Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients
Background: While estrogen is essential for bone remodeling, its impact on joint health is more nuanced. Previous studies suggest that high estrogen states, including those induced by estrogen replacement therapy (ERT), are associated with osteoarthritis and an increased risk of revisions after hip...
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Elsevier
2025-07-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266663832500146X |
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| author | Seyedeh Zahra Mousavi, BS Ethan R. Harris, BS Sanjana Agarwal, BS Prasenjit Saha, BA Eve R. Glenn, ScB Henry M. Fox, MD Umasuthan Srikumaran, MD, MBA, MPH |
| author_facet | Seyedeh Zahra Mousavi, BS Ethan R. Harris, BS Sanjana Agarwal, BS Prasenjit Saha, BA Eve R. Glenn, ScB Henry M. Fox, MD Umasuthan Srikumaran, MD, MBA, MPH |
| author_sort | Seyedeh Zahra Mousavi, BS |
| collection | DOAJ |
| description | Background: While estrogen is essential for bone remodeling, its impact on joint health is more nuanced. Previous studies suggest that high estrogen states, including those induced by estrogen replacement therapy (ERT), are associated with osteoarthritis and an increased risk of revisions after hip and/or knee arthroplasty. Given the rise in total shoulder arthroplasty (TSA) cases, it is important to investigate factors that may impact its outcomes. This study aimed to evaluate whether ERT use impacts TSA outcomes at 2, 4, and 10 years postoperatively. Materials and methods: This was a retrospective cohort study of females aged ≥55 years who underwent TSA, using the TriNetX Research Network. Patients were stratified by ERT use for at least 1-5 years preoperatively. One-to-one propensity score matching was performed based on age, race, bone density, osteoarthritis, and other comorbidities. Primary outcomes were revision rates at 2, 4, and 10 years. Secondary outcomes included prosthetic joint infections, mechanical complications, and shoulder instability, as well as 90-day postoperative medical complications. Tests of significance and risk ratios (RR) were calculated to compare outcomes with an alpha of <0.05. Results: After matching, 1,779 patients were included in each group. At 90 days, the ERT cohort had a higher risk of deep vein thrombosis (RR =1.91; P = .012). At 2 and 4 years postoperatively, the ERT group had a significantly higher risk of revisions (RR = 1.71 and 1.59, respectively), shoulder instability (RR = 1.81 and 1.80), and overall mechanical complications (RR = 1.60 and 1.67). At 10 years, the risk for revisions (RR = 1.59; P = .002) and mechanical complications (RR = 1.43; P = .005) persisted. Conclusion: Our findings suggest that ERT is associated with long-term increased risk of revision procedures and mechanical complications following TSA. This demonstrates the complex relationship between estrogen and bone health, highlighting the need for future studies investigating the impact of ERT on implant survival and osseointegration. |
| format | Article |
| id | doaj-art-d9de979a2e284c6599e32d97da5b785a |
| institution | Kabale University |
| issn | 2666-6383 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| spelling | doaj-art-d9de979a2e284c6599e32d97da5b785a2025-08-20T03:50:21ZengElsevierJSES International2666-63832025-07-01941345135110.1016/j.jseint.2025.04.022Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patientsSeyedeh Zahra Mousavi, BS0Ethan R. Harris, BS1Sanjana Agarwal, BS2Prasenjit Saha, BA3Eve R. Glenn, ScB4Henry M. Fox, MD5Umasuthan Srikumaran, MD, MBA, MPH6The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA; Corresponding author: Seyedeh Zahra Mousavi, BS, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USASchool of Medicine, The Johns Hopkins University, Baltimore, MD, USAThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USASchool of Medicine, The Johns Hopkins University, Baltimore, MD, USAThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USAThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USABackground: While estrogen is essential for bone remodeling, its impact on joint health is more nuanced. Previous studies suggest that high estrogen states, including those induced by estrogen replacement therapy (ERT), are associated with osteoarthritis and an increased risk of revisions after hip and/or knee arthroplasty. Given the rise in total shoulder arthroplasty (TSA) cases, it is important to investigate factors that may impact its outcomes. This study aimed to evaluate whether ERT use impacts TSA outcomes at 2, 4, and 10 years postoperatively. Materials and methods: This was a retrospective cohort study of females aged ≥55 years who underwent TSA, using the TriNetX Research Network. Patients were stratified by ERT use for at least 1-5 years preoperatively. One-to-one propensity score matching was performed based on age, race, bone density, osteoarthritis, and other comorbidities. Primary outcomes were revision rates at 2, 4, and 10 years. Secondary outcomes included prosthetic joint infections, mechanical complications, and shoulder instability, as well as 90-day postoperative medical complications. Tests of significance and risk ratios (RR) were calculated to compare outcomes with an alpha of <0.05. Results: After matching, 1,779 patients were included in each group. At 90 days, the ERT cohort had a higher risk of deep vein thrombosis (RR =1.91; P = .012). At 2 and 4 years postoperatively, the ERT group had a significantly higher risk of revisions (RR = 1.71 and 1.59, respectively), shoulder instability (RR = 1.81 and 1.80), and overall mechanical complications (RR = 1.60 and 1.67). At 10 years, the risk for revisions (RR = 1.59; P = .002) and mechanical complications (RR = 1.43; P = .005) persisted. Conclusion: Our findings suggest that ERT is associated with long-term increased risk of revision procedures and mechanical complications following TSA. This demonstrates the complex relationship between estrogen and bone health, highlighting the need for future studies investigating the impact of ERT on implant survival and osseointegration.http://www.sciencedirect.com/science/article/pii/S266663832500146XEstrogen replacement therapyTotal shoulder arthroplastyOrthopedic outcomesOsteoarthritisJoint healthShoulder surgery |
| spellingShingle | Seyedeh Zahra Mousavi, BS Ethan R. Harris, BS Sanjana Agarwal, BS Prasenjit Saha, BA Eve R. Glenn, ScB Henry M. Fox, MD Umasuthan Srikumaran, MD, MBA, MPH Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients JSES International Estrogen replacement therapy Total shoulder arthroplasty Orthopedic outcomes Osteoarthritis Joint health Shoulder surgery |
| title | Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients |
| title_full | Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients |
| title_fullStr | Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients |
| title_full_unstemmed | Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients |
| title_short | Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients |
| title_sort | impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty a propensity matched retrospective cohort study of 1 779 patients |
| topic | Estrogen replacement therapy Total shoulder arthroplasty Orthopedic outcomes Osteoarthritis Joint health Shoulder surgery |
| url | http://www.sciencedirect.com/science/article/pii/S266663832500146X |
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