Complications of Total Shoulder Arthroplasty

Bohsali, Kamal I.; Wirth, Michael A.; Rockwood, Charles A.

doi:10.2106/00004623-200610000-00024

Cited by 78 publications

(115 citation statements)

References 85 publications

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“…A revision rate of 7% after 13.4 years has been reported [27]. Complication rates, patient readmission rates, and duration of hospitalization vary between institutions [28,29].…”

Section: Complications Of Shoulder Arthroplastymentioning

confidence: 99%

“…Complication rates, patient readmission rates, and duration of hospitalization vary between institutions [28,29]. A meta-analysis by Bohsali has demonstrated a complication rate of 14.7% in a series of 2,810 total shoulder replacements [27]. The most common complications were (in order of decreasing frequency): prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, neural injury, infection, and deltoid muscle dysfunction.…”

Section: Complications Of Shoulder Arthroplastymentioning

confidence: 99%

“…Prosthetic loosening is the most common complication of shoulder arthroplasty accounting for approximately 40% of all complications [27,30]. Loosening typically is diagnosed several years after surgery and predominantly involves the glenoid component.…”

Section: Prosthetic Looseningmentioning

confidence: 99%

“…Periprosthetic fractures have a prevalence of about 1.5-3% (11% of all complications associated with shoulder arthroplasty) [27]. Fractures of the humerus may occur intraoperatively and later due to acute trauma or as a fatigue fracture (Fig.…”

Section: Periprosthetic Fracturementioning

confidence: 99%

“…Rotator cuff tears are the fourth most common complication after shoulder arthroplasty [27]. They are relevant for the survival of the implant because asymmetric load of prosthetic components leads to increasing wear and loosening.…”

Section: Rotator Cuff Tearsmentioning

confidence: 99%

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Shoulder arthroplasty

2008

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Shoulder prostheses are now commonly used. Clinical results and patient satisfaction are usually good. The most commonly used types are humeral hemiarthroplasty, unconstrained total shoulder arthroplasty, and semiconstrained inversed shoulder prosthesis. Complications of shoulder arthroplasty depend on the prosthesis type used. The most common complications are prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, nerve injury, infection, and deltoid muscle dysfunction. Standard radiographs are the basis of both pre- and postoperative imaging. Skeletal scintigraphy has a rather limited role because there is overlap between postoperative changes which may persist for up to 1 year and early loosening and infection. Sonography is most commonly used postoperatively in order to demonstrate complications (hematoma and abscess formation) but may also be useful for the demonstration of rotator cuff tears occurring during follow-up. CT is useful for the demonstration of bone details both pre- and postoperatively. MR imaging is mainly used preoperatively, for instance for demonstration of rotator cuff tears.

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“…A revision rate of 7% after 13.4 years has been reported [27]. Complication rates, patient readmission rates, and duration of hospitalization vary between institutions [28,29].…”

Section: Complications Of Shoulder Arthroplastymentioning

confidence: 99%

Section: Complications Of Shoulder Arthroplastymentioning

confidence: 99%

Section: Prosthetic Looseningmentioning

confidence: 99%

Section: Periprosthetic Fracturementioning

confidence: 99%

Section: Rotator Cuff Tearsmentioning

confidence: 99%

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Shoulder arthroplasty

2008

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Peri‐implant stress correlates with bone and cement morphology: Micro‐FE modeling of implanted cadaveric glenoids

Wee

Armstrong

Flint

et al. 2015

Journal Orthopaedic Research

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Aseptic loosening of cemented joint replacements is a complex biological and mechanical process, and remains a clinical concern especially in patients with poor bone quality. Utilizing high resolution finite element analysis of a series of implanted cadaver glenoids, the objective of this study was to quantify relationships between construct morphology and resulting mechanical stresses in cement and trabeculae. Eight glenoid cadavers were implanted with a cemented central peg implant. Specimens were imaged by micro-CT, and subject-specific finite element models were developed. Bone volume fraction, glenoid width, implant-cortex distance, cement volume, cement-cortex contact, and cement-bone interface area were measured. Axial loading was applied to the implant of each model and stress distributions were characterized. Correlation analysis was completed across all specimens for pairs of morphological and mechanical variables. The amount of trabecular bone with high stress was strongly negatively correlated with both cement volume and contact between the cement and cortex (r = −0.85 and −0.84, p < 0.05). Bone with high stress was also correlated with both glenoid width and implant-cortex distance. Contact between the cement and underlying cortex may dramatically reduce trabecular bone stresses surrounding the cement, and this contact depends on bone shape, cement amount, and implant positioning.

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Patterns of strain and the determination of the safe arc of motion after subscapularis repair—A biomechanical study

Knesek

Brunfeldt

Korenczuk

et al. 2015

Journal Orthopaedic Research

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This study characterizes the strain patterns and safe arcs for passive range of motion (ROM) in the superior and inferior subscapularis tendon in seven cadaveric shoulders, mounted for controlled ROM, after deltopectoral approach to the glenohumeral joint, including tenotomy of the subscapularis tendon 1 cm medial to its insertion on the lesser tuberosity. The tenotomy was repaired with end-to-end suture in neutral rotation. Strain patterns were measured during passive ROM in external rotation (ER), ER with 30å bduction (ERþ30), abduction, and forward flexion in the scapular plane (SP) before and after surgery. Percentages were calculated from 35 trials corresponding to five trials of each motion across seven specimens. With ER of 0À30˚, 89% of trials of superior subscapularis tendon and 100% of trials of inferior subscapularis tendon achieved strains >3%, with very similar patterns noted in ERþ30. In abduction of 0À90˚, 5.8% of trials of superior and 85.3% of trials of inferior tendon achieved >3% strain. With passive ROM in SP, 26.5% of trials reached 3% strain in superior tendon compared to 100% in inferior tendon. Strain patterns in abduction and SP differed significantly (p < 0.001). Selective tenotomy and repair of the superior subscapularis tendon with open reparative or reconstructive shoulder procedures, when feasible, may be favorable for protected early passive ROM and rehabilitation postoperatively.

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Complications of Total Shoulder Arthroplasty

Cited by 78 publications

References 85 publications

Shoulder arthroplasty

Shoulder arthroplasty

Peri‐implant stress correlates with bone and cement morphology: Micro‐FE modeling of implanted cadaveric glenoids

Patterns of strain and the determination of the safe arc of motion after subscapularis repair—A biomechanical study

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