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Safety of shoulder arthroplasty in lung transplant recipients

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Although shoulder arthroplasty is relatively safe in general population, it remains unclear in transplant recipient. Aim of this study was to determine outcomes and morbidity after shoulder arthroplasty in lung transplant recipients.

Methods

A retrospective analysis was performed at our university hospital center from 2001 to 2015. Main inclusion criterion was all lung transplant recipient who underwent shoulder arthroplasty. Clinical outcomes including Constant score, visual analogue scale (VAS), American Shoulder and Elbow Surgeons score (ASES) were determined in pre-operative period and a minimum follow-up of 36 months. Special attention was taken about complications.

Results

Among 700 lung transplant recipients, we identified 12 patients who underwent 14 shoulder arthroplasties. Arthroplasties were performed after proximal humeral avascular necrosis (n = 10), degenerative osteoarthritis (n = 1) and non-union of proximal humeral fracture (n = 1). 8 anatomical total shoulder arthroplasties and 6 reversed shoulder arthroplasties were performed. Mean follow-up was 61.4 months (± 22.1). Mean age was 47.1 (± 9.3) years. All patients had immunosuppression therapy at the time of surgery. Mean Constant score was improved at last follow-up [43(± 9.7) vs 94(± 4), p < 0.001]. VAS decreased from 6.4 (± 1.2) to 0.4 (± 0.8), p < 0.001. Mean ASES was improved from 33 (± 6) to 91 (± 5) at last follow-up (p < 0.001). Range of motion were improved between early post-operative evaluation and last follow-up: forward flexion: 85° (± 8°) vs 119°(± 13°); abduction: 83° (± 14°) vs 106°(± 23°); external rotation (RE1): 26° (± 7°) vs 36°(± 10°). At last follow-up, one revision was required for humeral prothesis loosening at 2 years post-surgery. One patient died due to acute pulmonary decompensation on chronic rejection 66 months after shoulder arthroplasty.

Conclusion

Shoulder arthroplasty is a safe procedure in this vulnerable population of lung transplant recipients. Such results encourage us to continue arthroplasty surgery when required.

Level of evidence

IV.

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Abbreviations

VAS:

Visual Analogue Scale

ASES:

American Shoulder and Elbow Surgeons score

FEV1:

First second of forced expiration

FVC:

Forced vital capacity

CBEU:

Cytobacteriological examination of the urine

ASA:

Anatomic shoulder arthroplasty

RSA:

Reverse Shoulder Arthroplasty

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France

    Ruben Dukan, Marc-Antoine Rousseau & Patrick Boyer

  2. Pneumology, Lung Transplantation Department, Universite Paris Diderot UFR de Medecine, Paris, France

    Herve Mal

  3. Thoracic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France

    Yves Castier

Authors
  1. Ruben Dukan
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  2. Herve Mal
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  3. Yves Castier
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  4. Marc-Antoine Rousseau
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  5. Patrick Boyer
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Correspondence to Ruben Dukan.

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Dukan, R., Mal, H., Castier, Y. et al. Safety of shoulder arthroplasty in lung transplant recipients. Arch Orthop Trauma Surg 141, 795–801 (2021). https://doi.org/10.1007/s00402-020-03485-5

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  • DOI: https://doi.org/10.1007/s00402-020-03485-5

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