Background: As indications for reverse total shoulder arthroplasty (RTSA) expand and patients present with increasing comorbidities, complications have become more frequent. Dislocation and instability are devastating complications and have become one of the leading causes of revision surgery. Current literature suggests multifactorial causes for dislocation, but studies are limited to physiologic and mechanical risk factors. The purpose of this study was to investigate social risk factors, including alcohol and drug abuse, and their association with dislocation after RTSA.
Methods: A retrospective cohort of all RTSA performed at a single center by the senior author between January 2012 and March 2021 was reviewed. All patients had minimum 1 year follow-up. Cases of revision arthroplasty were excluded. Patients were grouped into two cohorts based on the presence or absence of any postoperative dislocation events. Bivariate analysis was used to compare patient characteristics and identify risk factors for dislocation.
Results: 431 patients were included, 423 (98.1%) experienced no dislocation events, and 8 (1.9%) experienced at least one dislocation. The mean time to dislocation was 106.6 ± 159.9 days. Six (75%) of the 8 patients had dislocations within 3 months postoperatively. Chronic opioid use (OR 23.17, 3.86-139.00; P<0.001), alcohol abuse (OR 15.92, 3.76-67.44; P<0.001), and history of falling (OR 10.22, 2.03-51.45; P=0.005) were significant social risk factors for dislocation. In the multivariable model, alcohol abuse (OR 9.37, 1.70-51.67; P=0.010) and history of falling (OR 8.22, 1.54-43.88; P=0.014) were independent risk factors for dislocation following RTSA.
Conclusion: Alcohol abuse and history of falling are independent risk factors for dislocation following primary RTSA. Chronic opioid use is also a significant risk factor for dislocation Level of Evidence: IV
