Skip to main content
NCBI home page
Journal of Orthopaedics logoLink to Journal of Orthopaedics
. 2022 Nov 24;35:120–125. doi: 10.1016/j.jor.2022.11.012

Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review

David Hawkes 1,∗, Steven Brookes-Fazakerley 1, Simon Robinson 1, Vijay Bhalaik 1
PMCID: PMC9718996  PMID: 36471697

Abstract

Background

Reverse shoulder arthroplasty is a common procedure performed for a variety of shoulder pathologies.

Aims and objectives

This current concept review evaluates the intraoperative and early postoperative complications, with a specific focus given to neurological and vascular injury, fracture, dislocation and venous thromboembolism.

Conclusion

A detailed knowledge of potential complications will allow surgeons to mitigate risk and maximise outcomes.

Keywords: Shoulder arthroplasty, Reverse shoulder replacement, Complications, Nerve injure, Vascular injury

1. Introduction

Reverse shoulder replacement is a commonly performed procedure, accounting for 64% of all shoulder arthroplasties, with over 5000 cases performed in the UK in 2019.1 The indications have widened in recent years and it is now a treatment option for a variety of shoulder pathology. Similarly, a number of design modifications have been introduced with a move from the traditional medialised Grammont style prostheses to more lateralised designs which aim to optimise deltoid wrapping and the tension within the residual posterior rotator cuff.

The aim of this current concepts review is to evaluate the intraoperative and early postoperative complications of reverse shoulder arthroplasty. Focus is given to neurological and vascular injury, fracture, dislocation and venous thromboembolism. Whilst early post-operative infection could be considered within the same time frame, it falls outside the scope of this review.

2. Neurological injury

The incidence of neurological injury following reverse shoulder arthroplasty is typically reported at between 1 and 4%.2,3 However, rates of up to 20% are described by some authorship groups.4 This variation reflects differing diagnostic criteria, rates are higher when nerve injury is diagnosed electrodiagnostically as compared to clinically.5 It is therefore likely that the true incidence is probably underreported, especially considering subtle clinical presentations are masked by post-operative pain and shoulder immobilisation.

Nerve injuries range from transient neuropraxia to more extensive injuries such as axonotmesis or neurotmesis. The latter can cause significant morbidity with pain, numbness and weakness. The most commonly affected nerves are the axillary nerve or brachial plexus. Causes of injury can be classified as either direct (such as injury during dissection or retractor placement), or indirect (such as traction or thermal injury). Further, patients can have vulnerable nerves pre-operatively and symptoms from pre-existing compressive neuropathies can worsen after surgery.

2.1. Axillary nerve

The axillary nerve runs posteriorly beneath the joint capsule to course through the quadrangular space. The mean distance between the nerve and the inferior glenoid rim is 13.6 mm.6 The nerve then divides into anterior and posterior branches with the posterior branch innervating the posterior deltoid and teres minor before terminating as the lateral cutaneous nerve of the arm. The anterior branch wraps anteriorly around the deltoid at a mean of 65 mm from the midpoint of the acromion.7

Injury to the axillary nerve causes deltoid dysfunction, of particular significance due to the arms reliance on the deltoid for elevation following reverse replacement. There are three principal mechanisms of injury. The first is a direct injury to the anterior branch in the subdeltoid region. Here, the nerve lies close to the posterior humeral cortex. Caution is needed with retractor placement laterally around the humerus and care should be taken to ensure that these are placed deep to the clavipectoral fascia.5 Secondly, a direct injury can occur at the inferior glenoid rim. Here careful subperiosteal dissection and judicious use of inferior retractors are required. The final mechanism is indirect secondary to traction. Lädermann demonstrated EMG changes develop within the axillary nerve when the arm is excessively lengthened.5 Interestingly, lateralisation has no effect on nerve tension8 and therefore this might be favoured if additional stability needs to be built into the construct intraoperatively.

2.2. Brachial plexus

The clinical presentation following injury to the brachial plexus can be varied, with manifestations depending on the level, extent and type of injury. The mechanism of injury is predominantly indirect, secondary to traction. Kam demonstrated that shoulder abduction >70o, combined with external rotation >60o and extension >50o is the highest risk position for brachial plexopathy, especially when a downward force is placed on the humeral shaft.9 Supporting the arm from under the elbow during preparation of the humerus is therefore prudent. Further, Lenior demonstrated that extension increases stress on all nerves and it is therefore advisable to limit the time spent with the arm in this position.10 Additionally, pre-operative stiffness is a risk factor for plexus injury, with passive pre-operative external rotation of less than 10o increasing the risk of nerve injury post-operatively, presumably due to reduced tissue compliance.11 The use of an arm positioning device (such as Trimano) should be considered carefully as they could increase the risk of nerve injury if they hold the arm in an extreme position for a prolonged period.

2.3. Suprascapular nerve

The suprascapular nerve arises from the superior trunk of the brachial plexus, runs through the suprascapular notch inferior to the ligament and courses across the supraspinatus fossa before exiting through the spinoglenoid notch to innervate infraspinatus.

