Abstract
BACKGROUND: Arthroscopic rotator cuff repair (ARCR) has evolved to be the gold standard treatment for rotator cuff tears that are symptomatic despite conservative measures. Patients considered for this procedure may have underlying glenohumeral osteoarthritis (GHOA). The potential correlation of GHOA on short-term and long-term outcomes following ARCR remain unclear due to mixed literature that is limited by cohort size and/or generalizability. METHODS: Patients undergoing ARCR were identified from 2010 to Q1 2022 in the M165Ortho PearlDiver Mariner Patient Claims Database. Exclusion criteria included age <18 years, prior ARCR, concurrent nonrotator cuff related arthroscopic shoulder procedures, any upper extremity fractures, neoplasms or infections diagnosed within 90 days before surgery, and <90 days follow-up in the database. Ipsilateral GHOA diagnosis within 1 year prior to ARCR was determined. ARCR (+)GHOA patients were matched 1:4 with ARCR (-)GHOA patients based on age, sex, and Elixhauser Comorbidity Index. Occurrence of any, severe, and minor adverse events within 90 days, delayed functional outcomes between 3 months and 6 months (stiffness, pain, and instability), and 2-year retear were compared by multivariable logistic regression. Two-year retear rates and 5-year subsequent total shoulder arthroplasty (TSA) were assessed by Kaplan-Meier survival analysis and compared by log-rank test. RESULTS: Of 474,285 ARCR patients, concurrent GHOA was identified in 128,606 (27.1%). After matching, there were 84,209 ARCR (+)GHOA and 335,947 ARCR (-)GHOA patients. Compared to ARCR (-)GHOA patients, ARCR (+)GHOA patients had significantly higher odds of 90-day any adverse event (odds ratio [OR]: 1.75, P < .001), severe adverse event (OR: 1.52, P < .001), minor adverse event (OR: 1.86, P < .001), Surgical Site Infections (OR: 1.45, P < .001), wound complications (OR: 1.89, P < .001), plus increased 90-day readmissions (OR: 1.72, P < .001), and emergency visits (OR: 1.84, P < .001). Functionally, at 3-6 months postoperative, ARCR (+)GHOA patients had higher odds of stiffness (OR: 1.70, P < .001), pain (OR: 1.32, P < .001), and instability (OR: 2.89, P < .001). At 2 years, they had increased odds of retear (OR: 1.44, P < .001), and at 5 years, higher odds of TSA (OR: 1.55, P < .001). Among GHOA patients undergoing ARCR, older age (OR: 1.07), female sex (OR: 1.24), opioid use disorder (OR: 2.05), depression (OR: 1.58), anxiety (OR: 1.18), diabetes (OR: 1.36), and postoperative complications independently predicted progression to TSA (all P < .001). CONCLUSION: The presence of concurrent GHOA was associated with a significant increase in the odds of both short- and longer-term complications following ARCR. These findings highlight the importance of considering GHOA in establishing treatment plans for those considered for ARCR.