PAPER 160: A PROSPECTIVE STUDY OF THE EARLY COMPLICATION RATE OF THE INITIAL 100 REVERSE TOTAL SHOULDER ARTHROPLASTIES BY A SINGLE US SURGEON

Abstract

Purpose: This paper will present the types and rates of complications of an initial consecutive series of 100 reverse total shoulder arthroplasties (TSA).

Method: Since 2004, the initial 100 consecutive reverse TSA were performed by a single US surgeon in 97 patients with an average age of 72 years. A deltopectoral approach was used in all cases. Diagnoses include 49 shoulders with cuff tear arthropathy, 24 with a failed prior shoulder arthroplasty, 23 with an irreparable rotator cuff tear, 2 with a malunion and post-traumatic arthritis, 1 with rheumatoid arthritis, and 1 with osteoarthritis. All patients had painful pseudoparalysis. Average follow-up was 8 months, with 77 patients having a minimum 2-month follow-up. Two patients have expired (unrelated to surgery), and 1 patient has been lost to follow-up.

Results: Of the 100 shoulders, 9 had local perioperative complications (9%) including 2 dislocations requiring 1 open reduction and 1 closed reduction, 2 intraoperative glenoid fractures, 3 resolved mononeuropathies (radial, ulnar, and musculocutaneous), 1 resolving brachial plexopathy, 1 post-op hematoma, and 1 intraoperative broken screw head. Three of the 4 neuropathies occurred in revision arthroplasty shoulders. Six shoulders (6%) had systemic perioperative complications including subacute MI, DVT, PE, and C. difficile colitis. Two patients (2%) have had complications outside the perioperative period including 1 stable acromial fracture at 5 weeks post-op, and 1 patient with a subluxatable shoulder. No infections occurred. Other than the 2 dislocations and the acromial fracture, no radiographic complications, such as dissociation of the components or catastrophic failure of the glenosphere fixation, were observed. Seven shoulders (7%) had Grade 3 scapular notching and none (0%) had Grade 4 notching. The overall complication rate was 18% with rates of 17% vs. 21% in primary vs. revision arthroplasties, respectively (p=0.91). Transient nerve palsies were more frequent in revisions vs. primaries (12.5% vs. 1.3%, p=0.066).

Conclusion: There is an acceptably low rate of complications related to reverse TSA, particularly severe ones requiring reoperation (2%). Overall complication rates are not significantly different between revisions and primaries, but revisions trended towards more transient nerve palsies.