Saturday, February 15, 2014

Early dislocation after reverse total shoulder

Early dislocation after reverse total shoulder arthroplasty.

These authors report that complications occur in 19% to 68% of patients having reverse total shoulders. These complications include neurologic injury, instability, periprosthetic fracture, hematoma, infection, scapular notching, mechanical baseplate failure, and acromial fracture. Prosthetic instability accounts for up to half of these complications in some series. Factors associated with instability include component malposition, inadequate soft tissue tensioning, and subscapularis insufficiency. To this list we would add unwanted contact between the humeral component when the arm is in adduction, internal rotation or external rotation.

The majority of the 385 reverses performed by these authors received the  Trabecular Metal Reverse Shoulder .

In the experience of these authors,  11 patients ( 2.9%) treated with reverse total shoulder had a dislocation within 3 months of surgery ( mean time to dislocation was 3.4 weeks). Risk factors for dislocation appeared to include (1) prior surgery (64%), (2) male sex (82%), (3) BMI>30 kg/m2 (82%), and (4) lack of a a satisfactory subscapularis repair at the time of the reverse total shoulder (64%), but there was not a comparison group to determine the hazard ratios.

Interestingly, some of these patients were unaware that the shoulder had dislocated; the dislocation usually occurred with activities of daily living; and the diagnosis was made only at the time of routine followup.

Four required only closed reduction.
Five shoulders experienced recurrent instability required revision of the polyethylene insert. 
Two shoulders were converted to hemiarthroplasty due to persistent instability.

To learn more about shoulder arthritis and what can be done about it, see the Shoulder Arthritis Book.

To learn more about the rotator cuff, see the Rotator Cuff Book

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