Preoperative statin exposure and postoperative outcomes after primary shoulder arthroplasty: a propensity-matched analysis

Background: Statin use is associated with reduced incidence of periprosthetic fracture and revision surgery following total hip and knee arthroplasty, but whether a similar relationship exists for shoulder arthroplasty remains unclear. The objective of this study was to evaluate the association between preoperative statin exposure and both short- and long-term complications following primary shoulder arthroplasty. Methods: The TriNetX Research Network was used to identify patients who underwent primary total shoulder arthroplasty or shoulder hemiarthroplasty; they were separated into groups according to presence or absence of at least one statin prescription issued within the 3 months prior to surgery. Primary outcomes assessed included periprosthetic fracture and revision surgery using Kaplan-Meier survival analysis within 2 and 5 years. Results: A total of 21,346 matched pairs were included. Rates of periprosthetic fracture and revision surgery were similar within 2 years. The 5-year incidence of revision surgery was minimally elevated in the statin-exposed cohort (hazard ratio, 1.096; 95% CI, 1.002-1.198), whereas 5-year survival was improved among statin users according to post hoc analysis (hazard ratio, 0.915; 95% CI, 0.846-0.990). Statin use was associated with increased risk of venous thromboembolism, hemorrhagic anemia, transfusion, and all-cause readmission within 90 days postoperatively (P<0.05). Conclusions: No relationship between preoperative statin use and periprosthetic fracture following primary shoulder arthroplasty was observed. However, statin therapy did correlate with minimally increased risk of revision surgery within 5 years, which may be more reflective of improved patient survival than true implant failure. Level of evidence: III.