Complication rates comparing primary with revision reverse total shoulder arthroplasty

Bryan M Saltzman; Peter N Chalmers; Anil K Gupta; Anthony A Romeo; Gregory P Nicholson

doi:10.1016/j.jse.2014.04.015

Complication rates comparing primary with revision reverse total shoulder arthroplasty

J Shoulder Elbow Surg. 2014 Nov;23(11):1647-54. doi: 10.1016/j.jse.2014.04.015. Epub 2014 Jun 28.

Authors

Bryan M Saltzman¹, Peter N Chalmers², Anil K Gupta³, Anthony A Romeo², Gregory P Nicholson²

Affiliations

¹ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: bryan.m.saltzman@gmail.com.
² Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
³ Sports Medicine and Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA.

PMID: 24986694
DOI: 10.1016/j.jse.2014.04.015

Abstract

Background: Complication rates after reverse total shoulder arthroplasty (RTSA) have, in previous series, been reported to be high. The purpose of this study was to describe the complication rates, types, timing, and risk factors after revision RTSA, as compared with primary RTSA.

Methods: We performed a retrospective review of patients who underwent primary or revision RTSA to determine early (within 90 days) complication rates. Complications were subdivided into medical versus surgical and minor versus major.

Results: One hundred thirty-seven patients met the inclusion criteria. Of these, 111 underwent primary RTSA and 26 underwent RTSA as a revision from a previous arthroplasty. The overall complication rates were 25% after primary RTSA and 69% after revision RTSA. Minor complications accounted for 80% of the complications after primary RTSA and 94% after revision RTSA. Surgical complications were more frequent than medical complications in revision patients, occurring in 18% of primary cases and 62% of revisions. Revision patients more frequently required transfusions, with rates of 5% and 31% for primary cases and revisions, respectively. Overall, minor, surgical, intraoperative, perioperative, and postoperative complications were all significantly more frequent after revision RTSA. Multivariate logistic regression showed that revision status was the most significant predictor of overall (P < .001), minor (P < .001), surgical (P < .001), intraoperative (P = .002), and postoperative (P < .001) complication rates. Medical complications were predicted by body mass index (P < .001).

Conclusion: Revision RTSA has a significantly higher rate of complications than primary RTSA. These patients are significantly more likely to require transfusions. Patients should be aware that minor complications are frequent after revision RTSA and should be counseled accordingly.

Keywords: Complications; medical; reverse total shoulder arthroplasty; revision; surgical; transfusion.

Publication types

Comparative Study

MeSH terms

Aged
Arthroplasty, Replacement / adverse effects*
Arthroplasty, Replacement / methods
Female
Humans
Joint Diseases / surgery*
Male
Middle Aged
Postoperative Complications / etiology
Reoperation / adverse effects*
Retrospective Studies
Shoulder Injuries
Shoulder Joint / surgery*