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Risks of shoulder replacement surgery ‘higher than thought’

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Need for further surgery particularly high in younger men and serious complications surprisingly common in older people, say researchers.

The risks associated with shoulder replacement surgery for arthritic conditions are higher than previously estimated, according to UK researchers.

“All patients should be counselled about the risks of serious adverse events”

Study authors

They highlighted that the increased risk was particularly prevalent for patients who are either under 60 or over 85 years old.

The findings, published in the British Medical Journal, show that one in four men aged 55-59 years are at risk of needing further revision surgery, especially during the first five years after surgery.

In addition, the risks of serious adverse events within 90 days of surgery are much higher than previously estimated, particularly in those over 85 years, said the study authors.

They said the risks should be made clearer to patients before they opt for surgery and cautioned against “unchecked expansion” of shoulder replacement surgery in both younger and older patients.

The researchers, based at the University of Oxford, noted that the number of shoulder replacements performed was expanding rapidly.

In adults aged over 50, surgery increased more than 5.6-fold, from 1,018 cases in 1998 to 5,691 in 2016.

Despite this growth, the authors of the new research said no previous study had reported on the lifetime risk of further surgery, with serious events were considered rare.

As a result, they used hospital and mortality records to calculate precise risk estimates of serious adverse events and lifetime risk of revision surgery, after elective shoulder replacement surgery for arthritis.

The study included just over 58,000 procedures carried out in nearly 52,000 adults across England between April 1998 and April 2017. Average age at surgery was 72 years and average follow-up was 5.6 years.

“Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients”

Study authors

Rates of serious adverse events were calculated at 30 and 90 days after surgery and included major blood clots, heart attack, infections, stroke and death.

Revision risk according to age and sex was estimated at three, five, 10, and 15 years after surgery and over a patient’s lifetime.

The lifetime risk of revision surgery ranged from one in 37 in women aged 85 years and older to one in four in men aged 55-59 years. The risks of revision were highest during the first five years.

The risk of any serious adverse event at 30 days post-surgery was one in 28, and at 90 days post-surgery was one in 22.

Serious adverse events were linked with increasing age, comorbidity and being male – one in nine women and one in five men aged 85 years and older experienced at least one event within 90 days.

The researchers warned that the observed risks were higher than previously considered and for some patients could outweigh any potential benefits.

They said younger patients, particularly men, needed to be aware of a higher likelihood of early failure of shoulder replacement and the need for further and more complex revision surgery.

“All patients should be counselled about the risks of serious adverse events,” they said. “These risks are higher than previously considered, and for some could outweigh any potential benefits.

“Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients,” added the study authors.

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