Complications with reverse total shoulder arthroplasty and recent evolutions

Abstract

Since its description by Paul Grammont from Dijon, France, several tens of thousands of reverse total shoulder arthroplasties (RTSA) have been performed for diverse conditions. The purpose of this analysis is to identify the complications of this procedure in the literature and in clinical practice. A total of 240 papers concerning RTSA published between 1996 and 2012 have been identified. Over 80 papers describe complications associated with this type of implant. A list of prostheses satisfying European and US standards, CE and FDA approved, has been produced on the basis of information provided by the manufacturers. Data from the literature do not support a meta-analysis. The inventory of best practices shows excellent results in the short and medium term in specific indications, while the number of complications varies between 10 and 65 % in long-term series. Complications can be classified into (A) non-specific including infections (superficial and deep), phlebitis, haematoma, neurological complications of the suprascapular, radial and axillary nerves and (B) specific complications associated with RTSA including (1) on the glenoid side: intraoperative fracture of the glenoid and acromion, late fracture of the scapula, impingement at the scapular neck (notching), glenoid loosening, dissociation of the glenoid component (snatching of the glenosphere) and fractures of the glenoid baseplate; (2) on the humeral side: metaphyseal deterioration, humeral loosening, instability of the shoulder, stiffness with limitation of external and/or internal rotation; and (3) muscular complications with fatty degeneration of the deltoid. Additionally we have identified specific situations related to the type of implant such as the disassembly of the humeral or the glenoid component, dissociation of the polyethylene humeral plate, dissociation of the metaphysis and osteolysis of the tuberosities. The integration of results from different clinical series is difficult because of the lack of a database and the multitude of implants used.

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

“…The incidence of SN was variable, ranging from 0 to 96 %, and increased with longer follow-up [8,11,12]. In this study, we found SN in 30 % of our patients.…”

“…The failure to achieve appropriate deltoid tension in these cases is a well-known cause of instability [11,15]. Although good results after RSA are well documented, the problem of SN is of concern.…”

Reverse arthroplasty for osteoarthritis and rotator cuff deficiency after previous surgery for recurrent anterior shoulder instability

“…The use of semi-constrained reverse shoulder arthroplasty could theoretically reduce the rate of recurrent dislocation due to the inherent stability of this implant design [16]. Moreover, in cases of insufficient rotator cuff, favourable results have been described compared to non-constrained anatomic shoulder arthroplasty [17,18].…”

Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

“…In the last two decades, the number of shoulder arthroplasties has increased every year, probably due to the advances in implant design and surgical technique, which have made complicated surgical procedures possible [1,2]. However, many complications may affect the mid-and long-term results of this type of surgery, leading to loss of function, pain and failure of the implant.…”