Management of complications after reverse shoulder arthroplasty

Abstract

Reverse total shoulder arthroplasty (RTSA) has become the treatment of choice for patients with rotator cuff arthropathy. Complication rate after RTSA has been reported to be three to five times that of conventional total shoulder arthroplasty. Intraoperative and postoperative complications include neurological injury, infection, dislocation or instability, acromial or scapular spine fracture, hematoma, and scapular notching. Knowledge of optimal component placement along with preoperative planning and recognition of risk factors are essential in optimizing patient outcome. The purpose of this review article is to identify the most common and serious complications associated with the RTSA and discuss the current methods of management. Complications after RTSA pose a significant challenge for healthcare providers and economic burden to society. Therefore, it is essential to make the proper diagnosis and develop and implement early management plans to improve patient outcome and satisfaction.

Current Outcomes Following Reverse Total Shoulder Arthroplasty: A Composite

“…Scapular notching is by far the most common complication during the first 24 months postoperative. Scapular notching has an incidence of 38%, 57%, 55% and 73% in four recent studies respectively [12,15,24,25]. These findings oblige additional research to review instrumentation and confirm incidence levels on scapular notching in RTSA.…”

“…The deltopectoral approach is the most common and requires an experienced surgeon [10]. This surgical technique begins with an incision overlying the deltopectoral interval, preserving the cephalic vein, then tenotomizing the biceps tendon and the subscapularis if still intact [3,11,12]. Next, the joint capsule is circumferentially released and humeral head exposed to perform a humeral head osteotomy.…”

“…Patients need to be counseled on intraoperative, perioperative, and notably, short-term complications. The most common intraoperative complications are glenoid or humeral fractures along with poor screw fixation [12]. The consequence of poor screw fixation is its lasting impact and conversion to long-term complications such as glenoid screw lucency.…”

“…These findings oblige additional research to review instrumentation and confirm incidence levels on scapular notching in RTSA. In 2014, Feeley and colleagues [12] found that decreasing the neck-shaft angle or a higher inclination angle and 3 mm lateral offset of the glenosphere prosthesis decreased the rate of scapular notching by 16%. Furthermore, Zhou and colleagues [13] assert that continued complication management, by adding inferior placement of the glenosphere, is "the most important factor in the avoidance of inferior impingement."…”

“…An important question to consider is will the patient be free from scapular notching for the remainder of the prosthesis? [12] Feeley and colleagues [12] observed that of all the patients who did not experience scapular notching during the first 12 months (84% of patients), showed no new evidence of scapular notching during follow-ups up to 30 months. Conversely, Bacle and colleagues [15] found that after early scapular notching diagnoses were made, there was a 39% increase in the rate of notching beyond the 2-year follow-up period.…”