Skip to main content
SpringerLink
Log in

Incidence of complications related to shoulder arthroplasties identified on computed tomography

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Purpose

Determine incidence of shoulder arthroplasty complications identified on computed tomography (CT).

Materials and Methods

Retrospective institutional database review of patients with shoulder arthroplasties who underwent CT between 01/2006–11/2021 at a tertiary academic referral center with subspecialized orthopedic shoulder surgeons. CT reports were reviewed for arthroplasty type and complication. Data were stratified and summarized. Associations between complications and arthroplasty types were determined with Chi-squared goodness of fit test.

Results

Eight hundred twelve CTs in 797 unique patients were included (438 (53.9%) females and 374 (46.1%) males; mean age 67 ± 11 years). There were 403 total shoulder arthroplasties (TSA), 317 reverse total shoulder arthroplasties (rTSA), and 92 hemiarthroplasties (HA). Complications were present in 527/812 (64.9%) and incidences were: loosening/aseptic osteolysis 36.9%, periprosthetic failure 21.6%, periprosthetic fracture 12.3%, periprosthetic dislocation 6.8%, joint/pseudocapsule effusion 5.9%, prosthetic failure 4.8%, infection 3.8%, and periprosthetic collection 2.1%. Complications per arthroplasty were: 305/403 (75.7%) TSAs, 176/317 (55.5%) rTSAs, and 46/92 (50%) HAs (p < 0.001). Periprosthetic fracture (20.8%), prosthetic dislocation (9.8%), and prosthetic failure (7.9%) were highest in rTSAs (p < 0.001, p < 0.013, p < 0.001, respectively). Loosening/aseptic osteolysis most frequent in TSAs (54.1%) (p < 0.001). Periprosthetic failure most frequent in HA (32.6%) (p < 0.001). Significant associations were identified with joint/pseudocapsule effusion and loosening/aseptic osteolysis (p = 0.04) and prosthetic dislocation (p < .001).

Conclusion

In this single tertiary academic referral center cohort, the incidence of shoulder arthroplasty complication identified on CT was 64.9% and the most commonly occurring complication was loosening/aseptic osteolysis (36.9%). TSA had the highest incidence of complication (75.7%).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Fisher ES, Bell J, Tomek I, Esty A, Goodman D, Bronner K (2010) Trends and regional variation in hip, knee, and shoulder replacement: a Dartmouth atlas surgery report. Hanover, NH: Dartmouth Institute for Health Policy and Clinical Practice. 2010 Apr 6. Available from: https://www.ncbi.nlm.nih.gov/books/NBK586141/

  2. Wagner ER, Farley KX, Higgins I, Wilson JM, Daly CA, Gottschalk MB (2020) The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg 29(12):2601–2609. https://doi.org/10.1016/j.jse.2020.03.049

    Article  PubMed  Google Scholar 

  3. Weatherby PJ, Efejuku TA, Somerson JS (2021) Complications After Anatomic Shoulder Arthroplasty: Revisiting Leading Causes of Failure. Orthop Clin North Am 52(3):269–277. https://doi.org/10.1016/j.ocl.2021.03.002

    Article  PubMed  Google Scholar 

  4. Padegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR, Namdari S (2015) Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res 473(6):1860–1867. https://doi.org/10.1007/s11999-015-4231-z

    Article  PubMed  PubMed Central  Google Scholar 

  5. Buck FM, Jost B, Hodler J (2008) Shoulder arthroplasty. Eur Radiol 18(12):2937–2948. https://doi.org/10.1007/s00330-008-1093-8

    Article  PubMed  Google Scholar 

  6. Mueller U, Braun S, Schroeder S, Schroeder M, Sonntag R, Jaeger S, Kretzer JP (2017) Influence of humeral head material on wear performance in anatomic shoulder joint arthroplasty. J Shoulder Elbow Surg 26(10):1756–1764. https://doi.org/10.1016/j.jse.2017.05.008

