The association of sarcopenia with surgical outcomes and complications following reverse total shoulder arthroplasty: a matched cohort study with comparative analysis against anatomic total shoulder arthroplasty.

Background: Sarcopenia, defined as age-related loss of skeletal muscle mass and function, has been linked to poor outcomes postoperatively. While anatomic total shoulder arthroplasty (aTSA) relies on rotator cuff integrity, reverse total shoulder arthroplasty (rTSA) depends primarily on deltoid function. This retrospective cohort study aims to evaluate the association of sarcopenia with postoperative outcomes following total shoulder arthroplasty. Methods: This study utilized TriNetX to analyze data from a cohort of 24,566 patients who underwent total shoulder arthroplasty. One-to-one exact matching was done to control variables across the control rTSA, sarcopenia rTSA, and sarcopenia aTSA cohorts. Postoperative outcomes were assessed at 3 and 6 months and at 1, 2, and 3 years. Independent Results: Postoperatively the sarcopenic rTSA group demonstrated significantly higher odds of surgical complications (odds ratio [OR]: 2.22, Conclusion: Sarcopenia has been identified as a significant factor affecting patient outcomes following shoulder arthroplasty. Sarcopenic patients demonstrated higher rates of surgical complications, pain, prosthetic joint infection, postoperative blood transfusion, and readmission, as well as long-term complications and higher odds of revision, postoperative opioid abuse, and prosthetic complications. The slightly higher early complication rates in the rTSA sarcopenic cohort compared to the aTSA sarcopenic cohort may be attributable to patients selected for rTSA being generally more comorbid rather than to the procedure itself. Given that sarcopenia has been associated with adverse postoperative outcomes, early identification and further investigation into targeted postoperative interventions may help clarify its potential role in recovery.