Injury to the nerve can occur directly due to glenoid base plate screws, with the superior screw injuring the nerve at the suprascapular notch and the posterior screw the nerve at the spinoglenoid notch. Typically, with patients being cuff deficient, symptoms are of persistent postoperative pain and in this situation a CT scan can be useful to appreciate the orientation and length of the screws in relation to the known nerve anatomy (Fig. 1). Yang et al. described safe zones for screw placement: screws up to 30 mm were safe superiorly; and screws 16–18 mm were safe posteriorly. They did however note significant gender differences.12

Fig. 1.

Fig. 1

Open in a new tab

Coronal CT scan slice showing a long superior baseplate screw. Further examination of the axial slices demonstrated the screw within the suprascapular notch.

2.4. Other nerve injuries

Additional nerve injuries are also possible. The musculocutaneous nerve courses through the conjoint tendon at an average of 56 mm distal to the tip of the coracoid13 and injury can result from excessive medial retraction. Intraoperative periprosthetic humeral fracture is the biggest risk for radial nerve injury. The radial nerve enters the spiral groove nerve less than 25 mm from the inferior aspect of the latissimus dorsi tendon.14 Limiting instrumentation proximal to this therefore reduces the risk of radial nerve injury.

2.5. Nerve monitoring

Intra-operative nerve monitoring has the potential to identify evolving neurological dysfunction, allowing preventative action to be taken immediately. Nerve alerts are 5 times more common in reverse arthroplasty, as compared to anatomical replacement due to the distalisation that results.15 Aleem et al. reported nerve alerts in 36.2% of patients in a cohort of 284 shoulder arthroplasties. Post-operatively two transient, but no permanent, nerve injuries were seen. Similar findings have been reported by other authorship groups leading to suggestions that intra-operative nerve monitoring can aid surgical decision making.16,17

3. Bleeding and vascular injury

The axillary artery travels at an average of 10–18 mm from the inferior glenoid rim, but it is drawn significantly closer with external rotation of the glenohumeral joint.18 The anterior and posterior humeral circumflex arteries both arise from the third part of the artery. The anterior humeral circumflex artery courses laterally deep to coracobrachialis and the short head of biceps and branches before, within and distal to the intertubercular groove. The posterior humeral circumflex artery runs through the quadrangular space with the axillary nerve before branching to supply the posterior aspect of the shoulder.

3.1. Arterial injury

A number of case reports are presented in the literature highlighting the potential for arterial injury during reverse shoulder replacement. Wingert reported an avulsion injury of the axillary artery, requiring a synthetic artery bypass graft, secondary to excessive distalisation in a Grammont style protheses.19 There are further case reports of pseudoanyerysms of the posterior humeral circumflex artery which can be injured posteriorly at the level of the surgical neck.20 The anterior humeral circumflex artery and its venae comitantes, known as the “three sisters”, also need to be clearly identified and ligated prior to the subscapularis tenotomy as part of the surgical approach as these are also a potential cause of catastrophic haemorrhage. More commonly however, arterial injuries are described as part of the injury pattern in fracture dislocations which may go on to be treated with reverse shoulder arthroplasty.

3.2. Tranexamic acid

Tranexamic acid is an adjunct to reduced intra-operative blood loss. It is an anti-fibrinolytic that binds reversibly to plasminogen blocking its binding to fibrin and its subsequent conversion to plasmin. Its efficacy in shoulder arthroplasty has been widely studied in randomised control trials where it has been shown to reduce blood loss, haemoglobin drop and post-operative drain output.21,22 Further Kuo, in a meta-analysis of 680 shoulder arthroplasties, demonstrated its use lowered transfusion rates.23

Concern has existed regarding the use of tranexamic acid in patients with a previous history of thrombotic events. However, Carbone retrospectively reviewed 71,174 patients who underwent shoulder arthroplasty, reported tranexamic acid use in 13.7% and, after adjustment for covariates, found that it was not associated with an increased risk of complications.24 Topical thrombin has also been shown to be effective if an alternative is sought.25

3.3. Blood transfusion

Intra-operative blood loss has been reported at 346 mls in patients undergoing reverse replacement for massive irreparable rotator cuff tears,26 with no difference seen when using a prosthesis with or without a stem.27

Overall blood transfusion rates have been reported between 2.3 and 6.7%.28,29 Mai in a cohort of 781 shoulder arthroplasties concluded independent risk factors for transfusion included increasing age, a lower body mass index, discharge to a higher level of care, lower pre-operative haemoglobin and arthroplasty for fracture.29 Paynter retrospectively reviewed the electronic records of 369 patients who underwent reverse shoulder arthroplasty over a 10-year period. Eighty seven percent of post-operative laboratory blood tests did not influence patient management and therefore they recommended routine test are not required and rather a targeted approach can be adopted.30

3.4. Drains

Drains are used post-operatively by a number of authors to collect any ongoing bleeding before typically being removed on the first post-operative day. Trofa randomised 100 patients to have either closed suction drainage or not and did not report any differences in transfusion rates or peri-operative complications between the groups.31 Conversely, Chan retrospectively reviewed 105,116 shoulder arthroplasties, identifying drains were used in 20% of cases. In the group with drains there was a small increased risk of blood transfusion, but no increased risk of early post-operative infection or 30-day readmission.32

4. Fracture

Intra-operative fractures can occur either on the humeral or the glenoid side. The rate ranges from 1.4 to 2%, with the majority affecting the humerus.33,34 Post-operatively, acromial stress fractures can contribute significant morbidity.

