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Impact of external beam radiation on total shoulder arthroplasty outcomes: a propensity-matched cohort study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

External beam radiation therapy has a number of deleterious effects on the body, and a number of post-operative complications have been reported for several surgeries including total knee arthroplasty. However, few studies have investigated the impact of external beam radiation therapy for total shoulder arthroplasty (TSA). Our study aimed to assess the systemic and joint complications associated with TSA in patients with prior radiation exposures, as well as evaluate the surgical outcomes of radiation patients compared to non-radiation TSA patients.

Materials and methods

A retrospective cohort analysis was conducted using the TriNetX Analytics Network. A 1:1 propensity score matching function was utilized to create two cohorts with matched baseline characteristics within the TriNetX network. Comparisons of the primary and secondary outcomes between the two cohorts were made using odds ratios. A p value of < 0.05 was determined to be significant.

Results

A total of 75,510 patients that received TSA were identified with 1505 having a history of radiation therapy (RT) and 73,605 with no radiation therapy (non-RT). After propensity matching, both groups contained 1484 patients. RT patients were at higher risk for developing prosthetic joint infection, acute renal failure, altered mental state, cerebrovascular event, DVT, PE, pneumonia, respiratory failure, and UTI compared to non-RT patients at different time points (p < 0.5).

Conclusion

Patients with prior history of external beam radiation undergoing TSA had a higher risk of systemic complications and prosthetic joint infection compared to patients without a prior history. These complications suggest a more complicated post-operative management course for these patients.

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Funding

This project was supported in part by the Clinical and Translational Science Collaborative of Cleveland which is funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UL1TR002548. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA

    Kevin Y. Zhu, Amir H. Karimi, Monish Lavu, Robert J. Burkhart & Atul F. Kamath

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  1. Kevin Y. Zhu
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  2. Amir H. Karimi
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  3. Monish Lavu
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  4. Robert J. Burkhart
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  5. Atul F. Kamath
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Contributions

KYZ, AHK, ML were involved in the study concept and design. KYZ and RJB were involved in the acquisition of data and analysis of the data. KYZ, RJB, AFK were involved in the drafting of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atul F. Kamath.

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Conflict of interest

A.F.K. reports the following disclosures: research support (Signature Orthopaedics), paid presenter or speaker (DePuy Synthes and Zimmer Biomet), paid consultant (DePuy Synthes and Zimmer Biomet), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation). K.Y.Z, A.H.K, M.L., and R.J.B have nothing to disclose.

Ethical approval

Our analysis included de-indentified information from a publicly available Dataset, and therefore IRB approval was not required.

Informed consent

Our analysis included de-indentified information from a publicly available dataset, and therefore patient consent was not required.

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Zhu, K.Y., Karimi, A.H., Lavu, M. et al. Impact of external beam radiation on total shoulder arthroplasty outcomes: a propensity-matched cohort study. Arch Orthop Trauma Surg 144, 113–119 (2024). https://doi.org/10.1007/s00402-023-05048-w

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  • DOI: https://doi.org/10.1007/s00402-023-05048-w

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