Early and mid-range followup studies of shoulder arthroplasty have been encouraging, showing good and excellent results in > 90% of shoulders. Despite this success, complications in shoulder replacement surgery are inevitable, with an incidence of approximately 14%. Numerous complications have been identified and include the following factors in order of decreasing frequency: instability, rotator cuff tear, ectopic ossification, glenoid component loosening, intraoperative fracture, nerve injury, infection, and humeral component loosening. Successful treatment of these difficulties requires careful identification and subsequent analysis of all factors contributing to the complication, knowing that the etiology is often multifactorial. Failed shoulder arthroplasty can be successfully managed with revision surgery, but the technically challenging surgery and the overall results are inferior compared with other diagnostic categories.

Complications of shoulder arthroplasty

Long-term results of the Latarjet procedure for anterior instability of the shoulder

A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging

Neer Award 2008 : Arthropathy after primary anterior shoulder dislocation: 223 shoulders prospectively followed up for twenty-five years

In 2006, we reviewed articles published between 1996 and 2005 pertaining to anatomic total shoulder arthroplasty (TSA); that analysis revealed 414 complication events after 2,810 total shoulder replacements (a rate of 14.7%)[1][1]. Component loosening accounted for 161 (39%) of the 414 complications

Complications of Shoulder Arthroplasty.

Background: Few large series of arthropathy related to anterior glenohumeral instability are available in the orthopaedic literature, preventing analysis of the incidence and the risk factors of preoperative and postoperative glenohumeral arthritis.Hypothesis: Anterior stabilization surgery influences the risk factors of glenohumeral arthritis.Study Design: Retrospective review.Methods: There were 570 patients who underwent an instability procedure. Clinical and radiographic preoperative data were collected for these patients. Arthritis was evaluated preoperatively and postoperatively with the Samilson classification. The mean age at surgery was 31.9 years. Follow-up averaged 6.5 years.Results: The preoperative incidence of arthritis was 9.2%. Arthritic risk factors were older age at the initial dislocation and at surgery, increased length of time from the initial dislocation until surgery, and the presence of osseous glenoid rim lesions. Postoperative arthritis in patients without any preoperative arthri...

Glenohumeral Arthrosis in Anterior Instability Before and After Surgical Treatment Incidence and Contributing Factors

The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I–IV relevant to search terms. Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.

/pdf/arm-lengthening-after-reverse-shoulder-arthroplasty-a-review-2icirernx0.pdf

Arm lengthening after reverse shoulder arthroplasty: a review

Background
Glenohumeral instability is a common problem in young and active patients. Both open and arthroscopic procedures have proven to be effective options. In cases with large bone defects on the glenoid side or on the humeral head or in contact sports, arthroscopy leads to a high risk of recurrence. We report the results of the modified Latarjet procedure in a population of 26 soccer players affected by chronic anterior instability. To our knowledge there are no previous reports on the results of this procedure when used in a homogeneous group of sportsmen.

/pdf/chronic-anterior-glenohumeral-instability-in-soccer-players-23fffqgj2k.pdf

Chronic anterior glenohumeral instability in soccer players: results for a series of 28 shoulders treated with the Latarjet procedure

The indications for reverse shoulder arthroplasty
(RSA) continue to be expanded. Associated impairment of the deltoid
muscle has been considered a contraindication to its use, as function
of the RSA depends on the deltoid and impairment of the deltoid
may increase the risk of dislocation. The aim of this retrospective
study was to determine the functional outcome and risk of dislocation
following the use of an RSA in patients with impaired deltoid function.
Between 1999 and 2010, 49 patients (49 shoulders) with impairment
of the deltoid underwent RSA and were reviewed at a mean of 38 months
(12 to 142) post-operatively. There were nine post-operative complications (18%),
including two dislocations. The mean forward elevation improved
from 50° (sd 38; 0° to 150°) pre-operatively to 121° (sd 40;
0° to 170°) at final follow-up (p < 0.001). The mean Constant
score improved from 24 (sd 12; 2 to 51) to 58 (sd 17;
16 to 83) (p < 0.001). The mean Single Assessment Numeric Evaluation
score was 71 (sd 17; 10 to 95) and the rate of patient
satisfaction was 98% (48 of 49) at final follow-up. These results suggest that pre-operative deltoid impairment,
in certain circumstances, is not an absolute contraindication to
RSA. This form of treatment can yield reliable improvement in function
without excessive risk of post-operative dislocation. Cite this article: Bone Joint J 2013;95-B:1106–13.

Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle

Osteoarthritis results in changes in the dimensions
of the glenoid. This study aimed to assess the size and radius of curvature
of arthritic glenoids. A total of 145 CT scans were analysed, performed
as part of routine pre-operative assessment before total shoulder
replacement in 91 women and 54 men. Only patients with primary osteoarthritis and
a concentric glenoid were included in the study. The CT scans underwent
three-dimensional (3D) reconstruction and were analysed using dedicated
computer software. The measurements consisted of maximum superoinferior height,
anteroposterior width and a best-fit sphere radius of curvature
of the glenoid. The mean height was 40.2 mm (sd 4.9), the mean width
was 29 mm (sd 4.3) and the mean radius of curvature was 35.4
mm (sd 7.8). The measurements were statistically different
in men and women and had a Gaussian distribution with marked variation.
All measurements were greater than the known values in normal subjects. With current shoulder replacement systems using a unique backside
radius of curvature for the glenoid component, there is a risk of
undertaking excessive reaming to adapt the bone to the component
resulting in sacrifice of subchondral bone or under-reaming and
instability of the component due to a ’rocking horse‘ phenomenon. Cite this article: Bone Joint J 2013;95-B:1377–82.

Thomas Bradley Edwards

Papers

Glenohumeral Arthrosis in Anterior Instability Before and After Surgical Treatment Incidence and Contributing Factors

Arm lengthening after reverse shoulder arthroplasty: a review

Chronic anterior glenohumeral instability in soccer players: results for a series of 28 shoulders treated with the Latarjet procedure

Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle

Three-dimensional assessment of the dimensions of the osteoarthritic glenoid