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Study highlights instability, infection rates following reverse shoulder arthroplasty
Trappey GJ. Clin Orthop Relat Res. 2010 Nov 23. [Epub ahead of print]. doi: 10.1007/s11999-010-1686-9.
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The results of a recently published study show comparable instability rates for primary and revision reverse shoulder arthroplasty procedures, but a higher infection rate for revision operations.
Using prospective database, clinical charts and radiographs, George J. Trappey IV, MD, and colleagues identified 212 patients who underwent primary reverse shoulder arthroplasty (RSA) and 72 patients who had revision RSA.
The investigators found instability rates of 5% and 8% for the primary and revision groups, respectively. However, they discovered an infection rate of 7% in the revision group compared with 1% for the primary group, according to the study abstract.
Overall, the study revealed a higher rate of instability for patients with subscapularis tendons that could not be repaired compared with those who had repairable tendons (12% vs. 1%).
A comparison of diagnoses within the primary group showed similar rates of infection and revealed that patients with fracture sequel had the greatest rate of instability (28%). In addition, the study revealed that instability and infection did not impact improvement in American Shoulder and Elbow Surgeons, Constant and Western Ontario Osteoarthritis of the Shoulder scores.
“This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA,” the investigators wrote in their abstract.
Dr. Edwards and colleagues have reviewed their extensive experience with reverse shoulder arthroplasty confirming what other authors have demonstrated - namely, that prosthetic instability remains a small but devastating complication and is more prevalent in patients being revised following prior fracture-related surgery.
Not surprisingly, patients undergoing revision reverse shoulder replacement had a much higher likelihood of developing infection.
This study further highlights the evolution and increased use of the reverse shoulder replacement but appropriately raises caution regarding the very real complications especially in revision situations.
— William N. Levine, MD
Vice Chairman and Professor,
Department of Orthopedic Surgery
Columbia University Medical Center
New York
He has no direct financial interests in any products or services mentioned in this article.