These authors identified 11 primary anatomic total shoulder arthroplasties performed for instability arthropathy with a prior coracoid transfer procedure with a minimum of 2 years’ follow-up. A matched cohort of 33 patients with a total shoulder arthroplasty for primary osteoarthritis served as the control group.
The coracoid transfer cohort showed no significant difference in the final ASES score or SANE score in comparison to the matched cohort. The postoperative ASES pain score was higher in the coracoid transfer cohort, but the mean improvement from preoperative to postoperative values for the ASES score, ASES pain score were not different between cohorts. Both cohorts had high patient satisfaction without a statistically significant difference.
Comment: It was interesting to note that between 1 in 4 and 1 in 5 patients in both groups had complications. Overall, the total complication rates were 27.2% in the coracoid transfer group and 21.2% in the primary osteoarthritis group.
In the coracoid transfer cohort, there were a total of 3 complications in 3 different patients, for a total complication rate of 27.2%. Two early complications included a stitch abscess and a deep infection at 2 weeks requiring surgical debridement. A third patient in the prior coracoid transfer group was found to have aseptic glenoid loosening and polyethylene wear at 9 years.
Comment: It was interesting to note that between 1 in 4 and 1 in 5 patients in both groups had complications. Overall, the total complication rates were 27.2% in the coracoid transfer group and 21.2% in the primary osteoarthritis group.
In the coracoid transfer cohort, there were a total of 3 complications in 3 different patients, for a total complication rate of 27.2%. Two early complications included a stitch abscess and a deep infection at 2 weeks requiring surgical debridement. A third patient in the prior coracoid transfer group was found to have aseptic glenoid loosening and polyethylene wear at 9 years.
In the matched cohort, there were 7 complications in 4 patients, for a 21.2% total complication rate. The early complications included 2 neurapraxia injuries, a stitch abscess, and a small intraoperative glenoid fracture that did not require fixation or further treatment. The late complications included 2 cases of aseptic glenoid loosening and a late deep infection.
In the coracoid transfer group, 2 patients had undergone revision at final follow-up, for an 18.2%revision rate. The first case was a revision to RSA at 9.5 months for instability due to subscapularis failure after serial debridement following an acute deep infection at 2 weeks. The second case was a revision to RSA with iliac crest bone grafting at 9 years after TSA for aseptic glenoid loosening.
In the matched cohort, there were 2 revisions at final follow-up, for a 6.1% revision rate. The first case was a 2-stage revision to RSA at 5 years after TSA because of a deep methicillin-resistant Staphylococcus aureus infection. The second revision case was treated with RSA at 4 years postoperatively owing to aseptic glenoid loosening.
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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