Impact of estrogen replacement therapy on outcomes following total shoulder arthroplasty: a propensity-matched retrospective cohort study of 1,779 patients.

Seyedeh Zahra Mousavi, Ethan R Harris, Sanjana Agarwal, Prasenjit Saha, Eve R Glenn, Henry M Fox, Umasuthan Srikumaran

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Article in JSES international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

Investigating the Relationship Between Estrogen Replacement Therapy and Postoperative Complications Following Single-Level Lumbar Fusion: A Propensity Matched Analysis.Global spine journal · 2026
Article
Effect of Preoperative Hormone Replacement Therapy on Postmenopausal Women Undergoing Rotator Cuff Repair.Cureus · 2026
Article
Advanced Biomaterial-Based In Vitro Osteoarthritis Models: Integrating Sex as a Biological Variable in Hormonal, Subchondral Bone, and Mechanobiological Pathways.Journal of functional biomaterials · 2026
Review
Association between hormone replacement therapy and clinical outcomes in women with rotator cuff tears.Archives of ISPRM · 2026
Article

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Seyedeh Zahra MousaviThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Ethan R HarrisThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Sanjana AgarwalSchool of Medicine, The Johns Hopkins University, Baltimore, MD, USA.

Prasenjit SahaThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Eve R GlennSchool of Medicine, The Johns Hopkins University, Baltimore, MD, USA.

Henry M FoxThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Umasuthan SrikumaranThe Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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; 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.

Indexed as

Estrogen replacement therapyJoint healthOrthopedic outcomesOsteoarthritisShoulder surgeryTotal shoulder arthroplasty

Identifiers

PMID40959016

DOI10.1016/j.jseint.2025.04.022

PMCPMC12435046

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