Surreal image of a shoulder joint in the clouds at a mountain peak, symbolizing the risk of VTE following shoulder arthroplasty at high altitude.

Sky-High Risks: Does Altitude Affect Your Shoulder Arthroplasty Outcome?

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"Uncover the surprising link between high altitudes and increased risks of venous thromboembolisms following total shoulder arthroplasty."

Total shoulder arthroplasty (TSA) is a common and effective procedure for relieving pain and restoring function in individuals with severe shoulder arthritis. While generally safe, like all surgeries, it carries certain risks, including venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a condition where blood clots form in the veins, potentially leading to serious complications.

Traditionally, factors such as obesity, smoking, hypertension, diabetes, and hyperlipidemia have been recognized as risk factors for VTE following orthopedic surgeries. However, emerging research suggests that environmental factors, such as altitude, may also play a significant role. High altitudes can trigger physiological changes in the body that might predispose individuals to VTE.

This article explores a recent study investigating the relationship between high altitudes and the risk of VTE after TSA. We will delve into the study's findings, discuss the potential mechanisms behind this association, and provide practical advice for individuals considering TSA at higher elevations. Understanding these risks is crucial for both patients and surgeons to ensure the safest possible outcomes.

Altitude and VTE Risk: What the Research Shows

Surreal image of a shoulder joint in the clouds at a mountain peak, symbolizing the risk of VTE following shoulder arthroplasty at high altitude.

A retrospective study was conducted using the Medicare Standard Analytical Files database to investigate whether undergoing TSA at higher altitudes (>4,000 feet) is an independent risk factor for postoperative VTE. Researchers compared patients undergoing TSA at high-altitude centers with a matched control group undergoing the same procedure at low-altitude centers (<100 feet). The study meticulously excluded patients with pre-existing conditions like VTE, DVT, PE, and coagulation disorders.

The study revealed a significant association between high altitude and an increased risk of pulmonary embolism (PE) within the first 30 postoperative days. Specifically, patients undergoing TSA at higher altitudes experienced a significantly higher rate of PEs compared to those at lower altitudes. This trend persisted at the 90-day mark, indicating that the elevated risk extends beyond the immediate postoperative period.

Increased PE Risk: The odds of experiencing a PE within the first 30 days were significantly higher for patients undergoing TSA at high altitudes.
Sustained Risk: The increased risk of PE remained evident even 90 days after the surgery.
No Difference in DVT Rates: Interestingly, the study did not find a significant difference in the rates of deep vein thrombosis (DVT) between the high and low-altitude groups.

These findings suggest that altitude may be an independent risk factor for VTE, specifically PE, following TSA. While the exact mechanisms are not fully understood, several factors associated with high altitude could contribute to this increased risk.

What This Means for You: Practical Implications and Recommendations

If you are considering TSA, especially if you reside at or plan to undergo surgery at a high-altitude location, it is crucial to discuss these findings with your orthopedic surgeon. While this study highlights a potential risk, it does not mean that TSA is unsafe at high altitudes. Instead, it emphasizes the importance of personalized risk assessment and preventative strategies. Your surgeon can evaluate your individual risk factors and recommend appropriate measures to minimize the risk of VTE.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jor.2018.09.003, Alternate LINK

Title: A Higher Altitude Is An Independent Risk Factor For Venous Thromboembolisms Following Total Shoulder Arthroplasty

Subject: Orthopedics and Sports Medicine

Journal: Journal of Orthopaedics

Publisher: Elsevier BV

Authors: Dhanur Damodar, Rushabh Vakharia, Ajit Vakharia, Jon Sheu, Chester J. Donnally, Jonathan C. Levy, Lee Kaplan, Julianne Munoz

Published: 2018-12-01

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Everything You Need To Know

1

What is Total Shoulder Arthroplasty (TSA)?

Total shoulder arthroplasty (TSA) is a surgical procedure performed to alleviate pain and restore function in individuals suffering from severe shoulder arthritis. During TSA, the damaged components of the shoulder joint are replaced with artificial implants. This procedure is generally considered safe and effective, but it carries certain risks.

2

What is Venous Thromboembolism (VTE) and why is it relevant to Total Shoulder Arthroplasty (TSA)?

Venous thromboembolism (VTE) is a condition where blood clots form in the veins. These clots can potentially lead to serious complications. In the context of total shoulder arthroplasty (TSA), VTE is a known risk, encompassing both deep vein thrombosis (DVT), where clots form in the deep veins, and pulmonary embolism (PE), where a clot travels to the lungs. The presence of VTE can significantly impact the recovery and overall outcome of the TSA procedure.

3

How does altitude affect the risk associated with Total Shoulder Arthroplasty (TSA)?

Altitude, specifically high altitudes (above 4,000 feet), has been identified as a potential risk factor for postoperative pulmonary embolism (PE) following total shoulder arthroplasty (TSA). The study highlighted in this context showed that patients undergoing TSA at high-altitude centers experienced a significantly higher rate of PE compared to those at low-altitude centers. The exact mechanisms are not fully understood, but physiological changes associated with high altitude may predispose individuals to VTE.

4

What specific risks did the study find regarding altitude and Total Shoulder Arthroplasty (TSA)?

A study found that individuals undergoing total shoulder arthroplasty (TSA) at high altitudes face an elevated risk of pulmonary embolism (PE) within the first 30 and 90 days post-surgery. It is important to note that while the study found a significant association between high altitude and PE, it did not find a significant difference in the rates of deep vein thrombosis (DVT) between high and low-altitude groups.

5

What should I do if I am planning to undergo Total Shoulder Arthroplasty (TSA), especially at a high altitude?

If you're considering total shoulder arthroplasty (TSA), especially if you live at or plan to have surgery at a high altitude, discussing these findings with your orthopedic surgeon is crucial. Your surgeon can assess your individual risk factors and recommend preventive measures, such as blood thinners or other strategies, to minimize the risk of venous thromboembolism (VTE), specifically pulmonary embolism (PE). This personalized approach helps ensure the safest possible outcome following TSA.