Intra- and Postoperative Complications of Shoulder Arthroplasty

Abstract

This article addresses the recognition, etiology, treatment and prevention of complications of total shoulder arthroplasty observed in theAequalis multicenter study. Ten intraoperative humeral fractures were observed: three fractures occurred in the greater tuberosity and seven spiroid fractures occured in the diaphysis and were related to forceful external rotation during exposure of the humeral head. Two late postoperative fractures occurred and were secondary to trauma. Locoregional complications include three hematoma, three deep infections and ten nerve injuries. Anterior instability (five cases) was either traumatic (two cases) or atraumatic (three cases), following previous surgery and was typically associated with disruption of the anterior shoulder repair in all cases. Revision surgery for repair of the subscapularis was performed with simple sutures in three cases but necessitated a pectoralis major transfer in one case and a bone-quadriceps tendon graft in one case. Posterior instability occurred early on three occasions and was related to insufficient correction of excessive glenoid wear with plastic deformation and incompetence of the posterior capsule. Anterosuperior instability occurred in three cases and was related to superior cuff rupture or deltoid loss. Glenoid loosening required revision in four cases. No humeral loosening occurred with the cemented components while eleven humeral loosening and subsidence were observed with the twenty press-fitted components. A glenoid erosion occurred in two cases of hemiarthroplasty, a dissociation of the polyethylene from the metal tray in one case and a persistent stiff shoulder in one case.