4.1. Humerus

Intra-operative humeral fractures most commonly involve the humeral shaft, followed by the greater tuberosity and then the proximal metaphysis.34

Fractures can occur secondary to arm positioning or humeral canal preparation and component implantation. Forceful external rotation during the approach risks a spiral fracture of the humeral shaft, especially if the glenohumeral joint is stiff. Anterior translation of the shaft, to facilitate instrumentation, can results in greater tuberosity avulsions. Releasing supraspinatus, while preserving the posterior rotator cuff insertion, can reduce tension on the tuberosity and limit the risk of these avulsion fractures.35 Caution is required to ensure that the axis of the humerus is fully appreciated prior to canal preparation, especially if there is pre-existing deformity. Large press-fit stems with a high fill ratio present the highest risk of fracture during component implantation.36 Prophylactic cerclage cables or tapes may mitigate some of this risk or prevent calcar crack propagation in select cases.37 Risk factors for intra-operative fracture in primary cases include osteopenia,35 rheumatoid arthritis38 and female gender.36

Treatment depends on the location of the fracture, its displacement, the underlying bone quality and the stability of the component. However, the evidence to support decision making is limited to small cases series and expert opinion. Tuberosity fractures are predominantly treated with suture fixation.34 These fractures typically occur due to poor underlying bone quality and therefore anchoring to the humeral implant is recommended.35 Cerclage wiring is the most common treatment for metaphyseal fractures. Fractures that extend into the diaphysis are most commonly treated with cerclage wiring with or without revision to a long-stemmed humeral component achieving a distal fix (Fig. 2).34

Fig. 2.

Fig. 2

Open in a new tab

Arthrex Fibertape Cerclage System used for periprosthetic fracture fixation. Example shown here demonstrates use in anatomical replacement but the principles are transferable to reverse replacement.

4.2. Glenoid

Intra-operative glenoid fractures are rare (0.37%).34 They typically occur during reaming or implantation of the base plate, with the risk increasing if there is component mal-positioning.39 Patients undergoing reverse replacement for a proximal humerus fracture might be at higher risk, especially if the procedure is being performed at a delayed stage, due to disuse osteopenia.40 However, fractures have also been reported in glenoids with bone loss and sclerosis.41

Diligent pre-operative planning based on an up-to-date CT scan is required to understand the glenoid bone stock and version (Fig. 3). This is particularly important in cases of glenoid bone loss, where there might be a risk of perforating the anterior or posterior walls of the vault with a central peg or screw (Fig. 3). If an intraoperative fracture does occur, careful evaluation is required to understand the size and location of the fractured fragment. Small peripheral rim fractures are unlikely to be significant if they do not compromise stability of the base plate or backside contact. Indeed, in a systematic review by Dolci, 28% of patients who sustained an intra-operative glenoid fracture required no further intervention.34

Fig. 3.

Fig. 3

Open in a new tab

CT scan reconstructions demonstrating severe superior (24°) and posterior (6°) uncontained glenoid defect. Pre-operative planning revealed that ‘off the shelf’ solutions cannot restore the joint line. In this instance a patient specific implant is required.

Conversely, if the fractured fragment is larger and compromises baseplate stability additional intervention is required. Strategies described include fixation of the fractured fragment with the base plate screws, use of revision components with a longer central peg that can by-pass the defect and bone grafting. Finally, conversion to a hemiarthroplasty is the option in an unsalvageable situation.34 Interestingly, the majority of authors do not report their treatment, which probably reflects the rare but challenging nature of the problem.34

Pre-operative planning,42 the use of patient specific instrumentation43 and navigated surgery44 (Fig. 4) have all been shown to improve glenoid component positioning. It is therefore plausible that the risk of intra-operative glenoid fracture will reduce if these techniques gain more widespread use.

Fig. 4.

Fig. 4

Open in a new tab

Axial view CT scan demonstrating 4 part anterior fracture dislocation of the proximal humerus and glenohumeral joint with anterior glenoid rim fracture and narrow glenoid vault. Optimal position of baseplate insertion gained by using Eaxtech GPS CT navigation.

4.3. Acromion and scapular spine

Acromial and scapula spine stress fractures are a well-documented complication of reverse arthroplasty, with acromial fractures more common that spine fractures.45 The reported incidence in the literature varies widely from 0 to 15%.46 However, a recent systematic review by King et al., reported a rate of 2.8% in a population of 9048 patients.47

Patient and technical factors can contribute to the development of such fractures. It is essential that surgeons have a detailed knowledge of these in order to counsel patients appropriately and then modify their approach when necessary, especially given that their management remains a challenge.

