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. 2015 Nov 3;3(2):62-6.
doi: 10.11138/jts/2015.3.2.062. eCollection 2015 Apr-Jun.

Analysis of complications of reverse total shoulder arthroplasty

Raffaele Russo  1 , Giuseppe Della Rotonda  2 , Michele Ciccarelli  1 , Fabio Cautiero  1
Affiliations

Analysis of complications of reverse total shoulder arthroplasty

Raffaele Russo et al. Joints. .

Abstract

Purpose: the aim of this study was to analyze complications of reverse total shoulder arthroplasty (RTSA) used to treat different shoulder diseases.

Methods: from March 2000 to March 2013, 195 RTSA were implanted by the senior Author. The indications for reverse prosthesis surgery were secondary osteoarthritis (OA) in 49 cases, irreparable rotator cuff tear (RCT) in 48 cases, and complex humeral fractures in 75 cases, while 19 were patients requiring surgical revision for first prosthesis implant. We used different prostheses with different designs.

Results: the clinical and radiological results of all the patients were analyzed retrospectively at an average follow-up of 7 years. The cases were divided into four groups on the basis of the diagnosis and complications were classified as perioperative, postoperative, or late. The mean total Constant score improved from 28 to 69 points in the OA group; from 21 to 70.8 points in the irreparable RCT group, to 76.4 in the fracture group, and from 16.6 to 59.8 points in the revision group. Scapular notching was observed in 59 cases (30.2%). Thirty-three other complications (16.9%) were observed, namely: hematomas (n=3), instability of the humeral component (n=1), scapular spine fractures (n=2), ulnar nerve deficit (n=2), long thoracic nerve palsy (n=2), deep infections (n=2), periprosthetic fractures (n=6), glenoid fractures (n=2), implant loosening (n=2), anterior deltoid muscle deficiency (n=2) and periarticular heterotopic calcifications (n=9).

Conclusions: the rates of complications, especially fractures, reported in the present study were lower than those reported in the current literature.

Level of evidence: Level IV, therapeutic case series.

Keywords: complications; results; reverse shoulder prosthesis; surgical technique.

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Figures

Fig. 1
Fig. 1
A: Postoperative X-ray of the humeral spacer after removal of the infected prosthesis. B: Postoperative X-ray after TSRA revision.
Fig. 2
Fig. 2
Periprosthetic ossification of the medial compartment without significant loss of motion.
Fig. 3
Fig. 3
Four-part fracture treated with reverse prostheses and PPT (Puzzle Piece Technique) with cemented stem. X-ray at nine years of follow-up shows no signs of scapular notching, subtotal great tuberosity reabsorption, small ossification of pectoralis major tendon and asymptomatic reactive bone cyst around the superior screw of the glenoid baseplate.
Fig. 4
Fig. 4
A: A woman with a traumatic peri-prosthetic humeral fracture (type B fracture according to the Wright and Cofield classification) occurred seven years after reverse implant and treated nonoperatively. X-ray shows that fracture healed three months later. B: Healing of a type A fracture treated with plate and cerclage.
See this image and copyright information in PMC

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