These authors conducted a systematic review of the outcomes of reverse total shoulder arthroplasty (RTSA) in patients aged 65 years or younger. In the total of 6 studies reviewed, 245 participants underwent RTSA, with the most common indications being failed rotator cuff repair and rotator cuff tear arthropathy. Postoperative functional outcomes indicated a significant level of improvement across all reported outcomes at a mean follow-up of 49 months (range, 19-140 months) (P < .05).
However, the pooled mean complication rate was 18% (44/245). They suggested that this higher rate may be due to 36% of patients undergoing an RTSA for a failed arthroplasty procedure and the inclusion of older studies that lacked modern implants and techniques.
The overall rate of revision surgery was 18% (range, 3%-26%), with the most common reasons being deep infection, instability, and glenoid component loosening.
Comment: While the reported complication rates reported for reverse total shoulder from high volume centers may be diminishing, it seems likely that the complication rate in the hands of community surgeons is greater than what is represented in the literature. As the article points out, young age, male patients and revision surgery seem to be associated with higher rates of complications. The article below compares the complication rate in the literature with that reported to the FDA (which is also likely to be an under-representation).
These authors point out that most of the literature on shoulder arthroplasty failure comes from high-volume centers and that these reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
They 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.
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.
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%).
They concluded that the publicly available Food and Drug Administration database reveals modes of shoulder arthroplasty failure that 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.
Comment: This study points to the utility of the freely accessible FDA MAUDE database as a resource for identifying failure modes for shoulder arthroplasty not readily identified in the published literature. Some modes of failure appear in the MAUDE data base long before they appear in the published literature, such as the dissociation of the glenosphere from the the baseplate as shown below.
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