{
  "abstract": "Reverse total shoulder arthroplasty (rTSA) is a reliable procedure for a broad spectrum of shoulder pathologies, with post-operative dislocation representing a clinically impactful complication. Obesity has been associated with adverse peri-operative outcomes following shoulder arthroplasty; however, it has not been specifically assessed in relation to post-operative dislocation in the setting of rTSA. We hypothesized that severe obesity (body mass index [BMI] >35 kg/m2, corresponding to World Health Organization class II obesity) would be independently associated with an increased risk of dislocation following rTSA. A retrospective cohort study was performed using the PearlDiver Mariner national administrative claims database. Patients aged >17 years who underwent primary rTSA for degenerative shoulder osteoarthritis were identified using International Classification of Diseases, Tenth Revision (ICD-10) procedural codes. Patients with shoulder trauma, neoplasm, or infection within 90 days of the index procedure were excluded. Two cohorts were defined: non-obese (BMI <30 kg/m2) and severely obese (BMI >35 kg/m2; patients with BMI 30-35 kg/m2 were excluded), and matched 4:1 by age, sex, Elixhauser Comorbidity Index, and smoking status. Post-operative dislocation was identified using ICD-10 diagnostic codes (ICD-10-D-T84028A, ICD-10-D-T84029A). Outcomes were assessed at 6 months, 1 year, and 2 years post-operatively. Multivariable logistic regression and Kaplan-Meier survival analyses were performed. After 4:1 matching, 12,667 non-obese and 3,210 severely obese patients were included. Severely obese patients demonstrated statistically significantly higher rates of post-operative dislocation at 6 months (2.43% vs. 1.46%; P = .0002), 1 year (2.83% vs. 1.75%; P = .0001), and 2 years (3.30% vs. 2.16%; P = .0002). This corresponds to an absolute risk increase of approximately 1.1% at 2 years. On multivariable logistic regression, severe obesity was independently associated with increased dislocation risk at 2 years (odds ratio 1.54, 95% confidence interval 1.23-1.96; P < .0001), corresponding to a 54% relative increase in odds. Kaplan-Meier analysis demonstrated statistically significantly lower dislocation-free survivorship in the severely obese cohort (log-rank P < .0001). All 3 time-point comparisons remained statistically significant after Bonferroni correction (adjusted α = 0.017). Severe obesity (BMI >35 kg/m2) was associated with a statistically significant but modest increase in the risk of post-operative dislocation following rTSA at short-term follow-up. The magnitude of the association was moderate and the absolute risk difference small. These findings support obesity-specific pre-operative risk counseling on the risk of post-operative instability after rTSA.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Claire A Donnelley"
    },
    {
      "affs": [
        0
      ],
      "name": "Jonathan White"
    },
    {
      "affs": [
        0
      ],
      "name": "Joshua G Sanchez"
    },
    {
      "affs": [
        0
      ],
      "name": "Victoria Kong"
    },
    {
      "affs": [
        0
      ],
      "name": "Jonathan N Grauer"
    },
    {
      "affs": [
        0
      ],
      "name": "Xuan Luo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/afd6mfxccfh3f.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jsea.2026.100109",
  "fulltext_url": "https://europepmc.org/articles/PMC13743955",
  "id": "afd6mfxccfh3f",
  "issns": [
    "2471-5492"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999519",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Shoulder Injury and Treatment"
    ]
  ],
  "openalex": "W7214960424",
  "pdf_url": "https://europepmc.org/articles/PMC13743955?pdf=render",
  "pmcid": "PMC13743955",
  "pmid": "42999519",
  "published": "2026-09-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/afd6mfxccfh3f.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42999519",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999519"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Shoulder Injury and Treatment",
      "subfield": "surgery"
    }
  ],
  "title": "Severe obesity as an independent risk factor for post-operative dislocation following reverse total shoulder arthroplasty: a PearlDiver database analysis.",
  "title_text": "Severe obesity as an independent risk factor for post-operative dislocation following reverse total shoulder arthroplasty: a PearlDiver database analysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/afd6mfxccfh3f",
  "venue": "Journal of shoulder and elbow arthroplasty",
  "versions": []
}