Salib Andrew, Sanchez Joshua G, Huggins Lenique, Seddio Anthony E, Dhodapkar Meera M, Smith-Voudouris Julian, Norman Mackenzie, Koumpouras Fotios, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
J Shoulder Elbow Surg. 2025 Apr;34(4):e196-e204. doi: 10.1016/j.jse.2024.07.008. Epub 2024 Aug 16.
Total shoulder arthroplasty (TSA) is a common procedure that may be considered for patients with glenohumeral osteoarthritis. Patients undergoing this procedure may be afflicted by comorbid conditions, such as systemic lupus erythematosus (SLE), which may impact odds of various postoperative complications.
Adult patients with and without SLE who underwent TSA (anatomic or reverse) were queried from the January 2010 to October 2022 PearlDiver M165 database. Patients with and without SLE were matched (1:4) based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and 5-year implant survival were assessed and compared with multivariable analysis. Subanalyses were done for SLE patients with and without a prescription of immunomodulatory therapy (IMT; corticosteroids, hydroxychloroquine, and/or biologics) within 90 days before surgery and compared to non-SLE patients with multivariable analyses. Lastly, SLE patients with and without a 90-day history of IMT were directly compared with multivariate logistic regression. A Bonferroni correction was applied to univariable analyses and multivariable regressions.
Of 211,832 TSA patients identified, SLE was noted for 2228 (1.1%). After matching, 8261 patients without SLE and 2085 patients with SLE were selected. SLE patients were at an increased odds of 90-day aggregated events including severe (odds ratio [OR] = 3.50), minor (OR = 3.13), all (OR = 2.35), and orthopedic-related (OR = 1.41) adverse events (P < .0030 for all). There was no difference in 5-year implant survival. Of those with SLE, IMT medications were being received by 1267 (60.8%). Any, severe, minor, and orthopedic 90-day adverse events were significantly elevated for both those with and without IMT relative to those without SLE (P < .0030 for all except for orthopedic adverse events for those not on IMT, which were not significant). Relative to those not on IMT medications, those on IMT medications were at significantly higher odds of any, severe, minor, and orthopedic adverse events.
Following TSA, patients with SLE were found to be at an increased odds of 90-day adverse events but not of 5-year revisions. Furthermore, those on IMT medications were at higher risk of any, severe, minor, and orthopedic adverse events compared to those who were not on these medications. These findings may help with patient counseling and surgical planning when those with SLE are considered for TSA.
全肩关节置换术（TSA）是一种常见的手术，可用于治疗盂肱关节骨关节炎患者。接受该手术的患者可能患有合并症，如系统性红斑狼疮（SLE），这可能会影响各种术后并发症的发生几率。
从2010年1月至2022年10月的PearlDiver M165数据库中查询接受TSA（解剖型或反向型）的成年SLE患者和非SLE患者。根据年龄、性别和埃利克斯豪泽合并症指数对SLE患者和非SLE患者进行匹配（1:4）。评估90天不良事件和5年植入物存活率，并通过多变量分析进行比较。对术前90天内接受和未接受免疫调节治疗（IMT；皮质类固醇、羟氯喹和/或生物制剂）的SLE患者进行亚分析，并与非SLE患者进行多变量分析比较。最后，通过多变量逻辑回归直接比较有和没有90天IMT病史的SLE患者。对单变量分析和多变量回归应用邦费罗尼校正。
在211,832例已识别的TSA患者中，有2228例（1.1%）被诊断为SLE。匹配后，选择了8261例非SLE患者和2085例SLE患者。SLE患者发生90天综合事件的几率增加，包括严重（优势比[OR]=3.50）、轻微（OR=3.13）、所有（OR=2.35）和骨科相关（OR=1.41）不良事件（所有P<.0030）。5年植入物存活率没有差异。在SLE患者中，1267例（60.8%）正在接受IMT药物治疗。与非SLE患者相比，接受和未接受IMT的患者发生任何、严重、轻微和骨科90天不良事件的几率均显著升高（除未接受IMT的患者发生骨科不良事件不显著外，所有P<.0030）。与未接受IMT药物治疗的患者相比，接受IMT药物治疗的患者发生任何、严重、轻微和骨科不良事件的几率显著更高。
TSA术后，SLE患者发生90天不良事件的几率增加，但5年翻修的几率没有增加。此外，与未接受这些药物治疗的患者相比，接受IMT药物治疗的患者发生任何、严重、轻微和骨科不良事件的风险更高。当考虑为SLE患者进行TSA时，这些发现可能有助于患者咨询和手术规划。
