Evidence map›Paper›PMID 42542466›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026

Perioperative antihypertensive medication use is associated with no antifibrotic benefit but higher complications and revision rates following shoulder arthroplasty.

Tarishi Parmar, Miguel Fiandeiro, Mohammad Daher, Akin Adio, Jad Lawand, Adam Khan, Joseph Abboud

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Tarishi ParmarDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA. txp539@students.jefferson.edu.
Miguel FiandeiroPerelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Mohammad DaherDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA.
Akin AdioPerelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Jad LawandJohn Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, USA.
Adam KhanDepartment of Orthopedic Surgery, Southern California Permanente Medical Group, Panorama City, USA.
Joseph AbboudDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRenin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), are commonly prescribed antihypertensive medications with proposed antifibrotic and bone-protective effects. Their impact on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study evaluates the association between perioperative RAAS inhibitor exposure and postoperative outcomes after TSA.

methodsA retrospective cohort study using the TriNetX network identified patients undergoing primary shoulder arthroplasty (2005-2025), stratified by ACEi or ARB use. One-to-one propensity score matching was performed. Outcomes included 90-day medical complications and 1-year mechanical complications and revision.

resultsPost-matching, 27,938 patients per cohort (ARB vs. control) and 30,602 per cohort (ACEi vs. control) were included. Neither ARB nor ACEi use reduced rates of manipulation under anesthesia or capsular release at one year. Both cohorts had higher 90-day rates of emergency department visits, readmission, myocardial infarction, and acute renal failure. ACEi use was additionally associated with pulmonary embolism, deep-vein thrombosis, transfusion, and sepsis. At one year, both cohorts showed higher rates of periprosthetic joint infection, aseptic loosening, and revision. Dislocation risk was increased with ACEi use only.

conclusionPerioperative RAAS inhibitor use was not associated lower rates of antifibrotic procedures following TSA. Instead, RAAS inhibitor use was associated with higher rates of several perioperative medical complications and longer-term surgical events, including infection and revision. ACE inhibitor exposure demonstrated a broader complication profile compared with ARB exposure. However, because patients receiving RAAS inhibitors often have greater comorbidity burden, these findings should be interpreted as associative rather than causal. LEVEL OF EVIDENCE III: Retrospective Cohort Study.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsArthroplasty, Replacement, ShoulderPostoperative ComplicationsReoperationAgedFemaleHumansMaleMiddle AgedPerioperative CareRetrospective StudiesAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsAngiotensin-converting enzyme inhibitorsAngiotensin receptor blockersFibrosisPostoperative complicationsRenin-angiotensin-aldosterone system inhibitorsTotal shoulder arthroplasty

Identifiers

PMID42542466
PMCPMC13428774

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.