Abstract
Objectives:
Shoulder stabilization and reconstructive surgeries are indicated based on a variety of pathologies including instability, impingement, and rotator cuff tears. It is widely accepted that sports-related injuries about the shoulder involve some degree of cartilage damage at the time of injury, and surgery—by restoring normal anatomy and biomechanics—can reduce pain, restore function, and may slow the progression of subsequent osteoarthritis. The purpose of this study was to analyze common shoulder stabilization and reconstructive surgeries, both arthroscopic and open, and compare their odds of future total shoulder arthroplasty (TSA) at 5 and 10 years after index surgery.
Methods:
The TriNetX database of multi-institutional, cross-country aggregated patient data was queried from the period of May 2004 to May 2024 using International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. For any given procedure, cohorts were built by including patients who underwent the procedure of interest, while the control group was built using a combination of patients from the other cohorts who did not undergo the procedure of interest. The procedure of interest and control cohorts were then propensity matched for age, race, sex, and co-morbidities. Laterality was assessed separately to ensure ipsilateral index procedure and total shoulder arthroplasty. A total of 13 index surgeries were included. The primary outcome measure was TSA at 5 and 10 years after the index procedure.
Results:
A total of 355,960 patients comprised the cohorts for the 13 common shoulder surgeries analyzed. The procedure with the highest rate of subsequent TSA was the Latarjet procedure (3.99% at 5 years; 4.23% at 10 years); whereas the procedure with the lowest rate was arthroscopic capsulorrhaphy (0.91% at 5 years; 0.95% at 10 years). When compared to matched controls, procedures associated with increased odds of subsequent TSA were the Latarjet procedure (OR 3.34, P<0.0001 at 5 years; OR 3.56, P<0.0001 at 10 years), arthroscopic capsulorrhaphy (OR 1.47, P=0.0042 at 5 years; OR 1.43, P=0.0066 at 10 years), open rotator cuff repair, chronic (OR 1.39, P=0.0005 at 5 years), arthroscopic extensive debridement (OR 1.31, P<0.0001 at 5 years; OR 1.26, P<0.0001 at 10 years), and open biceps tenodesis (OR 1.28, P=0.0003 at 5 years; OR 1.20, P<0.0053 at 10 years). Procedures associated with decreased odds of subsequent TSA were arthroscopic distal clavicle resection (OR 0.56, P<0.0001 at 5 years; OR 0.56, P<0.0001 at 10 years), arthroscopic subacromial decompression (OR 0.65, P<0.0001 at 5 years; OR 0.63, P<0.0001 at 10 years), arthroscopic rotator cuff repair (OR 0.78, P<0.0001 at 5 years; OR 74, P<0.0001 at 10 years), and arthroscopic biceps tenodesis (OR 0.78, P<0.0001 at 5 years; OR 0.76, P<0.0001 at 10 years).
Conclusions:
In general, arthroscopic procedures were associated with decreased odds of subsequent TSA when compared to their open counterparts; this included distal clavicle resection, rotator cuff repair, and biceps tenodesis. However, arthroscopic capsulorrhaphy and arthroscopic extensive debridement were among the procedures associated with increased odds of subsequent TSA. The Latarjet procedure was associated with the highest odds of all procedures of future TSA.
