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Scapula fractures becoming more common following reverse shoulder arthroplasty
Rates of postoperative dislocation, infection have decreased with newer designs, surgeon says.
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Orthopedic surgeons who perform reverse shoulder arthroplasty more frequently for rotator cuff tear arthopathy and other indications should be aware of surgical and other factors that lead to unwanted complications, according to a surgeon who has studied these complications.
“What we really want to do with all these complications is avoid a resection arthroplasty,” said Lynn A. Crosby, MD, of Augusta, Ga.
During the 2009 Current Concepts in Joint Replacement Spring Meeting, Crosby reviewed problems that may lead to infection, dislocation or revision following reverse shoulder arthroplasty (RSA).
According to Crosby, dislocations have become rarer with the advent of improved, third-generation RSA prostheses. Infections are gradually decreasing too, he said. They tend to occur in these patients because they are a multiply operated group.
Tissue balancing
Dislocations, once a devastating and frequent complication, can be mitigated with good soft tissue balancing made possible by the third-generation systems, said Crosby, who believes overall rates are lower for this complication.
Concerning scapula fractures, Crosby and colleagues identified 24 fractures among 400 RSAs and categorized them into types 1, 2 or 3.
Type 1 is a true avulsion fracture often seen in patients with a long-standing arthopathy or a weakened acromion following acromioplasty where a small bone fragment dislodges during reduction. Support is the recommended treatment.
Severe anterior shoulder pain at 3 to 6 months postoperatively indicates a type 2 fracture. It is caused by acromioclavicular (AC) joint arthrosis that prevents normal distal clavicle movement and stresses the acromion to the point of fracture. Crosby recommended an AC joint resection or open reduction internal fixation of the acromion for unstable cases.
Stress-related fractures
True-scapular, or type 3, fractures are stress-related, caused by the prosthesis’ superior screw, according to 3-D CT scans Crosby and colleagues studied. They occur at about 8 months postoperative after a minor trauma.
“We recommend now that you do not use a superior screw in any system that has that ability. We feel this is a true stress riser and causes this fracture,” Crosby said.
For more information:
- Lynn A. Crosby, MD, can be reached at the Medical College of Georgia, Department of Orthopaedic Surgery, 937 15th St., Augusta, GA 30912; 706-721-4314; e-mail: lycrosby@mcg.edu. He is a paid consultant to and has intellectual properties with Exactech.
Reference:
- Crosby LA. Complications after reverse TSA: One door closes, another opens. #16. Presented at the 10th Annual Current Concepts in Joint Replacement Spring Meeting, May 17-20, 2009. Las Vegas.