The incidence of acromial and scapular spine fractures is highest in patients with inflammatory arthropathy (10.9%) or massive rotator cuff tears (3.8%), with the incidence lowest in proximal humerus fracture (0%).47 Further, female gender,48 a thinner acromion in the lateral and posterior half49 and osteoporosis50 have all been described as independent risk factors.

Acromial stress is influenced by component positioning. Glenoid lateralisation increases acromial stress in all planes of elevation. Conversely, placing the base plate more inferiorly on the glenoid decreases acromial stress. This occurs as changes in the glenoid component position alter the lever arm of the deltoid. Lateralisation reduces the perpendicular distance between the deltoid line of action and the centre of rotation. Therefore, the force in the deltoid has to increase to maintain the same moment arm, resulting in higher acromial stresses. Interestingly, altering humeral offset alone had no significant effect.51 Consequently, surgeons may moderate the degree of glenoid component lateralisation, especially if a number of patient specific risk factors already exist.

Treatment of these fractures remains both controversial and challenging. Conservative management with a broad arm sling and fixation with plate and screws have both been described but a lack of consensus remains. In a cohort of 44 patients with an acromial or scapular spine fracture following reverse arthroplasty, overall union rate was 55%. Union rates, however, were significantly higher in the operatively treated group (82%) as compared to the non-operatively treated group (45%). Nevertheless, clinical outcomes were inferior in both groups, as compared to controls, and were unrelated to bony union.51

5. Dislocation

The reported rates of dislocation following reverse shoulder replacement range from 1.4 to 9.2%,52,53 although in a contemporary series rates are lower at 0.84%.54 Dislocation can be considered either early, or late, with early dislocation usually defined as being within 3 months.55 Most early dislocation however occur within the first 4 weeks.53

The intraoperative assessment of construct stability requires a combination of tests to assess stability in multiple planes. A recently published strategy for trialling a proposed construct starts with removal of retractors, this is followed by evaluation of impingement free range of motion and finally by 4 stability tests.56 Firstly, anterior stability is tested in abduction and external rotation. Secondly posterior stability in evaluated in flexion and internal rotation. Thirdly the “bed shuffle test” is performed. In this test the arm is placed in slight extension and a cranially directed force is exerted through the elbow. Finally, the lateral trust test is evaluated. Here, with the arm by the side the surgeons index finger is used to trust the humerus laterally in an attempt to displaced the humerus off the glenosphere.56

Early dislocation is generally considered a technical error. Multiple factors have been proposed, including inadequate soft tissue tensioning57 component malposition,58 component size59 and insufficiency of subscapularis.60

Gutiérrez considered soft tissue tension to be the most important factor when considering the hierarchy of factors that influence early stability.57 Indeed, Kohan in a retrospective review of 22 patients with an early dislocation reported that inadequate soft tissue tension was accountable for the majority.53 Soft tissue tension is a product of both humeral length (i.e. distalisation) and offset (i.e. lateralisation). Distalisation can be increased by using a thicker liner, a longer humeral body, by reducing the stem insertion depth or by using an eccentric glenosphere. Lateralisation can be increased by lateralising the baseplate with either metal augments or bone, using a larger glenosphere or by using a lateralised humeral liner.

In addition to altering soft tissue tension, component size and positioning can have additional influences on stability. An inferiorly positioned base plate reduces inferior impingement,61 increasing the glenosphere size increases the jump distance59 and altering the humeral version affects the rotational range of motion possible before impingement.58

Cheung in a review of 119 consecutive patients undergoing reverse replacement reported an early dislocation rate of 9.2% and concluded failure to repair subscapularis was an independent predictor of instability. Similar findings however have not been corroborated in other studies.62

Stability is therefore multifactorial. Furthermore, adjustments of one parameter have influence on other factors, such as increased polyethylene wear with larger glenospheres63 and increased risk of acromial stress fractures with increased lateralisation.64 A detailed knowledge of the reverse system being utilised and the options for alteration is therefore essential when evaluating and addressing stability concerns intra-operatively.

6. Venous thromboembolism

Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, are potentially devastating complications that can result in significant morbidity and mortality. Risk assessment is mandated as part of routine practice and therefore an understanding of the incidence of VTE and the factors that can contribute to their development are essential.

Kunutsor in a meta-analysis of 668,699 shoulder arthroplasties reported a VTE incidence of 0.85%.65 Obesity (body mass index >30),65 older age,65,66 previous malignancy,67 a previous VTE,65 cardiovascular and respiratory comorbidities65 and arthroplasty for fracture66 are all proposed risk factors. A targeted, patient centred approach to VTE prophylaxis is therefore essential, especially considering the ageing population often with multiple comorbidities.

7. Conclusion

Reverse shoulder replacements are being performed increasing commonly for a wide variety of indications. Surgeons therefore ought to have a complete knowledge of the complication profile of the procedure, which will enable steps to be taken to both mitigate risk and maximise outcomes.

