Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review

Abstract

Introduction The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures. Significance We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients’ outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed. Results The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases. Conclusions A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further complication rate. This investigation may aid in the treatment decision-making for these complications.

Use of custom glenoid components for reverse total shoulder arthroplasty

“…The complications seen in this study are comparable to those reported in the literature for custom glenoid components and revision shoulder arthroplasty, with the relatively high rate of complications reflecting the challenging nature of complex revision surgeries [8]. Complications such as greater tuberosity fracture in both primary and revision cases were recently reported by Wixted et al [28] and Dolci et al [29]. Our complications when using a custom glenoid component are similar to those reported by Rangarajan et al [8], who reported four complications (21%): one greater tuberosity fracture; one humeral perforation requir- Several limitations need to be considered when interpreting the results of this study or considering performing this procedure.…”

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

“…Problems related with locking of the stem are about 5% in our series, this rate is similar to data of the Symposium of the French Orthopedic Society in 2019. Nevertheless, early rehabilitation could explain mobilization of stem or locking screws [11,42]. Main strength of this work remains the follow-up of 45 ± 19 months with a minimum follow-up of 2 years, on a multicenter population of 94 patients, with a single type of surgery.…”

Time-elapsed microstructural imaging of failure of the reverse shoulder implant

“…In the last 15 years, the number of Reverse Shoulder Arthroplasties (RSA) has increased exponentially as a choice for pain relief, improving shoulder function and implant survival [ 1 ]. Revision rates have been reported between 12% and 16% [ 1 , 2 ], with exceptions reaching 69% [ 3 ].…”

“…In the last 15 years, the number of Reverse Shoulder Arthroplasties (RSA) has increased exponentially as a choice for pain relief, improving shoulder function and implant survival [ 1 ]. Revision rates have been reported between 12% and 16% [ 1 , 2 ], with exceptions reaching 69% [ 3 ]. Aseptic loosening of the humeral component, and intra- and post-operative bone fracture, are among the ten most common complications potentially leading to revision surgery [ 1 ].…”

“…Revision rates have been reported between 12% and 16% [ 1 , 2 ], with exceptions reaching 69% [ 3 ]. Aseptic loosening of the humeral component, and intra- and post-operative bone fracture, are among the ten most common complications potentially leading to revision surgery [ 1 ]. In this context, large-volume micro-computed tomography (micro-CT) scanners enable visualization of the microstructure of entire bones [ 4 – 7 ], joints [ 8 ] and implants [ 7 ] under controlled loading, for advanced analyses of biomechanical failure of implantable devices.…”