JSES - 2026-05-19 - Journal Article
Elevated Risk of Medical Complications in Sickle Cell Disease Patients after Total Shoulder Arthroplasty.
Khanna A, Lawand JJ, Adio A, Holle AM, Eble S, Abboud JA
Topics
Key Takeaway
Sickle cell disease patients undergoing TSA face a 4.82-fold increased risk of DVT and wound dehiscence and a 4.36-fold increased risk of acute kidney injury within 90 days, without a corresponding increase in 2-year implant-related complications.
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Summary
This study used the PearlDiver database to determine whether SCD independently increases postoperative complication rates after TSA, excluding AVN patients to isolate SCD's effect. SCD patients matched 1:10 to controls showed significantly higher 90-day rates of DVT (1.4% vs 0.3%, OR 4.82), AKI (3.8% vs 0.9%, OR 4.36), wound dehiscence (1.4% vs 0.3%, OR 4.82), ED visits (20.0% vs 13.2%, OR 1.65), and readmissions (6.2% vs 3.0%, OR 2.13). At 2 years, revision, PJI, dislocation, and aseptic loosening rates were not significantly different between groups.
Key Limitation
The small SCD cohort (n=210) limits statistical power to detect differences in lower-frequency surgical complications such as PJI and dislocation, risking type II error for those endpoints.
Original Abstract
INTRODUCTION
Sickle cell disease (SCD) predisposes patients to vaso-occlusive and inflammatory complications that may be exacerbated by surgical stress. While SCD has been linked to adverse outcomes after lower-extremity arthroplasty, its effect on postoperative complications following total shoulder arthroplasty (TSA) is poorly understood, particularly independent of avascular necrosis (AVN). This study evaluates the association between SCD and postoperative outcomes after TSA using a national database.
METHODS
A retrospective cohort study was conducted using the PearlDiver database. Patients with sickle cell who underwent TSA were matched 1:10 with controls without sickle cell based on age, gender, comorbidities, Charlson comorbidity index, obesity, and tobacco use. Patients with preoperative avascular necrosis were excluded to isolate the independent effect of SCD. Postoperative complications were assessed at 90 days and two years, with statistical comparisons made using odds ratios (OR) and 95% confidence intervals (CI). A p-value of <0.05 was considered statistically significant.
RESULTS
The matched cohort included 210 SCD patients and 2,000 controls. Within 90 days, SCD patients had significantly higher rates of deep vein thrombosis (1.4% vs 0.3%, OR 4.82, p = 0.027), acute kidney injury (3.8% vs 0.9%, OR 4.36, p < 0.001), wound dehiscence (1.4% vs 0.3%, OR 4.82, p = 0.027), emergency department visits (20.0% vs 13.2%, OR 1.65, p = 0.007), and hospital readmissions (6.2% vs 3.0%, OR 2.13, p = 0.016). No significant differences were found for postoperative myocardial infarction, pneumonia, or blood transfusions. Over two years, no significant differences were observed in surgical complications such as revision rates, periprosthetic joint infection, dislocation events, or aseptic loosening.
CONCLUSION
SCD is associated with significantly increased early medical complications after TSA but does not appear to increase short-term implant complications. These findings highlight the need for focused perioperative risk mitigation in this high-risk population.