    Article  PubMed  Google Scholar 

  7. Wright TW, Cofield RH (1995) Humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am 77(9):1340–1346. https://doi.org/10.2106/00004623-199509000-00008

    Article  CAS  PubMed  Google Scholar 

  8. Campbell JT, Moore RS, Iannotti JP, Norris TR, Williams GR (1998) Periprosthetic humeral fractures: mechanisms of fracture and treatment options. J Shoulder Elbow Surg 7(4):406–413. https://doi.org/10.1016/s1058-2746(98)90033-7

    Article  CAS  PubMed  Google Scholar 

  9. Duncan CP, Haddad FS (2014) The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 96-B(6):713–716. https://doi.org/10.1302/0301-620X.96B6.34040

    Article  CAS  PubMed  Google Scholar 

  10. Kirchhoff C, Beirer M, Brunner U, Buchholz A, Biberthaler P, Crönlein M (2018) Validation of a new classification for periprosthetic shoulder fractures. Int Orthop 42(6):1371–1377. https://doi.org/10.1007/s00264-018-3774-5

    Article  PubMed  Google Scholar 

  11. Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH (2009) Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg 18(6):859–863. https://doi.org/10.1016/j.jse.2008.11.020

    Article  PubMed  Google Scholar 

  12. Grob A, Freislederer F, Marzel A, Audigé L, Schwyzer HK, Scheibel M (2021) Glenoid Component Loosening in Anatomic Total Shoulder Arthroplasty: Association between Radiological Predictors and Clinical Parameters-An Observational Study. J Clin Med 10(2):234. https://doi.org/10.3390/jcm10020234

    Article  PubMed  PubMed Central  Google Scholar 

  13. McLendon PB, Schoch BS, Sperling JW, Sánchez-Sotelo J, Schleck CD, Cofield RH (2017) Survival of the pegged glenoid component in shoulder arthroplasty: part II. J Shoulder Elbow Surg 26(8):1469–1476. https://doi.org/10.1016/j.jse.2016.12.068

    Article  PubMed  Google Scholar 

  14. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH (2009) Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br 91(1):75–81. https://doi.org/10.1302/0301-620X.91B1.21094

    Article  CAS  PubMed  Google Scholar 

  15. Matsen FA 3rd, Clinton J, Lynch J, Bertelsen A, Richardson ML (2008) Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am 90(4):885–896. https://doi.org/10.2106/JBJS.G.01263

    Article  PubMed  Google Scholar 

  16. Chalmers PN, Rahman Z, Romeo AA, Nicholson GP (2014) Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 23(5):737–744. https://doi.org/10.1016/j.jse.2013.08.015

    Article  PubMed  Google Scholar 

  17. Kohan EM, Chalmers PN, Salazar D, Keener JD, Yamaguchi K, Chamberlain AM (2017) Dislocation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 26(7):1238–1245. https://doi.org/10.1016/j.jse.2016.12.073

    Article  PubMed  Google Scholar 

  18. Teusink MJ, Pappou IP, Schwartz DG, Cottrell BJ, Frankle MA (2015) Results of closed management of acute dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg 24(4):621–627. https://doi.org/10.1016/j.jse.2014.07.015

    Article  PubMed  Google Scholar 

  19. Papadonikolakis A, Neradilek MB, Matsen FA 3rd (2013) Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am 95(24):2205–2212. https://doi.org/10.2106/JBJS.L.00552

    Article  PubMed  Google Scholar 

  20. Mueller U, Harzi A, Loescher R, Buelhoff M, Eckert JA, Kretzer JP (2021) Wear and damage in retrieved humeral inlays of reverse total shoulder arthroplasty-where, how much, and why? J Shoulder Elbow Surg 30(8):e517–e530. https://doi.org/10.1016/j.jse.2020.10.015

