Archives of Orthopaedic and Trauma Surgery (2018) 138:317–323
Bleeding in primary shoulder arthroplasty
· Asma Abdelmoula
· Thomas J. Heyse
· Christian D. Peterlein
· Brandon Greene
Bilal F. El‑Zayat
Received: 9 July 2017 / Published online: 6 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Introduction The aim of this investigation was to analyse “total blood loss” (TBL), “blood transfusion rate” (BT) and the
“amount of transfused blood units” (BU) between the diﬀerent primary shoulder arthroplasty (SA) types: reverse, anatomical
and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate.
Methods A retrospective charts analysis of patients who received primary SA for degenerative shoulder pathology in our
institution between 2004 and 2016 was performed. The demographic data, co-morbidities, haemoglobin and hematocrit level,
BT rate, amount of transfused BU etc. were collected. TBL was estimated. Linear regression, log-linear poisson regression
and logistic regression were used to compare the outcomes TBL, amount of transfused BU and BT rate, respectively, between
diﬀerent prosthesis types.
Results Of 278 patients included in this study 209 received reverse, 57 anatomical and 12 stemless SA. Mean TBL was
392.7 ml in reverse, 394.6 ml in anatomical and 298.3 ml in stemless SA. The BT rate and mean amount of BU were, respec-
tively, 14.4% and 0.32 in reverse and 8.77% and 0.23 in anatomical SA. None of the patients with stemless arthroplasty
received BT. Signiﬁcant risk factors for elevated TBL are operation time, higher BMI, male sex. Signiﬁcant risk parameters
for BT and higher amount of transfused BU are low BMI, cemented arthroplasty, coronary heart disease, ASA score > 2 and
previous therapy with vitamin K antagonists.
Conclusion Although there were little diﬀerences between the blood transfusion rates in reverse vs. anatomical arthroplasty,
there was no diﬀerence in total blood loss between these diﬀerent prosthesis types. None of the patients with stemless
arthroplasty received blood transfusion. There are various risk factors aﬀecting total blood loss and blood transfusion rate.
However, risk parameters inﬂuencing blood transfusion may be diﬀerent to them aﬀecting total blood loss.
Keywords Bleeding · Shoulder arthroplasty · Total blood loss · Blood transfusion · Reverse · Anatomical
Shoulder arthroplasty (SA) plays a central role in the treat-
ment of many glenohumeral joint pathologies when pre-
viously performed conservative procedures were not suc-
cessful. In the recent decades, the frequency of SA surgery
increased respectably [1, 2]. The treatment with SA leads
mostly to good long-term outcome [3–7]. However, one of
the most frequent perioperative complications is bleeding,
often resulting in blood transfusion. Depending on the study
the incidence of relevant bleeding appears to be between
4–43% [8–10]. Though bleeding and blood transfusion may
aﬀect patients’ health via appearance of cardiovascular inci-
dents, transfer of infectious diseases, occurrence of fever or
anaphylactic reaction [11, 12].
The main reason for the implantation of SA is osteoar-
thritis of the glenohumeral joint. Other indications for the
SA surgery are rotator cuﬀ arthropathy and fracture of the
proximal humerus . This study focused on primary SA
implanted for degenerative reasons. Depending on the ana-
tomical conditions and age of the patient diﬀerent prosthesis
designs can be used in primary SA. If the rotator cuﬀ is
intact, an anatomic prosthesis can be used. In case of exten-
sive rotator cuﬀ tears, a reverse SA should be implanted.
* Dominik Malcherczyk
Center for Orthopedics and Trauma Surgery, University
Hospital Marburg, Baldingerstrasse, 35043 Marburg,
Institute of Medical Biometry and Epidemiology, University
Marburg, Marburg, Germany