JSES - 2026-06-01 - Journal Article
Overweight and Premorbid Obesity Status Correlates With Thromboembolism Risk but Not Infection After Total Shoulder Arthroplasty.
Wang J, Nguyen P, Ibrahim K, Tanas Y, Henein C, Borja J, Horani K, Somerson J, Weiss WM
Topics
Key Takeaway
Elevated BMI increases DVT risk after TSA (overweight vs. normal: RR 1.48; obese vs. overweight: RR 1.36) but does not increase infection, revision, or mechanical complication rates within 2 years.
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Summary
This retrospective TriNetX database study stratified TSA patients by BMI category and used propensity score matching to compare 2-year complication rates across weight groups. Overweight patients had higher DVT risk versus normal BMI (RR 1.48), and obese patients had higher DVT (RR 1.36) and PE (RR 1.25) risk versus overweight patients. No significant differences were found for infection, wound disruption, sepsis, mechanical complications, revision surgery, or hardware removal across any BMI comparison.
Key Limitation
Inability to differentiate anatomic TSA from reverse TSA within the database prevents determination of whether obesity-related thromboembolic risk differs by implant type, which is clinically critical given the distinct patient populations and operative times involved.
Original Abstract
BACKGROUND
Total shoulder arthroplasty (TSA) is an effective treatment for shoulder arthritis. Although obesity is associated with complications after hip and knee arthroplasty, its association with TSA outcomes remains less defined. This study evaluated TSA outcomes stratified by body mass index (BMI).
METHODS
The TriNetX Research Network was queried for adults who underwent TSA between January 1, 2000, and April 6, 2023. Patients were stratified into normal weight (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obese (30-39.9 kg/m 2 ), and morbidly obese (≥40 kg/m 2 ) cohorts. Outcomes included infection, wound disruption, sepsis, deep vein thrombosis (DVT), pulmonary embolism (PE), mechanical complications, revision surgery, and hardware removal within 2 years. Propensity score matching controlled for age, sex, comorbidities, and smoking status. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were reported. Benjamini-Hochberg correction was performed as a sensitivity analysis.
RESULTS
Matched cohorts included 8,642 overweight versus normal BMI patients, 14,714 obese versus overweight patients, and 4,996 morbidly obese versus obese patients per group. Compared with normal BMI patients, overweight patients had higher DVT risk (RR 1.48, 95% CI 1.12-1.96; p = 0.006). Compared with overweight patients, obese patients had higher risks of DVT (RR 1.36, 95% CI 1.12-1.65; p = 0.002) and PE (RR 1.25, 95% CI 1.01-1.55; p = 0.037). In sensitivity analysis, only DVT among obese versus overweight patients remained significant. No significant differences were observed for infection, wound disruption, sepsis, mechanical complications, revision surgery, or hardware removal.
CONCLUSION
Elevated BMI was associated with weak-to-moderate increases in thromboembolic risk after TSA but not infection or revision surgery. These findings support individualized thromboembolic risk assessment while suggesting TSA remains relatively safe in patients with elevated BMI.
LEVEL OF EVIDENCE
Level III, Retrospective Cohort Comparison using Large Database, Prognosis Study.