Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications

Abstract

Reverse total shoulder arthroplasty is a treatment option for patients with symptomatic glenohumeral arthritis and a deficient rotator cuff. The reported complication rates vary from 0% to 68%. Given this variation, our purposes were to (1) determine the learning curve for the procedure, (2) identify complications and surgical pitfalls, and (3) compare our results with those of similar published series. We retrospectively reviewed 20 consecutive patients (mean age, 73 years; range, 45-88 years) who had reverse total shoulder arthroplasty by one surgeon, tabulating intraoperative and postoperative complications. Minimum followup was 3 months (average, 9 months; range, 3-21 months). The intraoperative complication rate for the first 10 patients was higher than that for the second 10 patients. There were 33 complications in 15 patients: 11 patients collectively had 22 intraoperative complications and eight patients collectively had 11 postoperative complications. At radiographic followup, 11 patients had scapular notching and nine patients had heterotopic ossification. Our complication rate was higher than published rates.

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

“…Studies examining intraoperative complications, such as periprosthetic fractures [2,11,12,16,20,[22][23][24] during revision reverse shoulder arthroplasty have been done. There is a relatively high frequency of early complications associated with the procedure, partly attributable to the technical demands of the surgery and its relatively recent approval for use (2004) in the United States [2,11,16,20,22,23].…”

“…There is a relatively high frequency of early complications associated with the procedure, partly attributable to the technical demands of the surgery and its relatively recent approval for use (2004) in the United States [2,11,16,20,22,23]. Therefore, the purposes of our study were to assess the frequency, risk factors, and early outcomes associated with intraoperative periprosthetic humerus fractures in patients undergoing revision reverse shoulder arthroplasty.…”

Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

“…In 2003, a second type of TSA (called a reverse prosthesis or reverse total shoulder arthroplasty [reverse TSA]) was approved by the FDA for patients who had intractable shoulder pain because of arthritis and who lacked an intact rotator cuff [55]. Despite the technical challenges it initially presented to surgeons, the short-term (8-10 years) results of reverse TSA have been encouraging [24,37,55], and the success of the reverse TSA prosthesis has been shown to contribute to the large increase in the number of shoulder replacement procedures performed annually in the United States [14,27]. Although TSAs and reverse TSAs are done safely in most patients, some patients have medical or surgical complications develop that can lead to poor functional results and unanticipated hospital costs [3,5,47,53].…”

A History of Reverse Total Shoulder Arthroplasty

“…The variables in the current prostheses have been developed to address concerns that have arisen with reverse shoulder arthroplasty. The persistent problems and high complication rate with this procedure have been described extensively in the current literature, with complications including hematoma formation [48], infection [5,15,18,45,48,49], scapular notching [28,44,45,49], instability [18,48,49], acromial insufficiency [15,48], and glenoid component failures [14,17,42,45]. Additionally, complications and patient satisfaction vary among primary cuff tear arthroplasty, revision cases, and fractures [5,15,18,45,48,49].…”