Funding/sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Informed consent (patient/guardian)

Not required.

Institutional ethical committee approval

Not required.

Authors contribution

David Hawkes: conceptualization, data curation, formal analysis, writing – original draft. Steven Brookes-Fazakerley: data curation, writing – review & editing. Simon Robinson: conceptualization, writing – review & editing, Vijay Bhalaik: conceptualization, writing – review & editing.

Declaration of competing interest

None.

Acknowledgements

None.

References

  • 1.National Joint Registry https://reports.njrcentre.org.uk/shoulders-primary-procedures-activity Shoulders - Primary Procedures [Available from:
  • 2.Lynch N.M., Cofield R.H., Silbert P.L., Hermann R.C. Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg. 1996;5(1):53–61. doi: 10.1016/s1058-2746(96)80031-0. [DOI] [PubMed] [Google Scholar]
  • 3.Vajapey S.P., Contreras E.S., Cvetanovich G.L., Neviaser A.S. Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: a review. J Clin Orthop Trauma. 2021;20 doi: 10.1016/j.jcot.2021.06.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Ball C.M. Neurologic complications of shoulder joint replacement. J Shoulder Elbow Surg. 2017;26(12):2125–2132. doi: 10.1016/j.jse.2017.04.016. [DOI] [PubMed] [Google Scholar]
  • 5.Lädermann A., Lübbeke A., Mélis B., et al. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011;93(14):1288–1293. doi: 10.2106/JBJS.J.00369. [DOI] [PubMed] [Google Scholar]
  • 6.Leschinger T., Hackl M., Buess E., et al. The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: an anatomic study. Injury. 2017;48(10):2042–2049. doi: 10.1016/j.injury.2017.06.024. [DOI] [PubMed] [Google Scholar]
  • 7.Bertelli J.A., Goklani M.S., Gasparelo K.R., Seltser A. Transdeltoid approach to axillary nerve repair: anatomical study and case series. J Hand Surg Am. 2021 doi: 10.1016/j.jhsa.2021.09.017. S0363-5023(21)00612-2 In press. [DOI] [PubMed] [Google Scholar]
  • 8.Marion B., Leclère F.M., Casoli V., et al. Potential axillary nerve stretching during RSA implantation: an anatomical study. Anat Sci Int. 2014;89(4):232–237. doi: 10.1007/s12565-014-0229-y. [DOI] [PubMed] [Google Scholar]
  • 9.Kam A.W., Lam P.H., Haen P., Tan M., Shamsudin A., Murrell G.A.C. Preventing brachial plexus injury during shoulder surgery: a real-time cadaveric study. J Shoulder Elbow Surg. 2018;27(5):912–922. doi: 10.1016/j.jse.2017.11.030. [DOI] [PubMed] [Google Scholar]
  • 10.Lenoir H., Dagneaux L., Canovas F., Waitzenegger T., Pham T.T., Chammas M. Nerve stress during reverse total shoulder arthroplasty: a cadaveric study. J Shoulder Elbow Surg. 2017;26(2):323–330. doi: 10.1016/j.jse.2016.07.020. [DOI] [PubMed] [Google Scholar]
  • 11.Nagda S.H., Rogers K.J., Sestokas A.K., et al. Neer Award 2005: peripheral nerve function during shoulder arthroplasty using intraoperative nerve monitoring. J Shoulder Elbow Surg. 2007;16(3 Suppl):S2–S8. doi: 10.1016/j.jse.2006.01.016. [DOI] [PubMed] [Google Scholar]
  • 12.Yang Y., Zuo J., Liu T., et al. Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty. Int Orthop. 2018;42(3):587–593. doi: 10.1007/s00264-017-3646-4. [DOI] [PubMed] [Google Scholar]
  • 13.LaPrade C.M., Bernhardson A.S., Aman Z.S., et al. Changes in the neurovascular anatomy of the shoulder after an open latarjet procedure: defining a surgical safe zone. Am J Sports Med. 2018;46(9):2185–2191. doi: 10.1177/0363546518773309. [DOI] [PubMed] [Google Scholar]
  • 14.Fu M.C., Hendel M.D., Chen X., Warren R.F., Dines D.M., Gulotta L.V. Surgical anatomy of the radial nerve in the deltopectoral approach for revision shoulder arthroplasty and periprosthetic fracture fixation: a cadaveric study. J Shoulder Elbow Surg. 2017;26(12):2173–2176. doi: 10.1016/j.jse.2017.07.021. [DOI] [PubMed] [Google Scholar]
  • 15.Parisien R.L., Yi P.H., Hou L., Li X., Jawa A. The risk of nerve injury during anatomical and reverse total shoulder arthroplasty: an intraoperative neuromonitoring study. J Shoulder Elbow Surg. 2016;25(7):1122–1127. doi: 10.1016/j.jse.2016.02.016. [DOI] [PubMed] [Google Scholar]
  • 16.Patel M.S., Wilent W.B., Gutman M.J., Abboud J.A. Incidence of peripheral nerve injury in revision total shoulder arthroplasty: an intraoperative nerve monitoring study. J Shoulder Elbow Surg. 2021;30(7):1603–1612. doi: 10.1016/j.jse.2020.09.024. [DOI] [PubMed] [Google Scholar]