    Article  PubMed  Google Scholar 

  21. Nicholson AD, Mathew JI, Koch CN et al (2022) Backside polyethylene wear in reverse shoulder arthroplasty. J Shoulder Elbow Surg 31(3):545–552. https://doi.org/10.1016/j.jse.2021.09.002

    Article  PubMed  Google Scholar 

  22. Friedman RJ, Barcel DA, Eichinger JK (2019) Scapular Notching in Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 27(6):200–209. https://doi.org/10.5435/JAAOS-D-17-00026

    Article  PubMed  Google Scholar 

  23. Spiry C, Berhouet J, Agout C, Bacle G, Favard L (2021) Long-term impact of scapular notching after reverse shoulder arthroplasty. Int Orthop 45(6):1559–1566. https://doi.org/10.1007/s00264-021-04998-3

    Article  CAS  PubMed  Google Scholar 

  24. Jang YH, Lee JH, Kim SH (2020) Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty. Bone Joint J. 102-B(11):1438–1445. https://doi.org/10.1302/0301-620X.102B11.BJJ-2020-0449.R1

    Article  PubMed  PubMed Central  Google Scholar 

  25. Randelli P, Randelli F, Compagnoni R et al (2015) Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency. Joints 3(1):31–37

    PubMed  PubMed Central  Google Scholar 

  26. Piper CC, Horneff JG 3rd (2022) Management of Subscapularis Insufficiency After Total Shoulder Arthroplasty. J Am Acad Orthop Surg 30(19):933–940. https://doi.org/10.5435/JAAOS-D-22-00222

    Article  PubMed  Google Scholar 

  27. Combes D, Lancigu R, Desbordes de Cepoy P, Caporilli-Razza F, Hubert L, Rony L, Aubé C (2019) Imaging of shoulder arthroplasties and their complications: a pictorial review. Insights Imaging. 10(1):90. https://doi.org/10.1186/s13244-019-0788-5

    Article  PubMed  PubMed Central  Google Scholar 

  28. Franceschini V, Chillemi C (2013) Periprosthetic shoulder infection. Open Orthop J 28(7):243–249. https://doi.org/10.2174/1874325001307010243

    Article  Google Scholar 

  29. Bohsali KI, Bois AJ, Wirth MA (2017) Complications of Shoulder Arthroplasty. J Bone Joint Surg Am. 99(3):256-269. https://doi.org/10.2106/JBJS.16.00935. Erratum in: J Bone Joint Surg Am. 2017 Jun 21;99(12):e67

  30. Bohsali KI, Wirth MA, Rockwood CA Jr (2006) Complications of total shoulder arthroplasty. J Bone Joint Surg Am 88(10):2279–2292. https://doi.org/10.2106/JBJS.F.00125

    Article  PubMed  Google Scholar 

  31. Zan RAA, Lazarini RF, Matsunaga FT, Netto NA, Belloti JC, Tamaoki MJS (2020) Glenoid failure after total shoulder arthroplasty with cemented all-polyethylene versus metal-backed implants: a systematic review protocol. BMJ Open 10(12):e043449. https://doi.org/10.1136/bmjopen-2020-043449

    Article  PubMed  PubMed Central  Google Scholar 

  32. Farshad M, Gerber C (2010) Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 34(8):1075–82. https://doi.org/10.1007/s00264-010-1125-2. Epub 2010 Sep 25. Erratum in: Int Orthop. 2011 Mar;35(3):455.

