Patients with Multiple Myeloma Have Increased Risks of Medical, but Not Surgical, Complications Following Total Shoulder Arthroplasty

Victoria E. Bergstein; Barry Ndeh; Seyedeh Zahra Mousavi; Fabio Greco; Henry Fox; Uma Srikumaran

Abstract

Background: Multiple myeloma (MM) is a hematologic malignancy associated with characteristic lytic bone lesions. Due to weakened bone quality from these lesions, MM has been previously associated with poor orthopaedic surgery outcomes, but this is understudied in the setting of total shoulder arthroplasty (TSA).Purpose: The purpose of this study was to investigate if patients with MM have increased risks of requiring revision after TSA.Methods: This was a retrospective review of a national insurance database. Patients who underwent TSA were identified and stratified by previous diagnoses of MM. The primary outcome was the incidence of TSA revision. Patients with and without MM were matched at a 1:4 ratio on the basis of age, biological sex, and CCI. Chi square analyses of the matched cohorts were performed to evaluate outcomes of interest.Results: Of 286,552 patients who underwent TSA, 1,949 (0.7%) patients had previous MM diagnoses. There was not a significant difference in the incidence of revision TSA between cohorts (3.7% vs 3.8%, p>0.99). Patients with MM were found to have significantly higher rates of fragility fracture (27.5% vs 16.9%, p<0.001), incision and drainage (0.6% vs 0.3%, p=0.015), acute kidney injury (3.4% vs 1.4%, p<0.001), pneumonia (2.6% vs 1.5%, p<0.001), stroke (1.7% vs 1.0%, p=0.0019), and blood transfusion (1.0% vs 0.6%, p=0.049).Conclusion: Patients with MM do not have an increased risk of TSA revision but are at increased risk for several medical complications. These results should inform shared decision-making for physicians and MM patients with end-stage shoulder osteoarthritis.What this study adds: This is a large-scale study demonstrating that while patients with MM undergoing TSA do not have an increased risk of revision surgery; however, they are at significantly higher risk for several medical complications.Potential impacts on research, practice or policy: This study provides reassuring findings can guide clinical practice by informing shared decision-making and treatment planning for patients with multiple myeloma and shoulder osteoarthritis, while helping to guide future research and policy aimed at optimizing perioperative care for this growing patient population.Study Design: Retrospective Cohort StudyLevel of Evidence: Level IIIKeywords: Arthroplasty, Complications, Fragility fractures, Hematologic malignancy, Multiple myeloma, Orthopedics, Osteoarthritis, Shoulder prosthesis.https://doi.org/10.70885/hmsj.2025.11.001

References

  1. Albagoush SA, Shumway C, Azevedo AM. Multiple Myeloma [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Dec 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534764/
  2. Bird SA, Boyd K. Multiple myeloma: an overview of management. Palliat. Care Soc. Pract. 2019 Jul 1;13:1178224219868235. doi:10.1177/1178224219868235
  3. Abduh MS. An overview of multiple myeloma: A monoclonal plasma cell malignancy’s diagnosis, management, and treatment modalities. Saudi J. Biol. Sci. 2024 Feb 1;31(2):103920. doi:10.1016/j.sjbs.2023.103920
  4. Terpos E, Christoulas D, Gavriatopoulou M, Dimopoulos MA. Mechanisms of bone destruction in multiple myeloma. [cited 2024 Nov 28];Available from: https://onlinelibrary.wiley.com/doi/10.1111/ecc.12761 doi:10.1111/ecc.12761
  5. Tosi P. Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement. Scientifica. 2013;2013(1):104546. doi:10.1155/2013/104546
  6. Melton LJ III, Kyle RA, Achenbach SJ, Oberg AL, Rajkumar SV. Fracture Risk With Multiple Myeloma: A Population‐Based Study*. J. Bone Miner. Res. 2005 Mar 1;20(3):487–493. doi:10.1359/JBMR.041131
  7. Willey JS, Lloyd SAJ, Bateman TA. Radiation Therapy-Induced Osteoporosis [Internet]. In: Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. John Wiley & Sons, Ltd; [cited 2024 Dec 17]. p. 728–733. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118453926.ch88 doi:10.1002/9781118453926.ch88
  8. Thorsteinsdottir S, Gislason G, Aspelund T, Sverrisdottir I, Landgren O, Turesson I, et al. Fractures and survival in multiple myeloma: results from a population-based study. Haematologica. 2020 Apr;105(4):1067–1073. doi:10.3324/haematol.2019.230011
  9. Wicha M, Tomczyk-Warunek A, Jarecki J, Dubiel A. TOTAL SHOULDER ARTHROPLASTY, AN OVERVIEW, INDICATINS AND PROSTHETIC OPTIONS. Wiadomosci Lek. Wars. Pol. 1960. 2020;73(9 cz. 1):1870–1873.
  10. Menendez ME, Park KJ, Barnes CL. Early Postoperative Outcomes After Total Joint Arthroplasty in Patients With Multiple Myeloma. J. Arthroplasty. 2016 Aug;31(8):1645–1648. doi:10.1016/j.arth.2016.01.029
  11. Salimy MS, Blackburn AZ, Alpaugh K, Lozano-Calderón SA, Bedair HS, Melnic CM. Postoperative Outcomes in Total Hip and Total Knee Arthroplasty for Patients Who Have Multiple Myeloma. J. Arthroplasty. 2023 Nov 1;38(11):2269–2274. doi:10.1016/j.arth.2023.05.019
  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis. 1987;40(5):373–383. doi:10.1016/0021-9681(87)90171-8
  13. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos M-V, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov 1;15(12):e538–e548. doi:10.1016/S1470-2045(14)70442-5
  14. Vogel MN, Weisel K, Maksimovic O, Peters S, Brodoefel H, Claussen CD, et al. Pathologic fractures in patients with multiple myeloma undergoing bisphosphonate therapy: incidence and correlation with course of disease. AJR Am. J. Roentgenol. 2009 Sep;193(3):656–661. doi:10.2214/AJR.08.2002
  15. Nador G, Ramasamy K, Panitsas F, Pratt G, Sadler R, Javaid MK. Testing and management for monoclonal gammopathy of uncertain significance and myeloma patients presenting with osteoporosis and fragility fractures. Rheumatology. 2019 Jul 1;58(7):1142–1153. doi:10.1093/rheumatology/kez127
  16. Yamashita T, Noiri E, Hamasaki Y, Matsubara T, Ishii T, Yahagi N, et al. Erythropoietin concentration in acute kidney injury is associated with insulin-like growth factor-binding protein-1. Nephrology. 2016;21(8):693–699. doi:10.1111/nep.12656
  17. Scharschmidt TJ, Lindsey JD, Becker PS, Conrad EU. Multiple Myeloma: Diagnosis and Orthopaedic Implications. JAAOS - J. Am. Acad. Orthop. Surg. 2011 Jul;19(7):410. doi:10.5435/00124635-201107000-00005
  18. Thein R, Herman A, Chechik A, Liberman B. Uncemented arthroplasty for metastatic disease of the hip: Preliminary clinical experience. The Journal of Arthroplasty. 2012;27(9):1658-1662. https://doi.org/10.1016/j.arth.2012.03.036

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