The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Abstract

Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

Complications and further surgery after reverse total shoulder arthroplasty

“…A recent systematic review which included 14,235 RTSAs reported a rate of 2.6%. 11 Others have reported higher rates, of up to 10%. 26 An intact acromion as the origin of the deltoid muscle is crucial to the function of a RTSA.…”

“…8,9 The most common complications are instability, periprosthetic infection, aseptic glenoid loosening, and fractures of the body or spine of the acromion. [8][9][10][11] Various review articles have dealt with each complication separately. [9][10][11][12][13][14] However, few have reported the overall complication rate and clinical outcome in a large cohort of patients with sufficient follow-up.…”

“…[8][9][10][11] Various review articles have dealt with each complication separately. [9][10][11][12][13][14] However, few have reported the overall complication rate and clinical outcome in a large cohort of patients with sufficient follow-up. 6,[15][16][17] The aim of this study was to report the complications, the clinical outcome, and the rate of further surgery in a large systematically and prospectively followed cohort of patients who underwent RTSA in a single centre.…”

Einfluss von Komplikationen und Komorbiditäten auf Liegedauer und Kosten bei der operativen Behandlung der proximalen Humerusfraktur

“…Auch eine codierte Demenzerkrankung zum Zeitpunkt der Operation ist mit einer mittleren Kostensteigerung von β = 682,12 EUR (95 %-KI: 477,28-886,95 EUR; p < 0,001) assoziiert. [26,27]. Die hohe Zufriedenheit der behandelnden Unfallchirurgen deckt sich auch mit den Ergebnissen der Delphi-Studie, welche in einem randomisiertkontrollierten Multicenterstudiendesign eine bessere Schulterfunktionalität gemessen am Constant Score nach inverser Schulterprothese im direkten Vergleich zur winkelstabilen Plattenosteosynthese nach AO(Arbeitsgemeinschaft für Osteosynthesefragen)-Typ-B2-und -C2-Frakturen in einem 2-Jahres-Follow-up nachweisen konnte [6].…”

Can Lateralization of Reverse Shoulder Arthroplasty Improve Active External Rotation in Patients with Preoperative Fatty Infiltration of the Infraspinatus and Teres Minor?

“…The treatment of rotator cuff tears was revolutionized with the introduction of RSA, which provides significant improvements in functional and clinical outcomes for many different shoulder pathologies [1]. Studies reporting on long-term outcomes of Grammontstyle designs have reported consistent limited restoration of external rotation [2].…”