthetic fracture, VTE, and blood transfusions. Based on these lower complication rates, surgeons should consider waiting a minimum of 3 months before performing the second portion of a staged bilateral shoulder arthroplasty.

      Level of evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Assenmacher A.T.
        • Alentorn-Geli E.
        • Aronowitz J.
        • Kergosien M.
        • Schleck C.D.
        • Sánchez-Sotelo J.
        • et al.
        Patient-reported activities after bilateral reverse total shoulder arthoplasties.
        J Orthop Surg (Hong Kong). 2019; 27 (2309499018816771. https://doi.org/10.1177/2309499018816771)
        • Berglund D.D.
        • Kurowicki J.
        • Triplet J.J.
        • Rosas S.
        • Moor M.
        • Horn B.
        • et al.
        Comparative outcomes between the first and second operated shoulders in bilateral shoulder arthroplasty.
        J Am Acad Orthop Surg Glob Res Rev. 2018; 2: e073https://doi.org/10.5435/jaaosglobal-d-17-00073
        • Berth A.
        • März V.
        • Wissel H.
        • Awiszus F.
        • Amthauer H.
        • Lohmann C.H.
        SPECT/CT demonstrates the osseointegrative response of a stemless shoulder prosthesis.
        J Shoulder Elbow Surg. 2016; 25: e96-e103https://doi.org/10.1016/j.jse.2015.09.009
        • Boileau P.
        Complications and revision of reverse total shoulder arthroplasty.
        Orthop Traumatol Surg Res. 2016; 102: S33-S43https://doi.org/10.1016/j.otsr.2015.06.031
        • Center for Medicare & Medicaid Services
        Medicare fee-for-service 2012 improper payments report [Internet].
        • Ceri L.
        • Mondanelli N.
        • Sangaletti R.
        • Bottai V.
        • Muratori F.
        • Giannotti S.
        Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: a case report.
        Trauma Case Rep. 2019; 23: 100242https://doi.org/10.1016/j.tcr.2019.100242
        • Choi W.S.
        • Lee K.H.
        • Park J.S.
        • Lee B.G.
        Bilateral bony increased-offset reverse shoulder arthroplasty in rheumatoid arthritis shoulder with severe glenoid bone defect: a case report.
        Acta Orthop Traumatol Turc. 2017; 51: 262-265https://doi.org/10.1016/j.aott.2015.03.002
        • Cox R.M.
        • Brolin T.J.
        • Padegimas E.M.
        • Lazarus M.D.
        • Getz C.L.
        • Ramsey M.L.
        • et al.
        Outcomes of bilateral shoulder arthroplasties: A comparison of bilateral total shoulder arthroplasties and bilateral reverse shoulder arthroplasties.
        Clin Orthop Surg. 2019; 11: 316-324https://doi.org/10.4055/cios.2019.11.3.316
        • Cox R.M.
        • Padegimas E.M.
        • Abboud J.A.
        • Getz C.L.
        • Lazarus M.D.
        • Ramsey M.L.
        • et al.
        Outcomes of an anatomic total shoulder arthroplasty with a contralateral reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2018; 27: 998-1003https://doi.org/10.1016/j.jse.2017.12.005
        • Fabricant P.D.
        • Chin C.S.
        • Grawe B.M.
        • Dines J.S.
        • Craig E.V.
        • Dines D.M.
        Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries.
        J Shoulder Elbow Surg. 2016; 25: 1774-1779https://doi.org/10.1016/j.jse.2016.04.004
        • Gerber C.
        • Lingenfelter E.J.
        • Reischl N.
        • Sukthankar A.
        Single-stage bilateral total shoulder arthroplasty: a preliminary study.
        J Bone Joint Surg Br. 2006; 88: 751-755https://doi.org/10.1302/0301-620X.88B6.17601
        • Gruson K.I.
        • Pillai G.
        • Vanadurongwan B.
        • Parsons B.O.
        • Flatow E.L.
        Early clinical results following staged bilateral primary total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2010; 19: 137-142https://doi.org/10.1016/j.jse.2009.04.005
        • Kim S.H.
        • Wise B.L.
        • Zhang Y.
        • Szabo R.M.
