JSES - 2026-08-27 - Journal Article
Hyperlipidemia Is Associated With an Increased Risk of Secondary Procedures in Patients Undergoing Arthroscopic Rotator Cuff Repair.
Prabhavalkar ON, Morriss NJ, Malin M, Jain S, Dussik CM, Phan A, Mannava S
Topics
Key Takeaway
Hyperlipidemia increases 5-year repeat rotator cuff repair rate from 7.0% to 9.8% (OR 1.440), but statin therapy does not reduce and may worsen reoperation risk.
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Summary
This study used the TriNetX federated database to evaluate whether hyperlipidemia and perioperative statin use affect secondary procedure rates after arthroscopic rotator cuff repair (CPT 29827), with propensity-score-matched cohorts of 40,430 patients per group. At 5 years, hyperlipidemia patients had significantly higher repeat repair rates (9.8% vs. 7.0%, OR 1.440) and higher arthroplasty rates (1.5% vs. 1.2%, OR 1.312). Statin therapy failed to reduce reoperation risk and was paradoxically associated with higher rates of repeat repair and arthroplasty in patients with low cholesterol levels.
Key Limitation
The database lacks tear size, chronicity, tissue quality, and repair technique data, making it impossible to determine whether hyperlipidemia independently drives retear or simply co-segregates with larger, more complex tears.
Original Abstract
INTRODUCTION
Hyperlipidemia (HLD) has been implicated as a risk factor for impaired tendon-to-bone healing after arthroscopic rotator cuff repair (RCR). While statin therapy may mitigate this effect, findings remain inconsistent. We hypothesized that HLD would be associated with higher rates of secondary procedures following RCR and that perioperative statin therapy could reduce this risk.
METHODS
A retrospective cohort study was conducted using the TriNetX Research Network, a federated database of over 120 million de-identified patient records. Adults undergoing primary arthroscopic RCR (CPT 29827) between October 2015 and August 2020 were identified. Patients were grouped as (1) no HLD, (2) HLD without statin use, and (3) HLD with perioperative statin use (prescription within 90 days before or after surgery). Outcomes included repeat RCR and arthroplasty at 6 months, 1, 3, and 5 years. Propensity score matching (1:1 nearest neighbor, caliper 0.1) was performed on demographics, comorbidities, and surgical factors. Odds ratios (RR) with 95% confidence intervals (CI) and Kaplan-Meier analyses were used with significance set at p < 0.05.
LEVEL OF EVIDENCE
Level III, Retrospective Cohort Comparison using Large Database, Prognosis Study
RESULTS
After matching, 40,430 patients were included per group. At 5 years, repeat repair occurred in 9.8% of patients with hyperlipidemia compared to 7.0% of controls (p < 0.001, OR = 1.440 (1.370-1.514)). Hyperlipidemia was associated with increased odds of arthroplasty at 3 years (1.1% vs. 1.0%, p = 0.024, OR = 1.169 (1.020 - 1.340)) and 5 years (1.5% vs. 1.2%, p < 0.001, OR = 1.312 (1.162 - 1.481)). Sub-analyses by total cholesterol and LDL levels did not show a consistent relationship between lipid level and reoperation risk. Statin therapy did not reduce reoperation risk and was associated with higher rates of repeat RCR and arthroplasty among patients with low cholesterol.
CONCLUSION
HLD was associated with modestly higher rates of secondary procedures following arthroscopic RCR, while lipid levels and statin therapy were not predictive of reduced reoperation, highlighting the complex role of lipid metabolism in tendon healing.