BACKGROUND:
Previous studies have indicated an increased risk of periprosthetic joint infection in patients treated with reverse shoulder arthroplasty compared with patients treated with anatomical total shoulder arthroplasty. The reason for this is unclear but may be related to a high prevalence of previous rotator cuff repair in patients who are treated with reverse shoulder arthroplasty. The purpose of this study was to determine previous non-arthroplasty surgery as a risk factor for revision due to periprosthetic joint infection after reverse shoulder arthroplasty for cuff tear arthropathy, massive irreparable rotator cuff tears or osteoarthritis.

METHODS:
Data was retrieved from the Danish Shoulder Arthroplasty Registry and medical records. We included 2,217 patients who had reverse shoulder arthroplasty for cuff tear arthropathy, massive irreparable rotator cuff tears or osteoarthritis between 2006 and 2019. periprosthetic joint infection was defined as at least 3 out of 5 tissue samples positive for the same bacteria or as definite or probable periprosthetic joint infection evaluated from the International Consensus Meeting. The Kaplan-Meier method was used to illustrate the unadjusted 14-year cumulative rates of revision. The Cox regression model was used to report hazard for revision due to periprosthetic joint infection. Results were adjusted for previous non-arthroplasty surgery, gender, diagnosis, and age.

RESULTS:
Revision was performed in 88 (4.0%) shoulders of which 40 (1.8%) were due to periprosthetic joint infection. There were 272 (12.3%) patients who had previous rotator cuff repair of which 11 (4.0%) were revised due to periprosthetic joint infection. The 14-year cumulative rate of revision due to periprosthetic joint infection was 14.1% for patients with previous rotator cuff repair and 2.7% for patients without previous surgery. The adjusted hazard ratio for revision due to periprosthetic joint infection for patients with previous rotator cuff repair was 2.2 (95% CI 1.04 to 4.60) compared to patients without previous surgery.

CONCLUSION:
There is an increased risk of revision due to periprosthetic joint infection after reverse shoulder arthroplasty for patients with previous rotator cuff repair. We recommend that patients with previous rotator cuff repair to be regarded as high-risk patients when considering reverse shoulder arthroplasty.





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