  • 17.Shinagawa S., Shitara H., Yamamoto A., et al. Intraoperative neuromonitoring during reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28(8):1617–1625. doi: 10.1016/j.jse.2019.01.007. [DOI] [PubMed] [Google Scholar]
  • 18.Stone M.A., Ihn H.E., Gipsman A.M., et al. Surgical anatomy of the axillary artery: clinical implications for open shoulder surgery. J Shoulder Elbow Surg. 2021;30(6):1266–1272. doi: 10.1016/j.jse.2020.09.018. [DOI] [PubMed] [Google Scholar]
  • 19.Wingert N.C., Beck J.D., Harter G.D. Avulsive axillary artery injury in reverse total shoulder arthroplasty. Orthopedics. 2014;37(1):e92–e97. doi: 10.3928/01477447-20131219-24. [DOI] [PubMed] [Google Scholar]
  • 20.Miwa Y., Matsumura N., Suzuki T., Iwamoto T., Nakamura M., Matsumoto M. Pseudoaneurysm of the posterior humeral circumflex artery after reverse shoulder arthroplasty: a case report. JBJS Case Connect. 2020;10(3) doi: 10.2106/JBJS.CC.20.00245. [DOI] [PubMed] [Google Scholar]
  • 21.Friedman R.J., Gordon E., Butler R.B., Mock L., Dumas B. Tranexamic acid decreases blood loss after total shoulder arthroplasty. J Shoulder Elbow Surg. 2016;25(4):614–618. doi: 10.1016/j.jse.2015.09.014. [DOI] [PubMed] [Google Scholar]
  • 22.Abildgaard J.T., McLemore R., Hattrup S.J. Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2016;25(10):1643–1648. doi: 10.1016/j.jse.2016.02.002. [DOI] [PubMed] [Google Scholar]
  • 23.Kuo L.T., Hsu W.H., Chi C.C., Yoo J.C. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis. BMC Muscoskel Disord. 2018;19(1):60. doi: 10.1186/s12891-018-1972-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Carbone A., Poeran J., Zubizarreta N., et al. Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events. J Shoulder Elbow Surg. 2021;30(1):104–112. doi: 10.1016/j.jse.2020.04.050. [DOI] [PubMed] [Google Scholar]
  • 25.Belay E.S., O'Donnell J., Flamant E., Hinton Z., Klifto C.S., Anakwenze O. Intravenous tranexamic acid vs. topical thrombin in total shoulder arthroplasty: a comparative study. J Shoulder Elbow Surg. 2021;30(2):312–316. doi: 10.1016/j.jse.2020.05.039. [DOI] [PubMed] [Google Scholar]
  • 26.Kim M.S., Kim J.D., Ro K.H., Park J.J., Rhee Y.G. Hematologic profile in reverse total shoulder arthroplasty: perioperative and postoperative blood loss. J Shoulder Elbow Surg. 2019;28(9):1737–1742. doi: 10.1016/j.jse.2019.01.027. [DOI] [PubMed] [Google Scholar]
  • 27.Sakek F., Haight H., Tuphe P., et al. Assessment of intraoperative bleeding in reverse shoulder arthroplasty - with or without a stem. Orthop Traumatol Surg Res. 2022;108(3) doi: 10.1016/j.otsr.2022.103245. [DOI] [PubMed] [Google Scholar]
  • 28.Ryan D.J., Yoshihara H., Yoneoka D., Zuckerman J.D. Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009. J Shoulder Elbow Surg. 2015;24(5):760–765. doi: 10.1016/j.jse.2014.12.016. [DOI] [PubMed] [Google Scholar]
  • 29.Mai D.H., Atlas A.M., Francis A.M., et al. Factors predicting hemodynamic interventions during inpatient Admission after shoulder arthroplasty. Bull Hosp Jt Dis. 2013;78(2):131–139. 2020. [PubMed] [Google Scholar]
  • 30.Paynter J.W., Raley J.A., Kyrkos J.G., et al. Routine postoperative laboratory tests are unnecessary after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020;29(8):1656–1664. doi: 10.1016/j.jse.2019.12.023. [DOI] [PubMed] [Google Scholar]
  • 31.Trofa D.P., Paulino F.E., Munoz J., et al. Short-term outcomes associated with drain use in shoulder arthroplasties: a prospective, randomized controlled trial. J Shoulder Elbow Surg. 2019;28(2):205–211. doi: 10.1016/j.jse.2018.10.014. [DOI] [PubMed] [Google Scholar]
  • 32.Chan J.J., Cirino C.M., Huang H.H., et al. Drain use is associated with increased odds of blood transfusion in total shoulder arthroplasty: a population-based study. Clin Orthop Relat Res. 2019;477(7):1700–1711. doi: 10.1097/CORR.0000000000000728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Zumstein M.A., Pinedo M., Old J., Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20(1):146–157. doi: 10.1016/j.jse.2010.08.001. [DOI] [PubMed] [Google Scholar]
