{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:06:58Z","timestamp":1784275618384,"version":"3.55.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Shoulder &amp; Elbow"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Folate deficiency is inversely correlated with inflammatory (markers\/conditions) and severe osteoarthritis. Osteoarthritis can lead to increased difficulty in shoulder reconstruction and longer operative times in total shoulder arthroplasty (TSA). Our goal is to see if folate deficiency is correlated with complications after TSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort analysis using the TriNetX database was used to identify individuals with low (\u22642.5\u2005ng\/mL) and normal (\u22652.6\u2005ng\/mL) folate levels before TSA. Outcomes were compared at 90 days, two years, and four years following TSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 90 days, folate deficient patients had a higher risk of periprosthetic joint infection (11.4% vs 5.9%, RR\u2009=\u20091.944,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.016), mechanical loosening (3.3% vs 0%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.014), periprosthetic fracture (14.4% vs 7.8%, RR\u2009=\u20091.833,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.011), dislocation (8.5% vs 3.9%, RR\u2009=\u20092.167,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.021), any mechanical complications (14.1% vs 6.5%, RR\u2009=\u20092.150,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.002), and instability\/subluxation (10.8% vs 5.6%, RR\u2009=\u20091.941,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.02) when compared to the control group. At the two-year and four-year time points, TSA folate deficient patients had an increased risk of dislocation, any mechanical complications, and instability\/subluxation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Folate deficiency in TSA patients is correlated with significant short- and long-term increase in several orthopedic complications. Folate deficient patients should be counseled on these risks before TSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17585732251362442","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T07:25:03Z","timestamp":1755501903000},"page":"748-758","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Folate deficiency and total shoulder arthroplasty outcomes"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4603-0540","authenticated-orcid":false,"given":"Prasenjit","family":"Saha","sequence":"first","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9481-5435","authenticated-orcid":false,"given":"Seyedeh Zahra","family":"Mousavi","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anagh","family":"Astavans","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Agarwal","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Fox","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Schmucker","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-8855","authenticated-orcid":false,"given":"Umasuthan","family":"Srikumaran","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sart.2024.08.003"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2020.04.024"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnim.2019.100104"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms150711324"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010215)91:4<854::AID-CNCR1073>3.0.CO;2-Z"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjnut.2023.07.018"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032546"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.090043"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032739"},{"key":"e_1_3_2_11_2","first-page":"121","article-title":"Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty","volume":"28","author":"Casp AJ","year":"2020","unstructured":"Casp AJ, Montgomery SR, Cancienne JM, et al. Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty. JAOSS 2020; 28: 121\u2013127.","journal-title":"JAOSS"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.09.018"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11050822"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sart.2023.06.013"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2019.03.003"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sart.2022.02.003"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000000531"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00882"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2022.06.006"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2022.10.028"},{"key":"e_1_3_2_21_2","first-page":"1149","article-title":"Folate deficiency is associated with increased radiographic severity of osteoarthritis in knee joints but not in hand joints","volume":"41","author":"Xu H","year":"2023","unstructured":"Xu H, Shin M-H, Kang J-H, et al. Folate deficiency is associated with increased radiographic severity of osteoarthritis in knee joints but not in hand joints. Clin Exp Rheumatol 2023; 41: 1149\u20131154.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu15071636"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.060406"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2018.01.010"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-04188-4"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10399"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28116"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-023-06695-w"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04231-7"},{"key":"e_1_3_2_30_2","article-title":"Folate-dependent hypermobility syndrome: a proposed mechanism and diagnosis","volume":"9","author":"Courseault J","year":"2023","unstructured":"Courseault J, Kingry C, Morrison V, et al. Folate-dependent hypermobility syndrome: a proposed mechanism and diagnosis. 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