  33. Hackett DJ Jr, Hsu JE, Matsen FA 3rd (2018) Primary Shoulder Hemiarthroplasty: What Can Be Learned From 359 Cases That Were Surgically Revised? Clin Orthop Relat Res 476(5):1031–1040. https://doi.org/10.1007/s11999.0000000000000167

    Article  PubMed  PubMed Central  Google Scholar 

  34. Young AA, Walch G, Pape G, Gohlke F, Favard L (2012) Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am 94(8):685–693. https://doi.org/10.2106/JBJS.J.00727

    Article  PubMed  Google Scholar 

  35. Parada SA, Flurin PH, Wright TW et al (2021) Comparison of complication types and rates associated with anatomic and reverse total shoulder arthroplasty. J Shoulder Elbow Surg 30(4):811–818. https://doi.org/10.1016/j.jse.2020.07.028

    Article  PubMed  Google Scholar 

  36. Rosenthal Y, Kwon YW (2020) Total Shoulder Arthroplasty Utilizing the Subscapularis-Sparing Approach. Orthop Clin North Am 51(3):383–389. https://doi.org/10.1016/j.ocl.2020.02.003

    Article  PubMed  Google Scholar 

  37. Levy DM, Abrams GD, Harris JD, Bach BR Jr, Nicholson GP, Romeo AA (2016) Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review. Int J Shoulder Surg. 10(2):78–84. https://doi.org/10.4103/0973-6042.180720

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nyffeler RW, Werner CM, Simmen BR, Gerber C (2004) Analysis of a retrieved delta III total shoulder prosthesis. J Bone Joint Surg Br 86(8):1187–1191. https://doi.org/10.1302/0301-620x.86b8.15228

    Article  CAS  PubMed  Google Scholar 

  39. Roche CP, Marczuk Y, Wright TW et al (2013) The Bone & Joint Journal 95B(4):530–535. https://doi.org/10.1302/0301-620X.95B4.30442

    Article  Google Scholar 

  40. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C (2007) Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am 89(3):588–600. https://doi.org/10.2106/JBJS.F.00226

    Article  PubMed  Google Scholar 

  41. Lin DJ, Wong TT, Kazam JK (2016) Shoulder Arthroplasty, from Indications to Complications: What the Radiologist Needs to Know. Radiographics. 36(1):192–208. https://doi.org/10.1148/rg.2016150055

    Article  PubMed  Google Scholar 

  42. Wirth MA, Rockwood CA Jr (1996) Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am 78(4):603–616. https://doi.org/10.2106/00004623-199604000-00018

    Article  CAS  PubMed  Google Scholar 

  43. Okoroha KR, Muh S, Gabbard M, Evans T, Roche C, Flurin PH, Wright TW, Zuckerman JD (2019) Early outcomes of shoulder arthroplasty according to sex. JSES Open Access 3(1):43–47. https://doi.org/10.1016/j.jses.2018.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  44. Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87(7):1476–1486. https://doi.org/10.2106/JBJS.D.02342

    Article  CAS  PubMed  Google Scholar 

  45. Singh A, Yian EH, Dillon MT, Takayanagi M, Burke MF, Navarro RA (2014) The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics. J Shoulder Elbow Surg 23(8):1187–1194. https://doi.org/10.1016/j.jse.2013.11.017

    Article  PubMed  Google Scholar 

  46. Brown JS, Gordon RJ, Peng Y, Hatton A, Page RS, Macgroarty KA (2020) Lower operating volume in shoulder arthroplasty is associated with increased revision rates in the early postoperative period: long-term analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Shoulder Elbow Surg 29(6):1104–1114. https://doi.org/10.1016/j.jse.2019.10.026

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Kendall S. Cooper, Garret M. Powell, Francis I. Baffour & Matthew A. Frick

  2. Division of Hospital and Emergency Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Garret M. Powell & Francis I. Baffour

  3. Division of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Garret M. Powell, Francis I. Baffour & Matthew A. Frick

  4. Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Matthew P. Johnson

Authors
  1. Kendall S. Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Garret M. Powell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francis I. Baffour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew P. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew A. Frick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Garret M. Powell.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cooper, K.S., Powell, G.M., Baffour, F.I. et al. Incidence of complications related to shoulder arthroplasties identified on computed tomography. Emerg Radiol 30, 475–483 (2023). https://doi.org/10.1007/s10140-023-02157-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-023-02157-2

Keywords

Search

Navigation