Complications associated with arthroscopic shoulder surgery

Weber, Stephen C.; Abrams, Jeffrey S.; Nottage, Wesley M.

doi:10.1053/jars.2002.31801

Cited by 215 publications

(88 citation statements)

References 63 publications

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“…7,16,20 Deep infection is not common, reported to occur in between 1% and 2% of rotator cuff repairs. 2,15 Athwal et al reported on a group of 39 cases of deep infection after rotator cuff repair, but only 3 of these were performed arthroscopically.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for surgical complications in rotator cuff repair in a veteran population

Owens

Williams

Wolf

2015

Journal of Shoulder and Elbow Surgery

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Section: Discussionmentioning

confidence: 99%

Risk factors for surgical complications in rotator cuff repair in a veteran population

Owens

Williams

Wolf

2015

Journal of Shoulder and Elbow Surgery

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“…1,4–8 In this study, we performed exploratory analysis for any relationship between surgery in the BCP and neurologic complications by assessing for postoperative cognitive dysfunction. At baseline, we observed differences in cognitive test results between patients who would subsequently undergo surgery in the BCP or LDP even after adjusting for patient age.…”

Section: Discussionmentioning

confidence: 99%

“…3 The BCP, however, has been reported to be associated with rare but devastating neurologic complications, including stroke, spinal cord ischemia, and transient visual loss. 1,4–8 The mechanism of these complications is unknown. Arterial blood pressure is measured from the brachial artery or even the popliteal artery (when the blood pressure cuff is placed on the lower leg) during shoulder surgery.…”

Section: Introductionmentioning

confidence: 99%

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Laflam¹,

Joshi

Brady

et al. 2015

Anesthesia &Amp; Analgesia

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Background Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated to increase susceptibility to rare, but devastating, neurologic complications after shoulder surgery in the beach chair position (BCP). We hypothesized that patients in the BCP have diminished cerebral blood flow autoregulation than those who undergo surgery in the lateral decubitus position (LDP). A secondary aim was to examine whether there is a relationship between patient positioning during surgery and postoperative cognition or serum brain injury biomarker levels. Methods Patients undergoing shoulder surgery in the BCP (n=109) or LDP (n=109) had mean arterial blood pressure (MAP) and regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy. A continuous, moving Pearson’s correlation coefficient was calculated between MAP and rScO2, generating the variable cerebral oximetry index (COx). When MAP is in the autoregulated range, COx approaches zero because there is no correlation between cerebral blood flow and arterial blood pressure. In contrast, when MAP is below the limit of autoregulation, COx is higher because there is a direct relationship between lower arterial blood pressure and lower cerebral blood flow. Thus, diminished autoregulation would be manifest as higher COx. Psychometric testing was performed before surgery and then 7–10 days and 4–6 weeks after surgery. A composite cognitive outcome was determined as the Z-score. Serum S100β, neuron-specific enolase, and glial fibrillary acidic protein were measured at baseline, after surgery, and on postoperative day 1. Results After adjusting for age and history of hypertension, COx (p=0.035) was higher and rScO2 lower (p<0.0001) in the BCP group than in the LDP group. After adjusting for baseline composite cognitive outcome, there was no difference in Z-score 7 to 10 day (p=0.530) or 4 to 6 weeks (p=0.202) after surgery between the BCP and the LDP groups. There was no difference in serum biomarker levels between the 2 position groups Conclusions Compared with patients in the LDP, patients undergoing shoulder surgery in the BCP are more likely to have higher COx indicating diminished cerebral autoregulation and lower rScO2. There were no differences in the composite cognitive outcome between the BCP and LDP groups after surgery after accounting for baseline Z-score.

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“…Arthroscopic surgery is technically challenging and complications or residual impairment related to the procedure, including stiffness, implant failure, nerve injury, and adhesive capsulitis, are estimated to range between 5.8% and 9.5% 10,11. It is estimated that recurrent defects occur in a very high proportion of cases, post-surgically 12,13…”

Section: Introductionmentioning

confidence: 99%

A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis

Centeno¹,

Al‐Sayegh²,

Bashir³

et al. 2015

JPR

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IntroductionShoulder pain is a common musculoskeletal complaint in the general population. Bone marrow concentrate (BMC) injections offer promising potential as a minimally invasive approach for treatment of shoulder pain in degenerative disease. In this study, we investigated the clinical outcomes of the BMC injections for treatment of shoulder pain and disability due to osteoarthritis (OA) and rotator cuff tears in a treatment registry population.MethodsA total of 115 shoulders in 102 patients were treated with autologous BMC injections for symptomatic OA at the glenohumeral joint and/or rotator cuff tears. Data were collected for factors potentially influencing outcome, including age, sex, body mass index, and the type of condition treated (ie, OA or rotator cuff tear). Clinical outcomes were assessed serially over time using the disabilities of the arm, shoulder and hand score (DASH), the numeric pain scale (NPS), and a subjective improvement rating scale. Baseline scores were compared to the most recent outcome scores at the time of the analysis and adjusted for demographic differences. We reported comparisons of pre- and post-treatment scores, the differences between osteoarthritis and rotator cuff groups, and the predictive effects on the clinical outcomes.ResultsAt the most current follow-up assessment after treatment, the average DASH score decreased (improved) from 36.1 to 17.1 (P<0.001) and the average numeric pain scale value decreased (improved) from 4.3 to 2.4 (P<0.001). These changes were associated with an average subjective improvement of 48.8%. No differences were observed between outcomes among the shoulders treated for OA versus rotator cuff tears, nor did age, sex, or body mass index influence pain or functional outcomes. There were no significant treatment-related adverse events reported.DiscussionWe observed preliminarily encouraging results following BMC injections for shoulder OA and rotator cuff tears. These results serve as basis for the design of an adequately powered randomized controlled trial.

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Complications associated with arthroscopic shoulder surgery

Cited by 215 publications

References 63 publications

Risk factors for surgical complications in rotator cuff repair in a veteran population

Risk factors for surgical complications in rotator cuff repair in a veteran population

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis

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