A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties
These authors note that early complication rates in reverse total shoulder arthroplasty have widely reported from 0% to 75%. Here is a distribution of some of these complications from the FDA database (left) and the Australian Orthopaedic Association database (right).
The chart below shows some of the reported complication rates.
In the practice of an individual surgeon, these authors sought to (1) determine the types and rates of early complications in reverse total shoulder arthroplasty, (2) characterize an early complication-based learning curve for reverse total shoulder arthroplasty, and (3) determine whether revision arthroplasties result in a higher incidence of complications. 200 reverse total shoulder arthroplasties in 191 patients were included of which 40 were revision arthroplasties. 192 shoulders were available for minimum 6-month followup.
Nineteen shoulders involved local complications (9.9%), including seven major and 12 minor complications.
Nine involved perioperative systemic complications (4.7%), including eight major complications and one minor complication.
The local complication rate was higher in the first 40 shoulders (23.1%) versus the last 160 shoulders
(6.5%).
Seven of 40 (17.5%) revision arthroplasties involved local complications, including two major and five minor complications compared to 12 of 152 (7.9%) primary arthroplasties, including five major and seven minor complications. Nerve palsies occurred less frequently in primary arthroplasties (0.6%) compared to revisions (9.8%).
The graph below shows the progressively lower complication rate with increasing surgeon experience.
