The Effect of Post-Traumatic Stress Disorder on Total Shoulder Arthroplasty Outcomes: A Retrospective Cohort Study

Abstract

Background: Total shoulder arthroplasty (TSA) continues to have increased use, and about 6 out of every 100 individuals are diagnosed with post-traumatic stress disorder (PTSD). Previous studies have shown that PTSD affects bone health and joint arthroplasty outcomes. Although both are common, their relationship has been poorly studied. Purpose: This study aimed to (1) investigate TSA 2-year mechanical outcomes in patients with a PTSD diagnosis and (2) investigate TSA 90-day medical outcomes in PTSD patients. Methods: This retrospective study utilized the multicenter database TriNetX to identify patients who were diagnosed with PTSD and who underwent TSA between 2003 and 2023 and had a 2-year follow-up. We identified 2345 patients in the PTSD-TSA cohort and 85 143 patients in the control group. Propensity score matching (1:1) was applied for cohorts based on demographics (age, sex, and race/ethnicity), body mass index, and comorbidities (diabetes mellitus, chronic kidney disease, heart failure, tobacco use, hypertensive diseases, liver diseases, anxiety disorders, major depressive disorder, substance use, and personality disorders). Medical outcomes and healthcare utilization were assessed at 90 days, while TSA complications and need for revision surgery were assessed at 2 years. Statistical analyses calculated risk ratios, confidence intervals, and P values using Student’s t -tests and χ 2 analysis. Results: Within 90 days, the PTSD cohort had a higher risk of wound disruption and blood transfusion than controls (2.2% vs 1.3%, respectively). At 2 years, patients with PTSD had higher rates than controls of shoulder dislocation (3.9% vs 2.4%, respectively) and revision surgery (controls 4.5% vs 3.0%). Conclusion: This retrospective cohort study using a large database found that, post-TSA, patients with PTSD had higher rates of 90-day and 2-year complications. This suggests that PTSD may have an impact on both short- and long-term TSA outcomes and that patients may benefit from tailored perioperative management. Level of Evidence: Retrospective cohort study, level III.