Management of complications after total shoulder arthroplasty

Abstract

The outcomes of total shoulder arthroplasty (TSA) for painful arthritis of the glenohumeral joint are excellent with significant improvement in pain and function. Increased use of total shoulder arthroplasty over the past decade has led to identification of common complications. Although the complication rate is low, accurate and timely diagnosis, appropriate management, and implementation of methods for prevention are critical to a successful long-term outcome. The most common complications include infection, glenoid and humeral component loosening, rotator cuff tear, periprosthetic fracture, and neurologic injury. The purpose of this review is to outline the best practices for diagnosing, managing, and preventing these complications.

Fig. 1

Posterior shoulder instability

Fig. 2

Axial CT scan showing a loose glenoid component

Fig. 3

Anterior superior escape on AP (a) and axillary X-rays showing a decentered humeral head (b)

Fig. 4

Brachial plexus MRI after traction injury during TSA resulting in complete brachial plexopathy revealing inflammation but no laceration or avulsion (Red arrow - pointing to inflammation surrounding injured brachial plexus; Green arrow - identifying the normal contralateral brachial plexus)

Fig. 5

TSA complication algorithm for management