Complications After Anatomic Shoulder Arthroplasty Revisiting Leading Causes of Failure
These authors point out that data from high volume centers may not reflect the complications seen by community surgeons who perform the majority of shoulder arthroplasties. This article attempts to capture data from resources that present the complications across the general population.
Here are a few takeaways.
(1) While radiographic evidence of loosening of the glenoid component continues to be a common finding, many of these shoulders are minimally symptomatic and revision for symptomatic glenoid component loosening seems to constitute a smaller percent of indications for revision.
(2) Managing posterior glenoid bone loss by eccentric reaming can remove the needed support for the glenoid component and contribute to glenoid component failure. There is some evidence that aggressively "correcting" glenoid retroversion may not be as necessary as once thought. The security and durability of augmented glenoid components is currently being evaluated. The indications for a reverse total shoulder in the retroverted glenoid in a shoulder with an intact rotator cuff are also being studied.
(3) Metal backed glenoid components have higher reported rates of revision than all polyethylene components.
(4) Soft tissue (subscapularis and rotator cuff) failure after anatomic total shoulder are increasingly reported as reasons for failure. Anterior and superior translation of the humeral head on the glenoid and superior tilt of the glenoid compent are associated with these soft tissue problems. It is suggested that protection of the cuff insertion, careful subscapularis repair, avoiding overstuffing, avoiding a superior position of the humeral component, and protection of the soft tissues during rehabilitation are important preventative measures.
(5) Some arthroplasties are painful without an identifiable cause. Preoperative use of narcotics and nicotine appear to be associated with this problem.
