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. 2021 Aug;2(8):618-630.
doi: 10.1302/2633-1462.28.BJO-2021-0092.R1.

Outcome and complications following revision shoulder arthroplasty : a systematic review and meta-analysis

Vinayak Ravi  1 , Richard James Murphy  2 , Robert Moverley  3 , Mina Derias  2 , Joideep Phadnis  1   2
Affiliations

Outcome and complications following revision shoulder arthroplasty : a systematic review and meta-analysis

Vinayak Ravi et al. Bone Jt Open. 2021 Aug.

Abstract

Aims: It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis.

Results: A total of 112 studies (5,379 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (601/3,041), instability 19% (577/3,041), rotator cuff failure 17% (528/3,041), and infection 16% (490/3,041). Intraoperative complication and postoperative complication and reoperation rates were 8% (230/2,915), 22% (825/3,843), and 13% (584/3,843) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (91/230, 40%) and instability (215/825, 26%). Revision to reverse total shoulder arthroplasty (TSA), rather than revision to anatomical TSA from any index prosthesis, resulted in lower complication rates and superior Constant scores, although there was no difference in American Shoulder and Elbow Surgeons scores.

Conclusion: Satisfactory improvement in patient-reported outcome measures are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA. Cite this article: Bone Jt Open 2021;2(8):618-630.

Keywords: American Shoulder and Elbow Surgeons (ASES) score; Complications; Outcomes; Replacement; Revision; Shoulder; Systematic review and meta-analysis; Total shoulder arthroplasty; humeral fractures; intraoperative complications; patient-reported outcome measures (PROMs); postoperative complications; revision shoulder arthroplasty; revision surgery; rotator cuff; total shoulder arthroplasty.

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Conflict of interest statement

ICMJE COI statement: J. Phadnis reports consultancy payments from Wright Medical, unrelated to this study.

Figures

Fig. 1
Fig. 1
Flowchart outlining the process of study selection for this systematic review.
Fig. 2
Fig. 2
American Shoulder and Elbow Surgeons (ASES) and Constant scores following revision shoulder arthroplasty. a) Postoperative scores (absolute score) following revision from any type of index prosthesis to reverse or anatomical total shoulder arthroplasty (TSA). b) Change in scores (postoperative score minus preoperative score) following revision from any type of index prosthesis to reverse or anatomical TSA. c) Postoperative scores (absolute score) following revision from index anatomical TSA only to reverse or anatomical TSA. d) Change in scores (postoperative score minus preoperative score) following revision from anatomical TSA only to reverse or anatomical TSA. Independent-samples t-test use for comparison of mean values (ns, no significant difference; ****, p < 0.0001).
See this image and copyright information in PMC

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