Complications of reverse shoulder arthroplasty: a concise review

Abstract

Reverse shoulder arthroplasty is an ideal treatment for glenohumeral dysfunction due to cuff tear arthropathy. As the number of patients treated with reverse shoulder arthroplasty is increasing, the incidence of complications after this procedure also is increasing. The rate of complications in reverse shoulder arthroplasty was reported to be 15%-24%. Recently, the following complications have been reported in order of frequency: periprosthetic infection, dislocation, periprosthetic fracture, neurologic injury, scapular notching, acromion or scapular spine fracture, and aseptic loosening of prosthesis. However, the overall complication rate has varied across studies because of different prosthesis used, improvement of implant and surgical skills, and different definitions of complications. Some authors included complications that affect the clinical outcomes of the surgery, while others reported minor complications that do not affect the clinical outcomes such as minor reversible neurologic deficit or minimal scapular notching. This review article summarizes the processes related to diagnosis and treatment of complications after reverse shoulder arthroplasty with the aim of helping clinicians reduce complications and perform appropriate procedures if/when complications occur.

Keywords: Complications; Replacement; Rotator cuff tear; Rotator cuff tear arthropathy; Shoulder; Arthroplasty.

Fig. 1.

Early dislocation after reverse shoulder arthroplasty (RSA). (A) Anteroposterior (AP) radiograph after primary RSA. AP (B) and scapular (C) scapular Y-views showed anterior dislocation (arrows) of the humeral prosthesis at 4 months after surgery. (D) Revision RSA with polyethylene liner change was performed, and no dislocation had recurred over 2 years of follow-up.

Fig. 2.

Two-stage revision for infected reverse shoulder arthroplasty (RSA). (A) Anteroposterior radiograph of primary RSA after 18 months. Radiolucency around the humeral stem (arrows) at the metaphysis and glenoid baseplate (arrowhead) was observed. (B) Implant removal and anti-mixed cement spacer insertion was performed. (C) After infection control, revision RSA with cemented humeral stem was performed, and (D) greater than 120˚ of left shoulder elevation was achieved at 2 years after the final surgery (photograph used with permission for study purpose).

Fig. 3.

Periprosthetic humeral fracture during reverse shoulder arthroplasty. (A) During surgery, the humeral spiral fracture was stabilized with cerclage wire (arrow), and the humeral stem was inserted with firm fixation. (B) Immediate postoperative anteroposterior radiograph showed fracture around the humeral stem (arrow). (C) The fracture was healed at 4 months after surgery (arrow).

Fig. 4.

Intraoperative glenoid fracture during reverse shoulder arthroplasty. (A) Preoperative humeral head deformity (arrow) with glenohumeral joint space narrowing was observed (arrowhead). (B) Glenoid fracture occurred during the reduction procedure, and surgery was converted to hemiarthroplasty (arrow).

Fig. 5.

Acromion fracture after reverse shoulder arthroplasty (RSA). (A) Initial anteroposterior (AP) radiograph and (B) early postoperative AP radiograph showed an intact acromion (arrow). (C) Acromial inferior tilt (arrow) was observed at 4 months after RSA. Two years after RSA, (D) inferior tilt of acromion (arrow) and (E) non-union of acromion (arrow) were observed on computed tomography. (F) The patient had decreased right shoulder elevation at 2 years after surgery (photograph used with permission for study purpose).

Fig. 6.

Brachial plexus injury after reverse shoulder arthroplasty. (A) Preoperative scapular Y-view of magnetic resonance imaging showed greater than 50% muscle atrophy in the supraspinatus (arrow) and infraspinatus (arrowhead). Preoperative (B) and postoperative (C) anteroposterior radiographs of the shoulder. (D) Decreased left shoulder elevation and (E) wrist drop sign were observed during follow-up, indicating brachial plexus injury (photograph used with permission for study purpose).