Friday, November 3, 2017

Total shoulder complications - glenoid component loosening remains the most prevalent

Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty

These authors reviewed the recent publications (1995-2015) regarding total shoulder complications and focused on glenoid loosening, which accounted for 80% of these adverse events.

They found that the most common  intraoperative complication was peri-prosthetic humerus fracture, which accounted for 1.5% of the overall complications.

The 90-day readmission rate for total shoulders was 4.5% as compared to 8.8% for hemiarthroplasty and 6,6% for 6.6% reverse total shoulder arthroplasty. 75% of the readmissions occurred in the first 60 postoperative days. Most readmissions were due to medical complications (82%) including deep venous thrombosis or pulmonary embolism, pneumonia, and congestive heart failure. Surgical complications contributed to 18% of readmissions. Infection was the most common surgical cause for TSA readmission (5.2%), as compared to 5.0% of hemiarthroplasty and 3.2% of reverse arthroplasty readmissions. Readmission due to dislocation was the second most common surgical diagnosis, at 5.1% of TSA readmissions (9.3% for Reverse arthroplasty and 1.9% for hemiarthroplasty).

Mid term complications included cuff tears, instability, dislocation, infection and subscapularis failure.

Longer term complications included loosening of the humeral component (which accounted for only 7% of the complications and was mainly a consequence of septic loosening) and glenoid component loosening (which accounted for 80% of the long term complications). The figure below shows an example of 'rocking horse loosening' related to decentering of the humeral head on the glenoid prosthesis.

Comment: This is an informative overview, reminding us of the grouping of complications in terms of time after surgery, and the persistent problem of glenoid component failure.

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Information about shoulder exercises can be found at this link.

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