Reverse total shoulder replacement: intraoperative and early postoperative complications

Abstract

Reverse total shoulder arthroplasty is a treatment option for patients with symptomatic glenohumeral arthritis and a deficient rotator cuff. The reported complication rates vary from 0% to 68%. Given this variation, our purposes were to (1) determine the learning curve for the procedure, (2) identify complications and surgical pitfalls, and (3) compare our results with those of similar published series. We retrospectively reviewed 20 consecutive patients (mean age, 73 years; range, 45-88 years) who had reverse total shoulder arthroplasty by one surgeon, tabulating intraoperative and postoperative complications. Minimum followup was 3 months (average, 9 months; range, 3-21 months). The intraoperative complication rate for the first 10 patients was higher than that for the second 10 patients. There were 33 complications in 15 patients: 11 patients collectively had 22 intraoperative complications and eight patients collectively had 11 postoperative complications. At radiographic followup, 11 patients had scapular notching and nine patients had heterotopic ossification. Our complication rate was higher than published rates.

Level of evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

A diagram illustrates the DePuy reverse shoulder prosthesis (Courtesy of DePuy Orthopaedics, Inc, Warsaw, IN).

Fig. 2

A photograph shows the Tornier reverse shoulder prosthesis (Courtesy of Tornier Inc, Stafford, TX).

Fig. 3

The Nerot classification (as presented by Valenti et al. [28]) of progressive scapular notching is shown: Grade 0, no notch; Grade 1 (lowest dotted line), notch confined to the scapular pillar; Grade 2 (lower middle dotted line), notch in contact with the lower screw; Grade 3 (upper middle dotted line), notch over the lower screw; Grade 4 (top dotted line), notch extending under the baseplate. (Modified and reprinted with permission and copyright © 2005 of The Journal of Bone and Joint Surgery, Inc, from Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–1486.)