Revision arthroplasty is associated with significantly higher morbidity but not mortality compared with primary shoulder arthroplasty

Background Revision total shoulder arthroplasty (TSA) is technically complex and associated with higher complication rates than primary TSA, though longitudinal comparative data remain limited. We hypothesized that revision TSA would be associated with higher postoperative morbidity and mortality. Methods A retrospective cohort study was conducted using the TriNetX Research Network. Adult patients undergoing revision TSA (CPT 23473, 23474) or primary TSA (CPT 23472) were identified, excluding fractures. Secondary analyses stratified revision procedures by CPT-defined revision of one component (CPT 23473) versus both humeral and glenoid components (CPT 23474), and by infection-related versus mechanical-complication-related diagnostic coding. Outcomes at three months, one year, and three years were assessed after 1:1 propensity score matching. Odds ratios (ORs) and Kaplan–Meier analyses were used. Results After matching, 7354 patients remained in each primary comparison cohort. Mortality was higher after revision TSA at three months (0.6% vs 0.2%; OR 2.29, 95% CI [1.31–3.98]; p = .003) but did not differ at one or three years. Hospital admission was more frequent after revision TSA at all time points (OR 1.32–2.17; all p < .001). After excluding patients with prior infection diagnoses, prosthetic joint infection/shoulder osteomyelitis (OR 3.51–5.53) and all postprocedural infection (OR 1.62–2.01) were more frequent after revision TSA at all time points (all p < .001). Periprosthetic fracture was also more frequent at all time points (OR 2.08–2.29; all p ≤ .001), while repeat revision was more frequent at one year (OR 1.65) and three years (OR 1.81; both p < .001). After separate propensity score matching, no measured outcomes differed significantly between one- and two-component revisions (2150 patients per cohort) or between infection- and mechanical-indication revisions (649 patients per cohort). Conclusion Revision TSA is associated with significantly higher postoperative morbidity and increased short-term mortality compared with primary TSA, although the mortality difference does not persist at one or three years. These findings provide important data for patient counseling and risk stratification. Level of Evidence Level III, retrospective comparative study.