It's Complicated....PO Day 101

French physicians were pioneers in shoulder arthroplasty (the surgical reconstruction of a joint). The first reported procedure was by Jean Pean in 1894. An American, Charles Neer, developed the first practical and widely used prosthesis for the shoulder in the 1950s.  Back to France in the early 1980s Paul Grammont, working in his home shop, designed the first generation of prosthesis for the reverse Total Shoulder Arthroplasty which had previously met with failures. For the next couple decades the French refined the operation but it was not until 2004 that  Reverse Total Shoulder Arthroplasty crossed the Atlantic and became the new surgical procedure on the block in the US.  It was met with a great many reservations and guidelines suggested it be reserved for patients over the age of 70 and offered as a treatment of "last resort." The rate of complication was reported as quite high, at least 50% and some suggested that 100% of the patients had some form of surgical or medical complication. It was reported that there was a very high learning curve for the surgeon and you didn't want to be one of the first seven people on whom your doctor operated. Seven seemed to be the number needed to become at all proficient. The last ten years have seen quite a change in attitude toward the operation and who should have it.

Risk of infection with rTSA is greater than in hip, knee or shoulder replacement but a report by the NIH (National Institute of Health) suggested a rate of only 7%. An article in the Journal of Shoulder and Elbow Surgery in March 2014 agreed with the 7% figure. The fact that some of the procedures were revision of previous TSA contributed to a higher risk of infection.

The NIH reported in 2010 that cases of implant instability in rTSA patients  occurred in 3.4% of the patients and most cases of dislocation happened in the first several month after surgery.

Mole' and Favard reported a 3% rate of fracture of the acromiom bone (an extension of the collar bone, I think). One article suggested the fracture might be the result of over zealous exercise.

Less common problems are neurologic injury, periprosthetic fracture, hematoma, scapular notching, dislocation, and mechanical baseplate failure.

In an article in the June 2014 issue of the Journal of Shoulder and Elbow Surgery the overall rate of complications with rTSA was 25%. However, 80% of the complications were considered minor.

The bottom line is the relatively high rate of complications is considered acceptable due to the very high improvement in shoulder function and quality of life.


I'm good with that.



Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September..