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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Complications of Shoulder Arthroplasty


- Hematoma:
    - Infection associated with hematoma formation after shoulder arthroplasty   

- Fractures
    - fractures may occur at the tip of the prosthesis;
    - long oblique and spiral fractures can be treated non operatively as long as good alignment is maintained;
    - transverse or short oblique fractures may not heal with non operative treatment and operative intervention shold be consideed;
    - references:
           - Humeral fractures after shoulder arthroplasty.
           - Humeral fracture following shoulder arthroplasty.   

           

- Loss of Tuberosity Fixation:
         - when the lesser and greater tuberosity fragments have been quatered (as is necessarily in 4 part frx), it is essential that a secure repair be re-established;
         - when fixation fails, only a poor postoperative result can be expected;

- Instability:
    - instability following shoulder arthroplasty should be divided into early and late;
         - early dislocations:
                - dislocations which occur in early post op period may be due to malposition of implant, soft tissue imbalance or due to inadequate postop protection;
                - treatment involves reduction (if possible) and immobilization;
         - late dislocation:
                - consider rotator cuff tear, component loosenig, or glenoid wear;
    - superior instability:
         - most often due to supraspinatus/infraspinatus tear;
    - inferior instability:
         - this is avoided by noting whether the deltoid, superior cuff and capsule are adequately tensioned w/ the arm at the side;
         - in some cases, unexpected inferior subluxation will be seen postoperatively;
                 - this may be due to loss of deltoid muscle tone, and once deltoid strength is re-established, the subluxation may improve;
    - anterior instability:
         - deficiency/tear of the subscapularis;
                 - most common reason for instability;
                 - anterior instability may result from avulsion of the tendon from the repair site;
                 - "over-stuffing the shoulder" with placement of a glenoid component will lateralize the humeral component and will place subscapularis tendon under increased tension and risk rupture;
                 - when diagnosed early may be amenable to surgical repair (consider Achilles tendon allograft for augmentation);
         - failure to restore proper length (= proper deltoid tension);
         - correct amount of retroversion (normally 30-35 mm);
                 - malrotation of the humeral component: retroversion less than 20 deg may lead to anterior dislocation;
         - previous anterior acromioplasty and excision of the CA ligament: may allow antero-superior dislocation;
         - may result from previous contracture of the posterior capsule;
         - anterior deltoid dysfunction;
    - posterior instability:
         - may occur when the humeral component is placed in more than 45 deg of retroversion;
         - may occur from posterior glenoid erosion;
         - may occur from over-tightening the anterior capsule and subscapularis;
    - references:
         - Instability of the shoulder after arthroplasty.
         - Complications of total shoulder arthroplasty.                     
         - Complications of total shoulder-replacement arthroplasty.                                             
         - Instability After Shoulder Arthroplasty: Results of Surgical Treatment. 

- Shoulder Stiffness:
       - soft tissue release: subscapularis adhessions require circumferential release 
       - over stuffed replacement: 
                - consider modular downsizing of the components (reduction of humeral head diameter and offset) 
       - arthroscopic release:
                - references:
                       - Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.
                       - Arthroscopic capsular release after hemiarthroplasty of the shoulder for fracture: a new treatment paradigm.
                       - The role of arthroscopy for the problem shoulder arthroplasty.



- Glenoid Loosening:
    - Radiographic and Computed Tomography Analysis of Cemented Pegged Polyethylene Glenoid Components in Total Shoulder Replacement.


Complications of total shoulder arthroplasty: Are they fewer or different?

Rotator cuff repair after shoulder replacement.

The complex characteristics of 282 unsatisfactory shoulder arthroplasties

The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, September 17, 2012 8:15 pm