Total shoulder vs. hip and knee arthroplasty: an analysis of perioperative outcomes

Abstract

Recent literature has yet to compare perioperative metrics of total shoulder arthroplasty (TSA) versus total hip (THA) and knee (TKA) arthroplasty. The National Surgical Quality Improvement Program database was utilized to investigate perioperative metrics for patients undergoing primary TSA, THA, or TKA from 2012-2020. Adjusted and unadjusted analyses were employed to compare patient characteristics, operative times, lengths of stay, readmissions, adverse events, and annual surgical volumes between cohorts. Of 748,153 included patients, 32,222 (4.31%), 279,528 (37.36%), and 436,403 (58.33%) underwent TSA, THA, and TKA, respectively. TSA operative times ([mean ± SD]: 109.21 ± 44.62 minutes) were longer than those for THA (91.28 ± 38.48 minutes) and TKA (90.02 ± 34.85 minutes). Conversely, TSA patients experienced shorter hospital stays (1.67 ± 3.36 days; p<0.001) relative to those receiving hip (2.38 ± 3.90 days) or knee (2.38 ± 3.51 days) arthroplasty. Logistic regression models controlling for demographics and comorbidities revealed patients undergoing TSA were less likely to be readmitted [adjusted relative risk (ARR) 0.78, 95% confidence interval (CI) 0.73-0.83] or sustain serious [ARR 0.79, 95% CI 0.73-0.85] or minor [ARR 0.59, 95% CI 0.52-0.66] adverse events than those receiving THA or TKA (p<0.001 for all). Finally, when comparing arthroplasty utilization rates from 2012-2020, the proportion of TSA increased significantly (3.16% to 5.08%) relative to THA (38.4% to 39.8%) and TKA (58.5% to 55.1%; ptrend<0.001). Although performed less frequently, TSA is associated with significantly shorter hospital stays, lower likelihoods of readmission, and fewer complications than THA and TKA. These findings corroborate the relative safety of TSA and highlight its increasing utilization in the United States.

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