Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review

Andrea Dolci; Barbara Melis; Marco Verona; Antonio Capone; Giuseppe Marongiu

doi:10.1177/21514593211059865

Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review

Geriatr Orthop Surg Rehabil. 2021 Dec 8:12:21514593211059865. doi: 10.1177/21514593211059865. eCollection 2021.

Authors

Andrea Dolci¹, Barbara Melis², Marco Verona¹, Antonio Capone¹, Giuseppe Marongiu¹

Affiliations

¹ Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy.
² Orthopaedic and Sport Trauma Unit, Casa di Cura Policlinico Città di Quartu, Quartu Sant'Elena, Italy.

Abstract

Introduction: The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures.

Significance: We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients' outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed.

Results: The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases.

Conclusions: A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further complication rate. This investigation may aid in the treatment decision-making for these complications.

Keywords: complication; intraoperative fracture; periprosthetic fracture; reverse shoulder arthroplasty; reverse shoulder replacement; systematic review.