Researchers found that people with low folate levels (a B vitamin) had twice as many complications after total shoulder replacement surgery compared to those with normal folate levels. The study looked at patients’ folate levels before surgery and tracked problems like infections, bone fractures, and joint dislocations for up to four years afterward. People with folate deficiency had higher rates of serious complications including infections (11.4% vs 5.9%) and mechanical problems with their new shoulder joint. This suggests that checking and correcting folate levels before shoulder surgery might help reduce complications.

The Quick Take

  • What they studied: Whether people with low folate (a B vitamin) have more complications after total shoulder replacement surgery
  • Who participated: Patients who had total shoulder replacement surgery, divided into groups based on their folate blood levels before surgery
  • Key finding: People with low folate had nearly twice the risk of serious complications like infections and joint problems within 90 days of surgery
  • What it means for you: If you need shoulder surgery, getting your folate levels checked and corrected beforehand might help reduce your risk of complications

The Research Details

This was a retrospective cohort study, which means researchers looked back at medical records of patients who already had shoulder replacement surgery. They used a large medical database called TriNetX to find patients and divided them into two groups: those with low folate levels (2.5 ng/mL or below) and those with normal folate levels (2.6 ng/mL or above). The researchers then tracked what happened to these patients at three different time points: 90 days, two years, and four years after their surgery.

This type of study design allows researchers to examine real-world outcomes in a large number of patients over several years. By comparing patients with different folate levels who underwent the same surgery, they could identify whether folate deficiency was linked to more complications.

The study used a large medical database which provides access to many patient records, making the findings more reliable. However, since it looked backward at existing records, the researchers couldn’t control all the factors that might affect outcomes, and the exact number of patients wasn’t specified in the abstract.

What the Results Show

Within 90 days of surgery, patients with low folate had significantly higher rates of multiple complications. Infections around the artificial joint occurred in 11.4% of folate-deficient patients compared to only 5.9% of those with normal folate levels. Mechanical loosening of the artificial joint happened in 3.3% of low-folate patients but 0% of normal-folate patients. Bone fractures around the artificial joint affected 14.4% of folate-deficient patients versus 7.8% of those with normal levels. Joint dislocations occurred in 8.5% of low-folate patients compared to 3.9% of the control group. Overall, any type of mechanical complication happened in 14.1% of folate-deficient patients but only 6.5% of those with normal folate levels.

The problems persisted long-term. Even at two and four years after surgery, patients who had low folate before their operation continued to have higher rates of joint dislocations, mechanical complications, and joint instability compared to those with normal folate levels.

Previous research has shown that folate deficiency is linked to increased inflammation and more severe arthritis. This study builds on that knowledge by showing that these effects continue to impact patients even after they receive artificial joint replacements.

The study didn’t specify exactly how many patients were included, which makes it harder to judge how reliable the results are. Since it looked backward at medical records, the researchers couldn’t control for other factors that might have influenced the outcomes, such as overall nutrition status, other health conditions, or surgical techniques.

The Bottom Line

If you’re planning to have shoulder replacement surgery, consider asking your doctor to check your folate levels beforehand. If they’re low, taking folate supplements or eating more folate-rich foods might help reduce your risk of complications, though more research is needed to confirm this.

This research is most relevant for people scheduled for total shoulder replacement surgery and their healthcare providers. People with arthritis or joint problems who might need surgery in the future should also pay attention to these findings.

The study showed that folate’s effects on complications appeared within 90 days of surgery and continued for at least four years, suggesting that addressing folate deficiency before surgery could have both immediate and long-term benefits.

Want to Apply This Research?

  • Track your daily folate intake from foods and supplements, aiming for the recommended daily amount of 400 micrograms for adults
  • Add folate-rich foods like leafy greens, beans, fortified cereals, and citrus fruits to your daily meals, especially if you have joint problems or are considering surgery
  • Log folate-rich foods daily and track any joint pain or mobility changes over time to discuss with your healthcare provider

This information is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider before making changes to your diet, supplements, or treatment plan, especially before any surgical procedure.