The Impact of Attention-Deficit/Hyperactivity Disorder on Postoperative Orthopedic Complications in Total Shoulder Arthroplasty: A Retrospective Cohort Study

Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by impulsiveness and challenges with adherence, potentially affecting surgical outcomes. While the effects of other mental health disorders, such as anxiety and depression, on orthopedic surgery complications, have been studied, the impact of ADHD – particularly on total shoulder arthroplasty (TSA) – remains unexplored. Purpose: This study aims to assess the influence of adult ADHD on postoperative outcomes following TSA. Methods: Using the TriNetX Database, adults undergoing TSA with and without a diagnosis of ADHD were identified. Cohorts were matched 1:1 using propensity score matching on demographic variables and comorbidities, including substance and mood disorders. Statistical tests, including risk ratios (RR) with 95% confidence intervals, independent t-tests, and chi-square tests, were employed to compare outcomes. Primary outcomes were orthopedic complications measured at two and four years postoperatively. Results: At 90 days postoperatively, patients with ADHD had a higher risk of prosthetic joint infection (PJI) (RR = 1.75; P = 0.015), deep infections (RR = 1.57; P = 0.028), and mechanical complications (RR = 1.96; P = 0.006). At the two-year follow-up, patients with ADHD had a higher risk of prosthetic dislocation (RR = 1.79; P = 0.009), overall mechanical complications (RR = 1.75; P < 0.001), and PJI (RR = 1.62; P < 0.001). Risks remained significant at four years postoperatively for PJI (RR = 1.53; P < 0.001), prosthetic dislocation (RR = 1.57; P = 0.031), overall mechanical complications (RR = 1.72; P < 0.001) and mechanical loosening (RR = 2.06; P = 0.012). Conclusion: Adult ADHD is associated with a significantly increased risk of postoperative orthopedic complications following TSA, including PJI, prosthetic dislocation, overall mechanical complications, and mechanical loosening up to four years after surgery. These findings suggest that ADHD-related behavioral factors may adversely affect postoperative recovery. Enhanced preoperative and postoperative counseling, tailored management, and vigilant long-term monitoring are recommended to mitigate risks and improve outcomes for this patient population.