Outcomes of shoulder arthroplasty in haematopoietic stem cell transplant patients

Background

With the growing population of patients undergoing haematopoietic stem cell transplants (HSCTs), the demand for shoulder arthroplasty (SA) in this population can be expected to increase. No studies in the literature have examined the outcomes of SA in HSCT patients.

Patients and methods

A retrospective review of 11 SAs in 10 patients with previous HSCT was performed. We characterized the clinical outcomes, survivorship, and peri-operative complication rates in patients who underwent SA after receiving a HSCT. We also performed a subanalysis based on implant and transplant type.

Results

Seven of ten patients died with average two and five year post-operative patient survival rates of 70% +/− 14% and 47% +/− 17%, respectively. At average follow up of 4.2 years of the seven patients with two year followup, pain and range of motion improved with SA (p = 0.0625–0.2500). At final follow-up, five of seven shoulders were rated as satisfactory or excellent with modified Neer ratings. Two and five year survival rates free of re-operation were 100% +/− 0% and 67% +/− 27%, respectively. There were no other complications. No differences in outcomes were seen based on implant or transplant type besides RSA being associated with greater mortality risk (p = 0.0424, hazard ratio = 10.6).

Conclusions

Patients with previous HSCT who undergo SA can expect to have good pain relief, range of motion improvement, subjective satisfaction, and low peri-operative complication rate with appropriate choice of implant. However, surgeons must inform patients about realistic post-operative outcomes given the high post-operative mortality rate.

Level of Evidence: Level IV, Prognosis.