Prior shoulder surgery and rheumatoid arthritis increase early risk of infection after primary reverse total shoulder arthroplasty

ABSTRACT Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular surgery for patients with rotator cuff arthropathy, unreconstructible proximal humeral fracture, and end-stage glenohumeral arthritis. The increased annual volume of RTSAs has resulted in more postoperative complications and revision rates between 3.3% and 10.1%. Postoperative infection is one of the most common complications requiring revision surgery after primary RTSA. This study assesses patient-specific risk factors for development of early infection after primary RTSA in a single high-volume shoulder arthroplasty institution. Methods From 2014 to 2019, 902 consecutive primary RTSAs were performed for surgical treatment of rotator cuff arthropathy, glenohumeral arthritis, inflammatory arthropathy, and/or dislocation. Excluding proximal humeral or scapula fractures, 756 cases met the inclusion criteria and had a minimum of 3 months follow-up. All surgeries were performed using the same surgical technique and received similar antibiotic prophylaxis. Age, patient demographics, medical history, smoking history, and prior ipsilateral shoulder treatment and/or surgery were recorded. Multivariable logistic regression analysis was used to determine risk factors associated with development of postoperative shoulder infection. Results Thirty-five patients did not meet minimum follow-up criteria and were lost to follow-up. Overall, 22 patients (22/721, 3%) developed a postoperative ipsilateral shoulder infection. Previous non-arthroplasty surgery and history of rheumatoid arthritis (RA) were significantly associated with the development of postoperative shoulder infection. Amongst patients who had previous non-arthroplasty shoulder surgery, there were 12 postoperative shoulder infections (12/196, 6%) compared to those without previous shoulder surgery (10/525, 2%) (p=0.003). Amongst patients with rheumatoid arthritis, there were 5 postoperative shoulder infections (5/58, 9%) compared to non-rheumatoid patients (17/663, 3%) (p=0.010). Patient age, gender, smoking status, history of diabetes mellitus, history of cancer/immunosuppression, and prior cortisone injection did not demonstrate significant associations with the development of postoperative infection. Conclusion Prior non-arthroplasty shoulder surgery and/or rheumatoid arthritis are independently associated with the development of postoperative infection after primary RTSA. Patients who demonstrate these risk factors should be appropriately evaluated and preoperatively counseled prior to undergoing primary RTSA. Strong consideration should be given to avoid minimally invasive non-arthroplasty surgery as a temporizing measure to delay definitive RTSA.