Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela.

Methods: A nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant.

Results: Patients developing a PJI had higher mean ECI (8 vs. 6;  < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81-2.43,  < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45-2.17,  < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49-2.06,  < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21-1.88,  = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13-1.54,  = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09-1.46,  = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06-1.43,  = 0.001).

Conclusions: The greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.