  • 34.Dolci A., Melis B., Verona M., Capone A., Marongiu G. Complications and intraoperative fractures in reverse shoulder arthroplasty: a systematic review. Geriatr Orthop Surg Rehabil. 2021;12 doi: 10.1177/21514593211059865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Brusalis C.M., Taylor S.A. Periprosthetic fractures in reverse total shoulder arthroplasty: current concepts and advances in management. Curr Rev Musculoskelet Med. 2020;13(4):509–519. doi: 10.1007/s12178-020-09654-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Wagner E.R., Houdek M.T., Elhassan B.T., Sanchez-Sotelo J., Cofield R.H., Sperling J.W. What are risk factors for intraoperative humerus fractures during revision reverse shoulder arthroplasty and do they influence outcomes? Clin Orthop Relat Res. 2015;473(10):3228–3234. doi: 10.1007/s11999-015-4448-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Wierks C., Skolasky R.L., Ji J.H., McFarland E.G. Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res. 2009;467(1):225–234. doi: 10.1007/s11999-008-0406-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.He Y., Xiao L.B., Zhai W.T., Xu Y.L. Reverse shoulder arthroplasty in patients with rheumatoid arthritis: early outcomes, pitfalls, and challenges. Orthop Surg. 2020;12(5):1380–1387. doi: 10.1111/os.12769. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Shah S.S., Roche A.M., Sullivan S.W., et al. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int. 2021;5(1):121–137. doi: 10.1016/j.jseint.2020.07.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Russo R., Della Rotonda G., Cautiero F., Ciccarelli M. Reverse shoulder prosthesis to treat complex proximal humeral fractures in the elderly patients: results after 10-year experience. Musculoskelet Surg. 2015;99(Suppl 1):S17–S23. doi: 10.1007/s12306-015-0367-y. [DOI] [PubMed] [Google Scholar]
  • 41.Zilber S., Camana E., Lapner P., Haritinian E., Nove Josserand L. Reverse total shoulder arthroplasty using helical blade to optimize glenoid fixation and bone preservation: preliminary results in thirty five patients with minimum two year follow-up. Int Orthop. 2018;42(9):2159–2164. doi: 10.1007/s00264-018-3891-1. [DOI] [PubMed] [Google Scholar]
  • 42.Berhouet J., Gulotta L.V., Dines D.M., et al. Preoperative planning for accurate glenoid component positioning in reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2017;103(3):407–413. doi: 10.1016/j.otsr.2016.12.019. [DOI] [PubMed] [Google Scholar]
  • 43.Dallalana R.J., McMahon R.A., East B., Geraghty L. Accuracy of patient-specific instrumentation in anatomic and reverse total shoulder arthroplasty. Int J Shoulder Surg. 2016;10(2):59–66. doi: 10.4103/0973-6042.180717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Hones K.M., King J.J., Schoch B.S., Struk A.M., Farmer K.W., Wright T.W. The in vivo impact of computer navigation on screw number and length in reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30(10):e629–e635. doi: 10.1016/j.jse.2021.01.017. [DOI] [PubMed] [Google Scholar]
  • 45.Mahendraraj K.A., Abboud J., Armstrong A., et al. Predictors of acromial and scapular stress fracture after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. J Shoulder Elbow Surg. 2021;30(10):2296–2305. doi: 10.1016/j.jse.2021.02.008. [DOI] [PubMed] [Google Scholar]
  • 46.Farshad M., Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 2010;34(8):1075–1082. doi: 10.1007/s00264-010-1125-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.King J.J., Dalton S.S., Gulotta L.V., Wright T.W., Schoch B.S. How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?: a systematic review. Bone Joint Lett J. 2019;101-b(6):627–634. doi: 10.1302/0301-620X.101B6.BJJ-2018-1187.R1. [DOI] [PubMed] [Google Scholar]
  • 48.Zmistowski B., Gutman M., Horvath Y., Abboud J.A., Williams G.R., Jr., Namdari S. Acromial stress fracture following reverse total shoulder arthroplasty: incidence and predictors. J Shoulder Elbow Surg. 2020;29(4):799–806. doi: 10.1016/j.jse.2019.08.004. [DOI] [PubMed] [Google Scholar]
  • 49.Yeazell S.T., Malige A., Visser T., Carolan G.F. The role of acromial morphometry in the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow. 2021;13(3):296–302. doi: 10.1177/1758573220906764. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Moverman M.A., Menendez M.E., Mahendraraj K.A., Polisetty T., Jawa A., Levy J.C. Patient risk factors for acromial stress fractures after reverse shoulder arthroplasty: a multicenter study. J Shoulder Elbow Surg. 2021;30(7):1619–1625. doi: 10.1016/j.jse.2020.09.012. [DOI] [PubMed] [Google Scholar]
