A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties

Abstract

Background Reported early complication rates in reverse total shoulder arthroplasty have widely varied from 0% to 75% in part due to a lack of standard inclusion criteria. In addition, it is unclear whether revision arthroplasty is associated with a higher rate of complications than primary arthroplasty. Questions/purpose We therefore (1) determined the types and rates of early complications in reverse total shoulder arthroplasty using defined criteria, (2) characterized an early complication-based learning curve for reverse total shoulder arthroplasty, and (3) determined whether revision arthroplasties result in a higher incidence of complications. . We determined local and systemic complications and distinguished major from minor complications. Results Nineteen shoulders involved local complications (9.9%), including seven major and 12 minor complications. Nine involved perioperative systemic complications (4.7%), including eight major complications and one minor complication. The local complication rate was higher in the first 40 shoulders (23.1%) versus the last 160 shoulders (6.5%). Seven of 40 (17.5%) revision arthroplasties involved local complications, including two major and five minor complications compared to 12 of 152 (7.9%) primary arthroplasties, including five major and seven minor complications. Nerve palsies occurred less frequently in primary arthroplasties (0.6%) compared to revisions (9.8%). Conclusions The early complication-based learning curve for reverse total shoulder arthroplasty is approximately 40 cases. There was a trend toward more complications in revision versus primary reverse total shoulder arthroplasty and more neuropathies in revisions. Level of Evidence Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

“…2,28,33,41,45 The complication-based learning curve decreases with experience, with reports identifying this range as 10 to 40 cases. 29,44,55 This is to be expected as surgeon inexperience has been identified as an independent risk factor for poorer shoulder outcomes after rotator cuff repair 46 arthroplasty. 24,47 Hospital surgical caseload volumes may also play a role in the frequency of complications.…”

Complications with reverse total shoulder arthroplasty and recent evolutions

“…The authors conclude that the early complication-based learning curve for RTSA is approximately 40 cases. There were more complications and more neuropathies in revision versus primary reverse arthroplasties [31].…”

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].…”