Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 717–722 | Cite as

Shoulder Arthroplasties have Fewer Complications than Hip or Knee Arthroplasties in US Veterans

  • Edward V. Fehringer
  • Ted R. Mikuls
  • Kaleb D. Michaud
  • William G. Henderson
  • James R. O’Dell
Clinical Research


Total shoulder arthroplasties (TSA) are being performed more commonly for treatment of arthritis, although fewer than either hip (THA) or knee (TKA) arthroplasties. Total shoulder arthroplasty also provides general health improvements that are comparable to THA. One study suggests TSAs are associated with lower morbidity and mortality than THAs and TKAs. To confirm and extend that study, we therefore examined the association of patient characteristics (sociodemographics, comorbid illness, and other risk factors) with 30-day complications for patients undergoing TSAs, THAs, or TKAs. We used data from the Veterans Administration (VA) National Surgical Quality Improvement Program (NSQIP) for fiscal years 1999 to 2006. Sociodemographics, comorbidities, health behaviors, operative factors, and complications (mortality, return to the operating room, readmission within 14 days, cardiovascular events, and infections) were available for 10,407 THAs, 23,042 TKAs, and 793 TSAs. Sociodemographic features were comparable among groups. The mean operative time was greater for TSAs (3.0 hours) than for TKAs (2.2 hours) and THAs (2.4 hours). The 30-day mortality rates were 1.2%, 1.1%, and 0.4% for THAs, TKAs, and TSAs, respectively. The corresponding postoperative complication rates were 7.6%, 6.8%, and 2.8%. Adjusting for multiple risk factors, complications, readmissions, and postoperative stays were less for TSAs versus THAs and TKAs. In a VA population, TSAs required more operative time but resulted in shorter stays, fewer complications, and fewer readmissions than THAs and TKAs.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Veteran Health Administration Total Joint Arthroplasty Total Shoulder Arthroplasties Veteran Health Administration Veteran Health Administration Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Edward V. Fehringer
    • 1
    • 4
  • Ted R. Mikuls
    • 1
  • Kaleb D. Michaud
    • 1
  • William G. Henderson
    • 2
    • 3
  • James R. O’Dell
    • 1
  1. 1.Nebraska Arthritis Outcomes Research Center (NAORC)OmahaUSA
  2. 2.University of Colorado Health Outcomes Program UCD, AMCDenverUSA
  3. 3.Denver VA Medical CenterDenverUSA
  4. 4.Department of Orthopaedic Surgery and RehabilitationUniversity of Nebraska Medical CenterOmahaUSA

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