Cannabis use disorder is not a risk factor for thrombotic events or medical complications following total shoulder arthroplasty

Background: In recent years, there has been an increase in utilization of cannabis. Existing studies have found cannabis use disorder (CUD) to be associated with increased incidence of perioperative complications in lower extremity arthroplasty. However, studies examining CUD following total shoulder arthroplasty (TSA) are limited. The aim of this study was to evaluate the effect of comorbid CUD on 2-year revision and 90-day postoperative outcomes in primary TSA for osteoarthritis. Methods: A retrospective cohort analysis was conducted using the PearlDiver database. Current Procedural Terminology, ICD-9, and ICD-10 codes were used to identify patients undergoing TSA for the indication of osteoarthritis and were divided into a CUD and control group. The primary outcomes of interest were 2-year all-cause revision, 90-day hospital readmission, and 90-day emergency department (ED) visit. Surgical perioperative complications included prosthetic joint infection, periprosthetic fracture, aseptic loosening, articular bearing surface wear, broken prosthesis, and prosthetic dislocation. Univariate analysis and multivariable logistic regression were conducted to analyze the data. Results: A total of 205,792 patients undergoing TSA were identified. The CUD cohort contained 2058 patients, and the control cohort contained 203,734 patients. After controlling for comorbidities, there were statistically significant differences in 2-year revision outcomes. Multivariable results also showed no association with 90-day medical or surgical complications, with the exception of convulsions, 90-day presentation to an eED, and readmission. Discussion and Conclusion: Our study showed that patients with CUD have an increased risk of 2-year all-cause revision, readmission, and ED presentation after undergoing TSA. However, CUD was not found to be an independent risk factor for adverse 90-day medical complications, deep vein thrombosis, or length of stay. The results of this research expand the literature on TSA and comorbid substance use. Further, our findings can assist orthopedic surgeons in counseling patients regarding CUD as a risk factor for complications of TSA.