  • 51.Lockhart J.S., Wong M.T., Langohr G.D.G., Athwal G.S., Johnson J.A. The effect of load and plane of elevation on acromial stress after reverse shoulder arthroplasty. Shoulder Elbow. 2021;13(4):388–395. doi: 10.1177/1758573220910093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Ekelund A.L. Management of painful reverse shoulder arthroplasty. Shoulder Elbow. 2017;9(3):212–222. doi: 10.1177/1758573217702333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Kohan E.M., Chalmers P.N., Salazar D., Keener J.D., Yamaguchi K., Chamberlain A.M. Dislocation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(7):1238–1245. doi: 10.1016/j.jse.2016.12.073. [DOI] [PubMed] [Google Scholar]
  • 54.Garcia-Fernandez C., Lopiz Y., Arvinius C., et al. Dislocation after reverse total shoulder arthroplasty using contemporary medialized modular systems. Can we still consider it such a frequent complication? Eur J Orthop Surg Traumatol. 2022;32(8):1525–1534. doi: 10.1007/s00590-021-03131-9. [DOI] [PubMed] [Google Scholar]
  • 55.Chalmers P.N., Rahman Z., Romeo A.A., Nicholson G.P. Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(5):737–744. doi: 10.1016/j.jse.2013.08.015. [DOI] [PubMed] [Google Scholar]
  • 56.Javed S., Imam M.A., Monga P. Intraoperative stability assessment in reverse shoulder arthroplasty. J Clin Orthop Trauma. 2019;10(3):617–619. doi: 10.1016/j.jcot.2018.11.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Gutiérrez S., Keller T.S., Levy J.C., Lee W.E., 3rd, Luo Z.P. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res. 2008;466(3):670–676. doi: 10.1007/s11999-007-0096-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Stephenson D.R., Oh J.H., McGarry M.H., Rick Hatch G.F., 3rd, Lee T.Q. Effect of humeral component version on impingement in reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20(4):652–658. doi: 10.1016/j.jse.2010.08.020. [DOI] [PubMed] [Google Scholar]
  • 59.Roche C., Flurin P.H., Wright T., Crosby L.A., Mauldin M., Zuckerman J.D. An evaluation of the relationships between reverse shoulder design parameters and range of motion, impingement, and stability. J Shoulder Elbow Surg. 2009;18(5):734–741. doi: 10.1016/j.jse.2008.12.008. [DOI] [PubMed] [Google Scholar]
  • 60.Cheung E.V., Sarkissian E.J., Sox-Harris A., et al. Instability after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018;27(11):1946–1952. doi: 10.1016/j.jse.2018.04.015. [DOI] [PubMed] [Google Scholar]
  • 61.Collotte P., Bercik M., Vieira T.D., Walch G. Long-term reverse total shoulder arthroplasty outcomes: the effect of the inferior shifting of glenoid component fixation. Clin Orthop Surg. 2021;13(4):505–512. doi: 10.4055/cios20245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Vourazeris J.D., Wright T.W., Struk A.M., King J.J., Farmer K.W. Primary reverse total shoulder arthroplasty outcomes in patients with subscapularis repair versus tenotomy. J Shoulder Elbow Surg. 2017;26(3):450–457. doi: 10.1016/j.jse.2016.09.017. [DOI] [PubMed] [Google Scholar]
  • 63.Haggart J., Newton M.D., Hartner S., et al. Neer Award 2017: wear rates of 32-mm and 40-mm glenospheres in a reverse total shoulder arthroplasty wear simulation model. J Shoulder Elbow Surg. 2017;26(11):2029–2037. doi: 10.1016/j.jse.2017.06.036. [DOI] [PubMed] [Google Scholar]
  • 64.Paszicsnyek A., Jo O., Rupasinghe H.S., et al. Factors influencing acromial and scapular spine strain after reverse total shoulder arthroplasty: a systematic review of biomechanical studies. J Clin Med. 2022;11(2):361. doi: 10.3390/jcm11020361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Kunutsor S.K., Barrett M.C., Whitehouse M.R., Blom A.W. Venous thromboembolism following 672,495 primary total shoulder and elbow replacements: meta-analyses of incidence, temporal trends and potential risk factors. Thromb Res. 2020;189:13–23. doi: 10.1016/j.thromres.2020.02.018. [DOI] [PubMed] [Google Scholar]
  • 66.Kolz J.M., Aibinder W.R., Adams R.A., Cofield R.H., Sperling J.W. Symptomatic thromboembolic complications after shoulder arthroplasty: an update. J Bone Joint Surg Am. 2019;101(20):1845–1851. doi: 10.2106/JBJS.18.01200. [DOI] [PubMed] [Google Scholar]
  • 67.Chen D.Q., Montgomery S.R., Jr., Cancienne J.M., Werner B.C. Postoperative venous thromboembolism and other complications after anatomic total shoulder arthroplasty in patients with a history of prostate or breast cancer. J Am Acad Orthop Surg. 2020;28(2):75–80. doi: 10.5435/JAAOS-D-18-00777. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Orthopaedics are provided here courtesy of Elsevier

RESOURCES