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Study highlights risks of shoulder replacement

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While many people with shoulder arthritis may gain substantial benefit from shoulder replacement surgery, the risks associated with the procedure are higher than previously thought, according to a new study published in the BMJ.

Researchers at the University of Oxford found that one in four men aged 55-59 years is at risk of needing further revision surgery, especially during the first five years after their initial operation. What’s more, the risks of serious adverse events (such as heart attacks, major blood clots and chest infections) within 90 days of surgery are much higher than previously estimated, particularly in those over 85 years.

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

“The decision to undergo a shoulder replacement is a balance between the potential benefits and possible risks of surgery,” explained lead author Richard Craig. “We hope that patients and surgeons will use the information from our study to help them decide whether to go ahead with a shoulder replacement for arthritis.”

For the study, the researchers looked at hospital and mortality records for nearly 52,000 people who had undergone non-emergency (elective) shoulder replacement surgery for arthritis. Patients’ average age at surgery was 72 years and the study included just over 58,000 shoulder replacement procedures.

The purpose of the study was to calculate precise risk estimates of serious adverse events, such as major blood clots, heart attack, infections, stroke and death, and the risk of revision surgery over a patient’s lifetime.

Results showed that 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 after surgery.

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.

Analysis further revealed that serious adverse events were associated with increasing age, other existing illness and male sex — one in nine women and one in five men aged 85 years and older experienced at least one serious adverse event within 90 days.

These risks are higher than previously considered, and for some could outweigh any potential benefits, the researchers noted.

They concluded that younger patients, particularly men, need to be aware of a higher likelihood of early failure of shoulder replacement and the need for further and more complex revision replacement surgery. And they said that all patients should be counselled about the risks of serious adverse events.