Friday, February 22, 2013

Complications of reverse total shoulder

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

This is a Level IV group of 35 patients (40 shoulders) in patients ranging in age from 46 to 64 years having reverse total shoulders for painful pseudoparesis, defined by the authors as inability to elevate the arm above 90 degrees in the presence of free passive elevation) secondary to a massive irreparable rotator cuff tear, with or without glenohumeral arthritis. The rotator cuff was considered irreparable if pseudoparalysis was chronic, the acromiohumeral distance was <6 mm on plain anteroposterior radiographs, or if there was fatty infiltration of the supraspinatus and infraspinatus muscles greater than stage 2 according to Goutallier. Patients with a minimum of 5 years (60 months) of clinical follow-up were included.

One or more complications occurred in 15 shoulders (37.5%), with 6 failures (15%) resulting in removal or conversion to hemiarthroplasty (3 with infection, 3 with glenoid loosening). Ten shoulders (25%) underwent partial or total component exchange, conversion to hemiarthroplasty, or removal.

More specifically there were
2 postoperative nerve palsies
1 soft tissue impingement requiring arthroscopic debridement
3 scapular fractures
1 periprosthetic humeral fracture
7 dislocations
1 worn poly liner requiring revision
3 glenoid loosenings
5 infections

In light of these complications in the hands of experienced surgeons, we would underline the statement in the conclusion: "it is imperative that the high complication rate is explained to patients". The value of this expensive and complication intense procedure needs to be carefully considered.


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