Title: Subsequent Total Shoulder Arthroplasty Following Common Shoulder Stabilization and Reconstructive Procedures

Background: Shoulder stabilization and reconstructive surgeries are indicated based on a variety of pathologies including instability, impingement, and rotator cuff tears. Surgery to restore anatomic and biomechanical normalcy may reduce pain, restore function, or may slow the progression of osteoarthritis. This study analyzes common shoulder stabilization and reconstructive surgeries and compares their odds of future total shoulder arthroplasty (TSA) development.

Methods: The TriNetX database patient data was queried from the period of May 2004 to May 2024 using ICD10 and CPT codes. Cohorts were built by including patients who underwent a procedure of interest, while the control group used a combination of patients from other procedural cohorts not undergoing the procedure of interest. Cohorts were then propensity matched for age, race, sex, and co-morbidities. Laterality was assessed separately to ensure ipsilateral index procedure and TSA. The primary outcome measured was TSA at 5 and 10 years postoperatively for 13 different shoulder procedures.

Results: A total of 355,960 patients were divided into procedural cohorts and 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. Compared to propensity-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).

Conclusion: In general, arthroscopic procedures had decreased associated odds of subsequent TSA when compared to their open counterparts. However, arthroscopic capsulorrhaphy and arthroscopic extensive debridement had increased odds of subsequent TSA. The Latarjet procedure had the highest odds of all procedures for future TSA.