Analysis of complications of reverse total shoulder arthroplasty

Russo, Roberto; Rotonda, Giuseppe Della; Ciccarelli, Michele; Cautiero, Fabio

doi:10.11138/jts/2015.3.2.062

Cited by 20 publications

(12 citation statements)

References 13 publications

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“…-10%), failed open reduction and internal fixation (ORIF) of proximal humerus fractures (5.2%) and tumours (0.8%). 4,6,7,9,10,12 Similar indications for RSA as mentioned above were found in our cohort, with the exception of rheumatoid arthritis and acute proximal humerus fractures ( Table I).…”

Section: Discussionsupporting

confidence: 83%

“…9 Similarly Russo et al found an increase from 10.8% to 36.8%. 12 This suggests that, although RSA may be a useful method to treat complex shoulder problems, it should be utilised with care in these patients as the best outcomes are seen in patients with primary shoulder pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic fractures, implant failure and haematoma formation that reportedly accounts for 1.4-4.0%, 1.8-29% and 2-3% of complications respectively, were rare in the sample group. 9,[12][13][14] Deltoid problems consisted of a prominent screw after a previous os acromiale ORIF irritating the deltoid muscle, necessitating removal, and a tear in the deltoid muscle requiring repair due to persistent pain. Deltoid injury is a rare complication, accounting for 0.9% of all complications.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10 The indications for reinterventions have been investigated by previous authors, but many of the published studies either have a small sample size, 10,11 short follow-up 7,11 or incomplete reporting on their indications for reintervention. 6,11,12 Two notable exceptions to the above are a systematic review by Zumstein et al 9 and a review article by Boileau. 13 These patients are also typically elderly with multiple co-morbidities that make them unsuitable for repeated high-risk anaesthetics (beach-chair position).…”

Section: Introductionmentioning

confidence: 99%

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Indications for surgical reintervention following reverse shoulder arthroplasty: a retrospective audit from 2006 to 2015

et al. 2017

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Background: Reverse shoulder arthroplasty (RSA) has increased in popularity and its indications have subsequently been expanded. With its increased use, the complication rates have also increased. Complications requiring additional surgeries have the highest morbidity and cost. The aim of this study was to determine the indications for additional surgery following RSA. Methods: All the surgical and clinical notes of patients treated with an RSA at our institution over a nine-year period were retrospectively reviewed. Sixty-seven RSAs met the inclusion criteria and their records were reviewed to assess their indication for surgery, complications, as well as microbiology results if infection was present. Results: Surgical reintervention was required in 16 (23.9%) RSAs. The prevalence was lowest in rotator cuff arthropathy and glenohumeral arthritis (nine RSAs or 18.4%), followed by failed hemi-or total shoulder arthroplasty (four RSAs or 36.4%) and highest if performed for uncommon conditions (two RSAs or 66.7%). Instability was an early complication, occurring in 10.7% of cases and accounting for 37.8% of all reinterventions. Infection was a late complication, occurring in 6.0% of cases and accounting for 48.6% of all reinterventions. The most common organisms identified were Staphylococcus epididermidis (n=4), Escherichia coli (n=3), Staphylococcus aureus (n=2) and Klebsiella pneumonia (n=2). Conclusions: RSA has the most reliable outcomes if performed for rotator cuff arthropathy and glenohumeral osteoarthritis. Instability and infection are the most common indications for surgical reintervention, and once present, often require repeated surgeries to be successfully treated. These complications should be avoided, as they are major contributors to morbidity and cost.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indications for surgical reintervention following reverse shoulder arthroplasty: a retrospective audit from 2006 to 2015

et al. 2017

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“…During the past 2 decades, the RTSA has been used to treat a range of complex shoulder diseases, including total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) implant failures, complex proximal humeral fractures, asymmetric glenoid wear, posterior humeral head subluxation in patients with intact rotator cuffs, and irreparable rotator cuff tears in the absence of arthritis 36 . However, several studies documented a steep learning curve with RTSA, reflecting the relative difficulty of the procedure because of its technically demanding nature, prosthesis design limitations, and iatrogenic morbidity 28, 36. Compared with TSA, which has a complication rate of roughly 10%, there is a significant variation in the complication rates for RTSA ranging from 14% to 75% 5, 26, 29.…”

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confidence: 99%

Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

et al. 2019

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Background Indications for reverse total shoulder arthroplasty (RTSA) have expanded. The purpose of this retrospective cohort study was to evaluate national trends in shoulder arthroplasty utilization and to compare national perioperative complication rates for hemiarthroplasty (HA), total shoulder arthroplasty (TSA), and RTSA in a matched cohort. Methods The National Inpatient Sample was queried from 2011-2013 to identify patients who underwent HA, TSA, or RTSA. Age, sex, race, insurance type, Elixhauser comorbidity index, and perioperative complications were identified. A coarsened exact matching algorithm was used to match RTSA patients with TSA and HA patients to compare medical and implant-related perioperative in-hospital complications. Multivariable logistic regression analysis was performed on unmatched data to identify risk factors for development of perioperative complications. Results Overall, 42,832 shoulder arthroplasties were identified (44% TSAs, 34% RTSAs, 19% HAs). After matching, RTSAs had 6.2 times the odds of a perioperative implant-related complication ( P < .001) and 2 times the odds of a red blood cell transfusion compared with TSAs ( P < .001). The logistic regression model showed that prior shoulder arthroplasty (odds ratio [OR], 15.1; P < .001), younger age (OR, 0.98; P = .006), earlier year of index surgery (OR, 0.83; P = .002), history of illicit drug use (OR, 6.2; P = .008), and depression (OR, 2.3; P = .003) were risk factors for development of in-hospital implant-related complications after RTSA. Conclusion The perioperative implant-related complication rate and postoperative transfusion rate of RTSAs were significantly higher than those of TSAs. In addition, prior shoulder surgery, younger age, earlier year of index surgery, history of illicit drug use, and depression were risk factors for implant-related complications after RTSA. However, the perioperative RTSA implant-related complications did decline each year, suggesting a growing national proficiency with performing RTSA.

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