Complications of Reverse Total Shoulder Arthroplasty

Sang-Eun Park; Jae-Jung Jeong; Young-Yul Kim; Se-Won Lee; Min-Gyu Park; Jae-Min Lee; Jong-Hun Ji

doi:10.4055/jkoa.2015.50.6.491

Journal List > J Korean Orthop Assoc > v.50(6) > 1013415

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Park, Jeong, Kim, Lee, Park, Lee, and Ji: Complications of Reverse Total Shoulder Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(6): 491-500.

Published online: 29 December 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.6.491

Complications of Reverse Total Shoulder Arthroplasty

Sang-Eun Park, M.D., Jae-Jung Jeong, M.D., Young-Yul Kim, M.D., Se-Won Lee, M.D., Min-Gyu Park, M.D., Jae-Min Lee, M.D., Jong-Hun Ji, M.D.

Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Correspondence to: Jong-Hun Ji, M.D. Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea. TEL: +82-42-220-9530, FAX: +82-42-221-0429, jijh87@gmail.com

Received 7 May 2015 Revised 29 June 2015 Accepted 21 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to analyze complications after reverse total shoulder arthroplasty and report the clinical outcomes with review of previously reported studies.

Materials and Methods

Complications after reverse total shoulder arthroplasty were analyzed for 98 patients who underwent reverse total shoulder arthroplasty and were followed-up for at least 6 months. Of 98 patients, 22 were men and 76 were women. The mean age was 75.0±6.5 years (range, 59-92 years) with a mean follow-up period of 22±19 months (range, 6-74 months). The types and time of occurrence of complications, methods of treatment, and clinical outcomes at the final follow-up were analyzed.

Results

Complications occurred in 18 of 98 patients (18.4%). Seven of them received operative treatment and 11 were treated conservatively. Two cases had postoperative dislocations and were addressed with open reduction. In 2 cases, periprosthetic fractures occurred and were treated with open reduction and plate fixation. Two acromial stress fractures and 8 cases of heterotopic ossification were managed conservatively. Infection and humeral component loosening occurred in one case, respectively, and were treated with revision arthroplasty. Glenoid component loosening occurred in 2 cases, one of which was treated with revision arthroplasty and the other was managed conservatively. At the final follow-up, clinical outcomes showed a statistically significant improvement. Compared to groups with no complications, there were no significant differences in final clinical outcomes. Scapular notching occurred in 43.9% (43/98 cases). No statistically significant differences of clinical outcomes were observed between the scapular notching group and the no notching group (p>0.05).

Conclusion

In our study, 18% of complications occurred after reverse total shoulder arthroplasty and final clinical outcomes of these complications showed significant improvement. Scapular notching developed in 44% and did not provide a significant clinical effect at short term follow-up.

Keywords: reverse total shoulder arthroplasty, complication, revision

Figures and Tables

Figure 1

Acromion fracture. A 77-year-old female patient complained of severe shoulder pain at postoperative 2 years. X-ray and computed tomography scan showed a complete acromion fracture. Acromial fracture was shown on X-ray (arrow).

Figure 2

Scapular notching (arrows) developed at postoperative 4 and 5 years, respectively. Classification according to the standard of Sirveaux.9)

Figure 3

Periprosthetic fracture near the tip of the humeral stem. Locking compression plate and cable (Zimmer, Warsaw, IN, USA) was used.

Figure 4

Postoperative complication of glenosphere loosening. At postoperative 4 months, an 83-year-old female patient suffered from progressive shoulder pain. X-ray showed progressive loosening of glenosphere at postoperative 1 month (A) and 3 months (B) and revision surgery with inferior tilted glenosphere and glenoid bone graft (C). The arrows of each figure indicated progressive loosening of the glenodsphere (A, B) and the inserted bone graft of the the glenoid defect (C).

Figure 5

Revision surgery of glenosphere loosening. (A) For the revision surgery, a deltopectoral approach was used. (B) After removal of the glenoid component, a chipbone graft was used for the glenoid bone defect. (C) Using the device of the BioRSA instrument, a bone plug was achieved from the allograft femoral head. (D) The allograft was inserted into the glenoid bone.

Figure 6

Radiography of the inserted prosthesis with antibiotic-loaded acrylic cement (PROSTALAC) in the proximal humerus after removal of the humeral stem (A), and revision arthroplasty using an augmented metal block in the proximal humeral stem at postoperative 2-year follow-up (B).

Figure 7

(A) Periprosthetic fracture of the humeral stem had developed on the postoperative 3-year follow-up X-ray. (B) Computed tomography scan showed loosening sign around the proximal humeral stem.

Figure 8

Postoperative 2-year follow-up radiography showed no bony abnormalities.

Table 1

Clinical Outcomes in Complications of Reverse Total Shoulder Arthroplasty

ASES, American Shoulder and Elbow Surgeons; UCLA, University of California, Los Angeles; SST, simple shoulder test.

Table 2

Treatments of Postoperative Complications after Reverse Total Shoulder Arthroplasty

^*Time interval from primary operation to the revision surgery.

Table 3

Comparison between Complication Rates and Revision Rates in the Reverse Total Shoulder Arthroplasty

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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