Ways to prevent adverse outcomes and complications of total shoulder arthroplasty

Chirkov N.N., Nikolaev N.S., Kaminskii A.V.

Abstract


Background
Total shoulder arthroplasty (TSA) is a well-established procedure for treatment of severe pathologies of the shoulder joint. However, it is a radical procedure that may result in adverse outcomes and complications.
The goal
was to identify causes of poor functional outcomes and complications after total shoulder replacement and search ways to prevent them.
Material and methods
Outcomes of 168 patients were reviewed. Reverse shoulder arthroplasty and cemented humeral fixation was employed for the majority of patients (n = 125; 74.4 %). Minimal follow-up was at least one year with an average term of 3 to 5 years. Clinical, biomechanical examinations, radiography, magnetic resonance imaging, computed tomography, electromyography, DEXA, VAS, ASES, UCLA, statistical analysis were employed in the study.
Results
Positive results of TSA were observed in 83.3 % of the cases and 16.7 % had poor outcomes. Patients developed implant dislocation in 9.5 %, infection in 3 %, early instability of shoulder component in 1.2 %, intraoperative fracture of the humerus shaft in 1.8 % and injury to vascular and nerve bundle in 1.2 % of the cases. Causes of poor outcomes were identified and ways of prevention presented. The best recovery was observed with anatomic shoulder replacement, integrity and functionality of the rotator cuff, absence of fatty degeneration verified with magnetic resonance imaging in sagittal plane. Clear understanding of the exact nature of osseous changes using computed tomography allows adequate positioning of implant components. Preoperative deltoid evaluation is important for posttraumatic cases as well as BMD measurements are vital for severe osteoporosis patients with application of reverse shoulder arthroplasty.
Conclusion
Preoperative planning and assessment of risk factors are important in preventing complications and improving outcomes of total shoulder replacement. The target audience is trauma and orthopaedic surgeons.

Keywords


arthroplasty, shoulder joint, adverse outcome, complication, prevention

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DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-3-312-317

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