Primary reverse shoulder arthroplasty using contemporary implants is associated with very low reoperation rates

• Published in: Journal of shoulder and elbow surgery Vol. 28; no. 6; pp. S175 - S180
• Main Authors: Kang, Jason R., Dubiel, Matthew J., Cofield, Robert H., Steinmann, Scott P., Elhassan, Bassem T., Morrey, Mark E., Sperling, John W., Sanchez-Sotelo, Joaquin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder - instrumentation; Arthroplasty, Replacement, Shoulder - methods; Female; Humans; implants; Joint Instability - surgery; Male; Middle Aged; Prosthesis Design; Prosthesis Failure - adverse effects; Prosthesis-Related Infections - surgery; reoperation; Reoperation - statistics & numerical data; Retrospective Studies; reverse; Reverse total shoulder arthroplasty; shoulder; shoulder arthroplasty; Shoulder Fractures - surgery; Shoulder Joint - surgery; Shoulder Prosthesis; Young Adult; Treatment Study; Level IV; Case Series; reoperation; shoulder arthroplasty; shoulder; reverse; implants; Reverse total shoulder arthroplasty
• DOI: 10.1016/j.jse.2019.01.026
• ISSN: 1058-2746

The early results of reverse shoulder arthroplasty (RSA) were influenced to some extent by the use of first-generation implants and surgeons’ learning curves, resulting in relatively high reoperation rates. The purpose of this study was to quantify the burden of and identify the indications for reoperation after primary RSA using contemporary implants and techniques. A retrospective review of 1649 primary RSAs implanted consecutively between 2009 and 2015 at a single institution was conducted. All arthroplasties were performed by 5 fellowship-trained shoulder surgeons at a tertiary referral center. Demographic characteristics, indications for primary RSA, and reoperations were analyzed and categorized for trends associated with each type of reoperation performed. A total of 39 reoperations (2.37%) were performed for a variety of indications. Overall, only a few patients with infection or instability required reoperation (0.55%). The most common indications for reoperation were related to the humeral component (1.03%); the majority of humeral component complications were related to a specific design flaw of 1 implant system. RSAs performed for proximal humeral fracture sequelae more commonly underwent reoperation owing to instability or humeral component–related issues; all 4 cases of aseptic humeral stem loosening occurred in the setting of proximal humeral fracture sequela treatment. Only 0.36% of all primary RSAs required reoperation because of glenoid complications. Primary RSA performed with contemporary implants and surgical techniques seems to be associated with a very low rate of reoperation. The most common reasons for reoperation were humeral component fracture for 1 particular implant, humeral loosening, dislocation, infection, and glenoid failure, each occurring at a rate under 1%.