Increased Risk of Periprosthetic Fractures and Revision Arthroplasty in Patients Undergoing Shoulder Arthroplasty With a History of Prior Fragility Fractures: A Matched Cohort Analysis

Jan 25, 2023The Journal of the American Academy of Orthopaedic Surgeons

Higher Risk of Bone Fractures and Repeat Surgery After Shoulder Replacement in Patients with Previous Fragile Bone Fractures

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Abstract

Among 91,212 total shoulder arthroplasty patients, 14.3% had a fragility fracture prior to surgery.

Patients with a history of fragility fractures had increased odds of periprosthetic fractures (odds ratio 2.24) within two years after surgery.
The risk of sustaining a subsequent fragility fracture was significantly higher (odds ratio 9.11) in those with prior fragility fractures.
Deep infection rates were elevated (odds ratio 1.68) in patients with a history of fragility fractures compared to those without.
The likelihood of requiring all-cause revision surgery also increased (odds ratio 1.68) for patients who had experienced fragility fractures.
Treatment for osteoporosis prior to surgery did not significantly affect the rates of postoperative complications.

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INTRODUCTION: As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures.

METHODS: A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA. Rates of revision SA, periprosthetic fractures, infection, and postoperative fragility fractures were evaluated using multivariate logistic regression analysis. Risks of these complications were also studied in patients with and without preoperative osteoporosis treatment. Statistical significance was set at P < 0.05.

RESULTS: A total of 91,212 SA patients were identified, with 13,050 (14.3%) experiencing a fragility fracture within the 3 years before SA. Two years after SA, there were increased odds of periprosthetic fracture (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.68 to 2.99), fragility fracture (OR 9.11, 95% CI 8.43 to 9.85), deep infection (OR 1.68, 95% CI 1.34 to 2.12), and all-cause revision SA (OR 1.68, 95% CI 1.44 to 1.96) within those patients who had experienced a fragility fracture within 3 years before their SA. Patients who were treated for osteoporosis with bisphosphonates and/or vitamin D supplementation before their SA had similar rates of postoperative periprosthetic fractures, fragility fractures, and all-cause revision SA to those who did not receive pharmacologic treatment.

CONCLUSION: Sustaining a fragility fracture before SA portends substantial postoperative risk of periprosthetic fractures, infection, subsequent fragility fractures, and all-cause revision SA at the 2-year postoperative period. Pharmacotherapy did not markedly decrease the rate of these complications. These results are important for surgeons counseling patients who have experienced prior fragility fractures on the risks of SA.

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Increased Risk of Periprosthetic Fractures and Revision Arthroplasty in Patients Undergoing Shoulder Arthroplasty With a History of Prior Fragility Fractures: A Matched Cohort Analysis

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