        Increasing incidence of shoulder arthroplasty in the United States.
        J Bone Joint Surg Am. 2011; 93: 2249-2254https://doi.org/10.2106/JBJS.J.01994
        • Kurowicki J.
        • Triplet J.J.
        • Rosas S.
        • Berglund D.D.
        • Horn B.
        • Levy J.C.
        Comparative outcomes of various combinations of bilateral shoulder arthroplasty [Epub ahead of print].
        Hand (N Y). 2019; https://doi.org/10.1177/1558944718820953
        • Levy O.
        • Walecka J.
        • Arealis G.
        • Tsvieli O.
        • Della Rotonda G.
        • Abraham R.
        • et al.
        Bilateral reverse total shoulder arthroplasty—functional outcome and activities of daily living.
        J Shoulder Elbow Surg. 2017; 26: e85-e96https://doi.org/10.1016/j.jse.2016.09.010
        • Mellano C.R.
        • Kupfer N.
        • Thorsness R.
        • Chalmers P.N.
        • Feldheim T.F.
        • O'Donnell P.
        • et al.
        Functional results of bilateral reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2017; 26: 990-996https://doi.org/10.1016/j.jse.2016.10.011
        • Morris B.J.
        • Haigler R.E.
        • O'Connor D.P.
        • Elkousy H.A.
        • Gartsman G.M.
        • Edwards T.B.
        Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy.
        J Shoulder Elbow Surg. 2015; 24: 474-481https://doi.org/10.1016/j.jse.2014.08.008
        • Namdari S.
        • Yagnik G.
        • Ebaugh D.D.
        • Nagda S.
        • Ramsey M.L.
        • Williams G.R.
        • et al.
        Defining functional shoulder range of motion for activities of daily living.
        J Shoulder Elbow Surg. 2012; 21: 1177-1183https://doi.org/10.1016/j.jse.2011.07.032
        • Stevens C.G.
        • Murphy M.R.
        • Stevens T.D.
        • Bryant T.L.
        • Wright T.W.
        Bilateral scapular fractures after reverse shoulder arthroplasties.
        J Shoulder Elbow Surg. 2015; 24: e50-e55https://doi.org/10.1016/j.jse.2014.09.045
        • Stevens C.G.
        • Struk A.M.
        • Wright T.W.
        The functional impact of bilateral reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2014; 23: 1341-1348https://doi.org/10.1016/j.jse.2013.12.012
        • Triplet J.J.
        • Kurowicki J.
        • Berglund D.D.
        • Rosas S.
        • Horn B.J.
        • Levy J.C.
        Loss of functional internal rotation following various combinations of bilateral shoulder arthroplasty.
        Surg Technol Int. 2018; 33: 326-331
        • Welborn B.T.
        • Butler R.B.
        • Dumas B.P.
        • Mock L.
        • Messerschmidt C.A.
        • Friedman R.J.
        Patient reported outcome measures of bilateral reverse total shoulder arthroplasty compared to bilateral anatomic total shoulder arthroplasty.
        J Orthop. 2019; 17: 83-86https://doi.org/10.1016/j.jor.2019.08.001
        • Wendling A.
        • Vopat M.L.
        • Yang S.Y.
        • Saunders B.
        Near-simultaneous bilateral reverse total shoulder arthroplasty for the treatment of bilateral fracture dislocations of the shoulder.
        BMJ Case Rep. 2019; 12: e230212https://doi.org/10.1136/bcr-2019-230212
        • Wiater B.P.
        • Boone C.R.
        • Koueiter D.M.
        • Wiater J.M.
        Early outcomes of staged bilateral reverse total shoulder arthroplasty: a case-control study.
        Bone Joint J. 2013; 95-B: 1232-1238https://doi.org/10.1302/0301-620X.95B9.31445
        • Wirth B.
        • Kolling C.
        • Schwyzer H.K.
        • Flury M.
        • Audigé L.
        Risk of insufficient internal rotation after bilateral reverse shoulder arthroplasty: clinical and patient-reported outcome in 57 patients.
        J Shoulder Elbow Surg. 2016; 25: 1146-1154https://doi.org/10.1016/j.jse.2015.11.010