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Shoulder arthroplasty following solid organ transplant: A systematic review and meta-analysis
  • Patel AV
  • Duey AH
  • Stevens AJ
  • Vaghani PA
  • Cvetanovich GL
  • et al.
J Orthop. 2022 Nov 26;35:150-154 doi: 10.1016/j.jor.2022.11.015.
CET Conclusion
Reviewer: Reshma Rana Magar, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This systematic review and meta-analysis compared demographics, functional and radiographic outcomes, and complications of shoulder arthroplasty in solid organ transplant recipients versus non-transplant patients. Studies were assessed for eligibility by two independent reviewers, but whether the data were also extracted in duplicate was not reported. Only 5 studies were included, including two retrospective cohort and three retrospective case series (level of evidence: III and IV respectively), suggesting high risk of bias. Patients in the SOT group had significantly lower visual analog scale (VAS) pain scores (p-value<0.01), but a significantly higher risk of death (p-value<0.01) score. Level of heterogeneity between studies was not reported for meta-analysed outcomes. The findings revealed comparable improvements in range of motion and patient-reported outcomes in SOT patients versus non-transplant patients without a significant increase in complications, leading the authors to conclude that shoulder arthroplasty is a safe option for SOT patients. The authors report a difference in mortality between the two groups, but then report that surgery is safe. From the data presented – we cannot be sure if the excess deaths in the transplant group were due to having a transplant (most likely) or due to undergoing shoulder surgery. You would need a control cohort of transplant patients who did not have shoulder surgery to be sure.
Aims: This study aimed to compare the outcomes of shoulder arthroplasty among solid organ transplant (SOT) recipients versus non-transplant patients.
Interventions: A literature search was conducted on PubMed, Scopus, MEDLINE, and Web of Science. Study selection was performed by two independent reviewers. The quality of the included studies was assessed Methodological Index for Nonrandomized Studies (MINORS) criteria.
Participants: 5 studies were included in the review.
Outcomes: The outcomes of interest included preoperative and postoperative forward elevation (FE), external rotation in adduction (ER), and internal rotation (IR); patient-reported outcomes; implant migration and loosening; and death, surgical and medical complications.
Follow Up: N/A
INTRODUCTION:

The purpose of this study is to report a systematic review and meta-analysis of solid organ transplant (SOT) patients undergoing shoulder arthroplasty to compare functional and radiographic outcomes, demographics, and complications with non-transplant patients.

METHODS:

Studies were included if they examined patients undergoing shoulder arthroplasty in the setting of prior solid organ transplantation and included post operative range of motion, patient-reported outcomes, complications, or revisions. Studies were excluded if they were national database analyses or lacked clinical data. Pubmed, MEDLine, Scopus, and Web of Science were queried using relevant search terms in July 2022. Data was pooled, weighted, and a paired t-test and chi-square analysis was performed.

RESULTS:

There were 71 SOT and 159 non-SOT shoulders included in the study. The most common indication for surgery was avascular necrosis (n = 26) in the solid organ transplant group and osteoarthritis (n = 60) in the non-SOT group. Forward elevation, external rotation, ASES, and VAS pain scores improved significantly in both cohorts following surgery. There was no significant difference in age at surgery (p-value = 0.20), postoperative forward elevation (p-value = 0.08), postoperative external rotation (0.84), and postoperative ASES scores (p-value = 0.11) between the two cohorts. VAS pain scores were significantly lower in the SOT cohort (p-value<0.01). The risk of death was significantly higher in the SOT group (p-value<0.01). but the rate of overall complications (p = 0.47), surgical complication (p-value = 0.79), or revision surgery (p-value = 1.00) was not significantly different between the two cohorts.

CONCLUSION:

Shoulder arthroplasty is a safe, effective option in patients following solid organ transplant. There is not an increased risk of adverse outcomes, and SOT patients had comparable range of motion and patient-reported outcomes when compared to their non-SOT peers.

LEVEL OF EVIDENCE:

III.