Craig RS, et al. - In this population based cohort study, researchers provided accurate risk estimates of serious adverse events following elective shoulder replacement surgery for arthritis, including age and sex specific estimates of the lifetime risk of revision surgery. Between April 1998 and April 2017, 58,054 elective shoulder replacements in 51,895 adults (aged ≥50 years). Data reported that rates were 4.6% overall, 0.3% for pulmonary embolism and for myocardial infarction, 1.9% for lower respiratory tract infection, 1.0% for acute kidney injury, 1.4% for urinary tract infection, 0.2% for cerebrovascular event, and 0.5% for all-cause death. Investigators found that the estimated lifetime risk of revision surgery following an elective shoulder replacement was much higher in younger patients, especially men (one in four for ages 59 years and younger). Findings suggested that younger patients, especially men, must be aware of the higher probability of early shoulder replacement failure and the need for further and more complex revision replacement surgery. The risks of serious adverse events should be advised to all patients. The risks of serious adverse events were much higher than previously estimated within 90 days of shoulder replacement surgery. In both younger and older patients, the findings warn against unchecked expansion of shoulder replacement surgery. The more accurate risk estimates for age and sex are long overdue and should improve shared decision making between patients and clinicians.