These authors used the American Board of Orthopaedic Surgery database to identify primary TSA cases performed for osteoarthrosis submitted by American Board of Orthopaedic Surgery Part II Board Certification candidates. Candidates were grouped based on fellowship training and subspecialty examination being taken.
From 2010 to 2017, 854 candidates performed at least 1 primary TSA (anatomic or reverse) after a diagnosis of osteoarthritis; 2720 submitted cases met the authors' inclusion criteria.
Candidates completing a Shoulder fellowship performed significantly more TSAs per candidate compared with all other groups. The Shoulder fellowship group had significantly lower complication rates as compared with the Sports Medicine fellowship and Hand and Upper Extremity fellowship groups.
Comment: What got our attention was the observation that between one in four and one in five patients had a surgical or medical complication, re-operation and or readmission within 10 weeks after surgery, see below. The overall self-reported complication rate (medical and surgical) among all candidates in this study was 20.9%. This is ten times greater than what we see in our practice.
The overall self-reported early surgical complication rate in this study among all candidates was 14.2% with bone fracture (2.7%) and nerve palsy/injury (2.5%) most common. These rates all seem quite high.
By contrast, the complication rate reported in the literature for anatomic and reverse shoulder arthroplasty among experienced shoulder surgeons ranges from 8% to 12%. Two recent studies showed a readmission rates of 2.7% and 5% in 30 days.
These authors suggest that the increased complication rate in this study of newly trained orthopedic surgeons may be secondary to the potential learning curve in primary and reverse shoulder arthroplasty. Experience teaches not only how to do an operation well, but when to do it, on whom, under what conditions and what perioperative care is critical to the result.
Here's a related article
Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016
Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
Comment: What got our attention was the observation that between one in four and one in five patients had a surgical or medical complication, re-operation and or readmission within 10 weeks after surgery, see below. The overall self-reported complication rate (medical and surgical) among all candidates in this study was 20.9%. This is ten times greater than what we see in our practice.
By contrast, the complication rate reported in the literature for anatomic and reverse shoulder arthroplasty among experienced shoulder surgeons ranges from 8% to 12%. Two recent studies showed a readmission rates of 2.7% and 5% in 30 days.
These authors suggest that the increased complication rate in this study of newly trained orthopedic surgeons may be secondary to the potential learning curve in primary and reverse shoulder arthroplasty. Experience teaches not only how to do an operation well, but when to do it, on whom, under what conditions and what perioperative care is critical to the result.
Here's a related article
Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016
Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
These authors analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery.
For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%).
For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%).
For anatomic shoulder arthroplasties, the failure modes have not appreciably changed over recent years
For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%).
For reverse shoulder arthroplasties, the failure modes have not appreciably changed over recent years
Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers.
The authors conclude that the Food and Drug Administration database reveals modes of shoulder arthroplasty failurethat are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
The authors conclude that the Food and Drug Administration database reveals modes of shoulder arthroplasty failurethat are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.
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