Skip to main content
SpringerLink
Log in

Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Reverse total shoulder arthroplasty is a treatment option for patients with symptomatic glenohumeral arthritis and a deficient rotator cuff. The reported complication rates vary from 0% to 68%. Given this variation, our purposes were to (1) determine the learning curve for the procedure, (2) identify complications and surgical pitfalls, and (3) compare our results with those of similar published series. We retrospectively reviewed 20 consecutive patients (mean age, 73 years; range, 45–88 years) who had reverse total shoulder arthroplasty by one surgeon, tabulating intraoperative and postoperative complications. Minimum followup was 3 months (average, 9 months; range, 3–21 months). The intraoperative complication rate for the first 10 patients was higher than that for the second 10 patients. There were 33 complications in 15 patients: 11 patients collectively had 22 intraoperative complications and eight patients collectively had 11 postoperative complications. At radiographic followup, 11 patients had scapular notching and nine patients had heterotopic ossification. Our complication rate was higher than published rates.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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

Similar content being viewed by others

References

  1. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(1 suppl S):147S–161S.

    Article  PubMed  Google Scholar 

  2. Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25:129–133.

    PubMed  Google Scholar 

  3. Cook JA, Ramsay CR, Fayers P. Using the literature to quantify the learning curve: a case study. Int J Technol Assess Health Care. 2007;23:255–260.

    Article  PubMed  Google Scholar 

  4. De Wilde L, Sys G, Julien Y, Van Ovost E, Poffyn B, Trouilloud P. The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection. Acta Orthop Belg. 2003;69:495–500.

    PubMed  Google Scholar 

  5. De Wilde LF, Plasschaert FS, Audenaert EA, Verdonk RC. Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery. Clin Orthop Relat Res. 2005;430:156–162.

    Article  PubMed  Google Scholar 

  6. Favard L, Lautmann S, Sirveaux F, Oudet D, Kerjean Y, Huguet D. Hemiarthroplasty versus reverse arthroplasty in the treatment of osteoarthritis with massive rotator cuff tear. In: Walch G, Boileau P, Mole D, eds. Shoulder Prosthesis: Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:261–268.

    Google Scholar 

  7. Fleisch MC, Newton J, Steinmetz I, Whitehair J, Hallum A, Hatch KD. Learning and teaching advanced laparoscopic procedures: do alternating trainees impair a laparoscopic surgeon’s learning curve? J Minim Invasive Gynecol. 2007;14:293–299.

    Article  PubMed  Google Scholar 

  8. Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients: surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1, pt 2):178–190.

    Article  PubMed  Google Scholar 

  9. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1697–1705.

    Article  PubMed  Google Scholar 

  10. Grammont P, Trouilloud P, Laffay JP, Deries X. Etude et réalisation d’une nouvelle prothèse d’épaule. Rheumatologie. 1987;39:407–418.

    Google Scholar 

  11. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–68.

    PubMed  CAS  Google Scholar 

  12. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty: survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006;88:1742–1747.

    Article  PubMed  Google Scholar 

  13. Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2003;85:2318–2324.

    PubMed  Google Scholar 

  14. Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86:496–505.

    Article  PubMed  Google Scholar 

  15. Kjaersgaard-Andersen P, Frich LH, Sojbjerg JO, Sneppen O. Heterotopic bone formation following total shoulder arthroplasty. J Arthroplasty. 1989;4:99–104.

    Article  PubMed  CAS  Google Scholar 

  16. Kreder HJ, Deyo RA, Koepsell T, Swiontkowski MF, Kreuter W. Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington. J Bone Joint Surg Am. 1997;79:485–494.

    PubMed  CAS  Google Scholar 

  17. Lavernia CJ. Hemiarthroplasty in hip fracture care: effects of surgical volume on short-term outcome. J Arthroplasty. 1998;13:774–778.

    Article  PubMed  CAS  Google Scholar 

  18. Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–140.

    Article  PubMed  CAS  Google Scholar 

  19. Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89:292–300.

    Article  PubMed  Google Scholar 

  20. Matsen FA 3rd, Boileau P, Walch G, Gerber C, Bicknell RT. The reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2007;89:660–667.

    PubMed  Google Scholar 

  21. Nwakama AC, Cofield RH, Kavanagh BF, Loehr JF. Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing. J Shoulder Elbow Surg. 2000;9:302–307.

    Article  PubMed  CAS  Google Scholar 

  22. Rittmeister M, Kerschbaumer F. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg. 2001;10:17–22.

    Article  PubMed  CAS  Google Scholar 

  23. Rockwood CA Jr. The reverse total shoulder prosthesis: the new kid on the block. J Bone Joint Surg Am. 2007;89:233–235.

    Article  PubMed  Google Scholar 

  24. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600.

    Article  PubMed  Google Scholar 

  25. Sirveaux F, Favard L, Oudet D, Huguet D, Lautman S. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and nonrepairable cuff rupture. In: Walch G, Boileau P, Mole D, eds. Shoulder Prosthesis: Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:247–252.

    Google Scholar 

  26. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: results of a multicentre study of 80 shoulders. J Bone Joint Surg Br. 2004;86:388–395.

    Article  PubMed  CAS  Google Scholar 

  27. Taylor HD, Dennis DA, Crane HS. Relationship between mortality rates and hospital patient volume for Medicare patients undergoing major orthopaedic surgery of the hip, knee, spine, and femur. J Arthroplasty. 1997;12:235–242.

    Article  PubMed  CAS  Google Scholar 

  28. Valenti PH, Boutens D, Nerot C. Delta 3 reversed prosthesis for osteoarthritis with massive rotator cuff tear: long-term results (> 5 years). In: Walch G, Boileau P, Mole D, eds. Shoulder Prosthesis: Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:253–259.

    Google Scholar 

  29. Vanhove B, Beugnies A. Grammont’s reverse shoulder prosthesis for rotator cuff arthropathy: a retrospective study of 32 cases. Acta Orthop Belg. 2004;70:219–225.

    PubMed  Google Scholar 

  30. Werner CM, Steinmann PA, Gilbart M, Gerber C. 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. 2005;87:1476–1486.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Carl Wierks MD, Richard L. Skolasky ScD, Jong Hun Ji MD & Edward G. McFarland MD

  2. c/o Elaine P. Henze, BJ, ELS, Medical Editor, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A672, Baltimore, MD, 21224, USA

    Edward G. McFarland MD

Authors
  1. Carl Wierks MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard L. Skolasky ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong Hun Ji MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward G. McFarland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward G. McFarland MD.

Additional information

Each author certifies that he or she has no commercial associations (eg consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

About this article

Cite this article

Wierks, C., Skolasky, R.L., Ji, J.H. et al. Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications. Clin Orthop Relat Res 467, 225–234 (2009). https://doi.org/10.1007/s11999-008-0406-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0406-1

Keywords

Search

Navigation