Effect of Antifibrotic Medications on Development of Postoperative Adhesive Capsulitis and Need for Manipulation Under Anesthesia Following Total Shoulder Arthroplasty.

Background: The local inflammatory response after total shoulder arthroplasty leads to increased scar formation and, potentially, adhesive capsulitis. Recent research has evaluated the use of antifibrotic medications to decrease rates of postoperative adhesive capsulitis (AC).

Methods: PearlDiver database was used to analyze patients from 2010 to 2022 who underwent total shoulder arthroplasty, identified by Common Procedural Terminology codes. Medication usage was determined using National Drug Codes. Patients who developed ipsilateral AC within 6 months after surgery or underwent a manipulation under anesthesia (MUA) within 12 months of diagnosis of AC were identified. Logistic regression analysis was used to evaluate patient characteristics and drug class usage that increased odds for postoperative AC within 12 months and for MUA within 6 months of diagnosis of AC.

Results: Overall, 1.3% (993/79,010) of patients developed postoperative AC within 6 months of surgery. Of those who developed AC, 7.2% (71/993) underwent MUA within 12 months of diagnosis. Medication use with any of the drug classes had no markedly decreased odds for the development of AC or subsequent MUA. Male sex, increasing age, and diagnosis of depression all markedly decreased the odds of developing AC ((odds ratio) OR = 0.42, P = 0.001; OR = 0.95, P < 0.001; OR = 0.59, P = 0.04, respectively) and subsequent need for MUA (OR = 0.68, P ≤ 0.001; OR = 0.96, P < 0.001; OR = 0.87, P = 0.04, respectively).

Conclusion: Patients on an antifibrotic medication had no difference in the odds of being diagnosed with AC within 6 months of surgery and for MUA within 12 months of diagnosis of AC. Male sex, increasing age, and presence of depression markedly decreased the odds.