Complication, revision, and readmission rates following reverse total shoulder arthroplasty in wheelchair-dependent patients

Background Wheelchair-dependent individuals place high mechanical demand on their upper extremities, relying on their shoulders as weight-bearing joints for propulsion and transfers. Although reverse total shoulder arthroplasty (rTSA) is effective for rotator cuff–deficient shoulders, outcomes in wheelchair users remain understudied. This study evaluated short-term complication and revision rates following rTSA in wheelchair-dependent patients using a large national claims database. Methods A retrospective cohort study was performed using PearlDiver Mariner, identifying patients who underwent primary rTSA. Wheelchair dependence was defined by International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Wheelchair users were propensity score–matched 1:5 to controls by age, sex, Charlson-Deyo Comorbidity Index, and length of stay. The primary outcomes were 2-year revision rates and 90-day all-cause readmission and emergency department (ED) visits. Secondary analyses evaluated specific post-operative complications including dislocation, periprosthetic fracture, and infection. Results Of 106,362 patients undergoing rTSA, 133 wheelchair users were matched to 665 controls. No significant difference was observed in 2-year revision rates (6.76% vs. 3.61%; P = .09). However, wheelchair users demonstrated higher 90-day rates of dislocation (4.51% vs. 1.65%; P = .048) and periprosthetic fracture (3.76% vs. 0.30%; P = .0019). All-cause 90-day ED utilization was also greater among wheelchair users (27.1% vs. 18.1%; P = .017). Conclusion Wheelchair-dependent patients undergoing rTSA experience significantly higher early complication and ED visit rates, though 2-year revision rates appear similar. These findings highlight the unique mechanical and functional challenges faced by wheelchair users, underscoring the importance of specialized perioperative care and rehabilitation strategies in this high-demand population.