Reverse total shoulder arthroplasty-from the most to the least common complication

Abstract

Reverse total shoulder arthroplasty (RTSA) has been reported to be associated with a complication rate that is four times that of conventional total shoulder arthroplasty. It is the purpose of this article to identify and understand the most common and most serious complications of RTSA and to review current methods of prevention and treatment. The current literature was reviewed to identify type and prevalence of reported complications and to identify risk factors, preventive measures as well as technical details for management strategies for complications of RTSA. The variable accuracy of reporting and the heterogeneity of methodology in the literature limited our study, however, a definitive ranking of most to least common complication emerged. The currently identified most common complication is scapular notching. The clinically most relevant complications are infection, instability and acromial fractures. Haematoma formation used to be very frequent but can be controlled, glenoid component loosening, however, is rare when compared with conventional total shoulder replacement. In conclusion, RTSA is associated with a high rate of complications. Their incidence and the results of their treatment are inconsistently reported. To document and then prevent complications, a standardised monitoring tool including clear definitions and assessment instructions appears necessary.

Fig. 1

Radiological anteroposterior view of scapular notching grade 2 (according to Nérot classification) at three (a) and eight years (b) after reverse total shoulder arthroplasty (RTSA) (Delta III)

Fig. 2

Glenoid component loosening six months after reverse total shoulder arthroplasty (RTSA) for irreparable rotator cuff arthropathy and osteoarthritis. Radiolucency is seen particularly around the inferior screw (arrow) and around the glenoidal implant central peg (double arrow)

Fig. 3

Radiological anteroposterior view (a) and intraoperative views (b, c) of an infected reverse total shoulder arthroplasty (RTSA)

Fig. 4

Staged treatment of infected reverse total shoulder arthroplasty (RTSA). Radiological anteroposterior view of implanted cement spacer (a) as treatment for an infected RTSA (Fig. 3) and late re-implantation of RTSA (b) with reasonable clinical results (c–e)

Fig. 5

Anteroposterior view of a reverse total shoulder arthroplasty (RTSA) with anterolateral dislocation