Common Problems After Shoulder Replacement

Total shoulder replacements (TSRs) aren't as common as total hip or total knee replacements. But their number is increasing every year. Along with this increase are more postoperative problems. In this report, surgeons from the University of Texas review the most common of these complications.

Reports of TSR complications range from zero to 62 per cent. The average number of complications reported is around 14 per cent. Many surgeons only perform one or two TSRs each year. Studies show fewer problems occur when done by high-volume surgeons. Problems such as loosening, infection, nerve damage, and rotator cuff tears can occur.

Postoperative failure of the TSR is usually multifactorial. In other words, there is more than one reason why a TSR fails. Instability often leading to dislocation results from any of the causes listed. Long-term studies (10 years or more) of TSR outcomes are still scarce. The authors report only finding three of 39 studies in the long-term group.

Recent advances in the design and methods of inserting TSRs have shown good short-term results. For example, improved cement techniques and a pegged instead of a keeled insertion have improved results. The pegged implant has two or three pegs that fit into holes to hold the implant in place. The keel design looks more like a fin on a shark or as named, like the keel on the bottom of a boat. It slips into a matching slit-shaped hole.

The reverse shoulder prosthesis (RSP) has also improved results for patients with massive rotator cuff tears. The RSP is also being used as the revision implant when the first TSR fails.

Reference: 

Kamal I. Bohsali, MD, et al. Complications of Total Shoulder Arthroplasty. In The Journal of Bone and Joint Surgery. October 2006. Vol. 88-A No. 10. Pp. 2279-2292.

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