Elevated risk of medical complications in sickle cell disease patients after total shoulder arthroplasty

Sickle cell disease (SCD) predisposes patients to vaso-occlusive and inflammatory complications that may be exacerbated by surgical stress. While SCD has been linked to adverse outcomes after lower-extremity arthroplasty, its effect on post-operative complications following total shoulder arthroplasty (TSA) is poorly understood, particularly independent of avascular necrosis. This study evaluates the association between SCD and post-operative outcomes after TSA using a national database. A retrospective cohort study was conducted using the PearlDiver database. Patients with sickle cell who underwent TSA were matched 1:10 with controls without sickle cell based on age, gender, comorbidities, Charlson Comorbidity Index, obesity, and tobacco use. Patients with pre-operative avascular necrosis were excluded to isolate the independent effect of SCD. Post-operative complications were assessed at 90 days and 2 years, with statistical comparisons made using odds ratios (ORs) and 95% confidence intervals. A P value of < .05 was considered statistically significant. The matched cohort included 210 SCD patients and 2,000 controls. Within 90 days, SCD patients had significantly higher rates of deep vein thrombosis (1.4% vs. 0.3%, OR: 4.82, P = .027), acute kidney injury (3.8% vs. 0.9%, OR: 4.36, P < .001), wound dehiscence (1.4% vs. 0.3%, OR: 4.82, P = .027), emergency department visits (20.0% vs. 13.2%, OR: 1.65, P = .007), and hospital readmissions (6.2% vs. 3.0%, OR: 2.13, P = .016). No significant differences were found for post-operative myocardial infarction, pneumonia, or blood transfusions. Over 2 years, no significant differences were observed in surgical complications such as revision rates, periprosthetic joint infection, dislocation events, or aseptic loosening. SCD is associated with significantly increased early medical complications after TSA but does not appear to increase short-term implant complications. These findings highlight the need for focused perioperative risk mitigation in this high-risk population.