Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replace by a prosthetic implant. Such joint replacement surgery generally is to relieve arthritis pain or fix severe physical joint damage. Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints.
As the cartilage lining wears away: the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may tolerated with some medications and lifestyle adjustments; there may come a time when surgical treatment is necessary.
The shoulder joint
There are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid; but requires the subscapularis to cut. The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.
Underweight patients have a high number of adverse events and postoperative infections after total shoulder arthroplasty; even compared with super morbidly obese patients; according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.
New Haven, Connecticut, and colleagues evaluated data on 15,725 patients from the National Surgical Quality Improvement Program database who underwent total shoulder arthroplasty from 2005 to 2016. The authors sought to evaluate the relationship between body mass index (BMI) and adverse events after total shoulder arthroplasty.
The body mass index
The researchers patients according to their BMI: underweight (<18.5 kg/m²); normal weight (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), obese (30 to 40 kg/m²); morbidly obese (40 to 50 kg/m²), and super morbidly obese (>50 kg/m²). The investigators found that compared with patients who normal weight; those who were underweight were more apt to have any adverse event (odds ratio [OR], 2.30), a major adverse event (OR, 3.32), or major postoperative infection (OR, 2.97).
Even patients in the super morbidly obese group are less likely to have any adverse event (OR, 0.88); a major adverse event (OR, 0.39), or postoperative infection (OR, 0.52). Compared with patients in all other categories, patients who were underweight were also more likely to undergo readmission within 30 days of surgery.
Underweight patients are an extremely at-risk population who have previously not received significant focus,” the authors write. In conclusion, “Physicians and health care systems should give additional consideration to this fragile population, as they often already do for those at the other end of the BMI spectrum.”