Risk factors for periprosthetic fractures following total shoulder arthroplasty in patients younger than 50 years of age

Abstract

Background

The rise of total shoulder arthroplasties (TSAs) has led to a concomitant increase in the incidence of periprosthetic fractures (PPFs). The treatment of PPF remains a technical challenge for orthopedic surgeons, as surgical management can lengthen recovery time and cause secondary complications, including potential nonunion, implant failure, and neurovascular injury. Prior studies investigated risk factors associated with PPFs following TSA in patients over the age of 60. To date, no studies have exclusively examined the potential risk factors for PPF in patients under the age of 50. Therefore, the purpose of this study was to investigate these potential risk factors for PPF following TSA in patients under the age of 50.

Methods

Patients who underwent primary TSA with subsequent postoperative PPF within 2 years of surgery were identified using a national claims database. Patients were stratified into 5 age cohorts as follows: under 20, 20-30, 30-40, 40-50, and 50-60 years of age. Baseline demographics between the study cohorts were compared using Pearson’s chi-squared test and Student t-tests, where appropriate. Multivariate logistic regression analysis was utilized to observe significant differences in risk factors for 2-year PPFs using the age 50-60 cohort as a reference with the output recorded as the odds ratios (OR), 95% confidence intervals (95% confidence interval), and the P value. A P value less than .05 was used as the significance level for this study.

Results

Risk factors for increased 2-year PPFs included neurological disease (OR: 1.97), chronic kidney disease (OR: 1.51), drug abuse (OR: 2.38), and prior shoulder trauma (OR: 3.45) compared to the age 50-60 cohort (P < .05 for all). Protective factors included shoulder osteoarthritis (OR: 0.72) and male sex (OR: 0.43) for the risk of PPF (P < .05 for all).

Conclusion

This study identified several risk factors associated with increased incidence of PPFs within 2 years following TSA in patients under the age of 50, including neurological disease, chronic kidney disease, drug abuse, and prior shoulder trauma. Of note, shoulder osteoarthritis and male sex were protective factors against early PPF. The findings highlight the importance of evaluating younger TSA patients for these risk factors preoperatively. Modifiable risks such as drug abuse should be addressed, while nonmodifiable risks may warrant closer follow-up or surgical technique adjustments. Overall, this risk stratification can guide surgeons in counseling younger patients and optimizing outcomes following surgery.