Elevated Risk of Medical and Implant-Related Complications in Patients with Hypothyroidism After Total Shoulder Arthroplasty: A 1:1 Propensity Matched Cohort Analysis

Jad J Lawand; Abdullah Ghali; Caleb Casanova; Emmanouil Papakostas; Khalid Al Khelaifi; Bashir Zikria; Adam Z Khan; Joseph A Abboud

doi:10.1016/j.jse.2024.10.015

Elevated Risk of Medical and Implant-Related Complications in Patients with Hypothyroidism After Total Shoulder Arthroplasty: A 1:1 Propensity Matched Cohort Analysis

J Shoulder Elbow Surg. 2024 Dec 17:S1058-2746(24)00933-9. doi: 10.1016/j.jse.2024.10.015. Online ahead of print.

Authors

Jad J Lawand¹, Abdullah Ghali², Caleb Casanova², Emmanouil Papakostas³, Khalid Al Khelaifi³, Bashir Zikria⁴, Adam Z Khan⁵, Joseph A Abboud⁶

Affiliations

¹ John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555. Electronic address: jadjlawand@gmail.com.
² Department of Orthopaedics, Baylor College of Medicine, 1 Baylor Plz, Houston, TX 77030.
³ Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
⁴ Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁵ Department of Orthopaedic Surgery, Southern California Permanente Medical Group, 13652 Cantara St, Panorama City, CA 91402.
⁶ Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.

PMID: 39701443
DOI: 10.1016/j.jse.2024.10.015

Abstract

Background: There is currently limited work that evaluates the effect of co-morbid hypothyroidism on complications and outcomes following total shoulder arthroplasty (TSA). This study aims to evaluate the impact of hypothyroidism on 90-day medical complications as well as 2-year implant related complications and revision rates following TSA.

Methods: This retrospective database analysis evaluated patients who underwent TSA between October 1, 2015, and March 9, 2022. Patients with 2-year follow-up were categorized based on the presence of preoperative hypothyroidism within three months before TSA versus euthyroid status, resulting in 7,716 hypothyroid and 46,568 euthyroid patients. A 1:1 propensity score matching was performed, adjusting for age, gender, race, ethnicity, and comorbid conditions (diabetes, hypertension, chronic kidney disease, tobacco use, obesity, heart failure, and liver diseases). Postoperative complications were assessed at 90 days, and implant-related complications were evaluated at two years. A Bonferroni correction was applied to account for multiple comparisons.

Results: After matching, 7,716 matched patients were included in each cohort. Hypothyroid patients had significantly higher risks of sepsis, infection, pulmonary embolism, stroke, and hospital readmission (all p < 0.0001), as well as higher rates of anemia, pneumonia, renal failure, and blood transfusion requirements (all p < 0.0001) within 90 days postoperatively. Myocardial infarction did not meet the significance threshold (p = 0.005). At two years, these patients had elevated rates of periprosthetic fractures, prosthetic joint infection, dislocation, revision surgeries, and mechanical loosening (all p < 0.0001).

Conclusion: Hypothyroidism is associated with an increased risk of 90-day medical complications and 2-year implant-related complications following shoulder arthroplasty. Further investigation into these findings and potential for perioperative medical optimization is indicated.

Keywords: Endocrine Disorders; Hypothyroidism; Implant Loosening; Periprosthetic Joint Infection; Preoperative Risk Factors; Surgical Complications; TSA; Total Shoulder Arthroplasty.