Back to the real world...PO Day 201

It's as if I have been on a vacation from thinking about shoulders and surgery and complications over the past week. But it's time to get back to the reason for this blog, shoulder surgery, particularly reverse Total Shoulder Arthroplasty.

A high volume practice did a review of patients who had experienced dislocation after shoulder surgery. Of the group there were 21 patients who had the reverse total shoulder procedure and experienced an acute dislocation. All 21 were initially treated in the office by reduction (popping the joint back in place) and immobilizing the arm for six weeks in a 30 degrees of external rotation position.

Thirteen of the patients experienced the dislocation within the first ninty days after rTSA surgery. The average length of time to the first dislocation was 200 days. 

Of these 21 patients, 13 were successfully treated by reduction and immobilization, 6 required revision surgery and 2 remained unstable.

It was concluded that cause for dislocation fell into three general categories: soft tissue impingement or asymmetric soft tissue tension, undersizing the implant that resulted in excessive laxity in the shoulder, or acromial fracture that caused a secondary laxity. Men seemed to experience excessive laxity of the shoulder more often and women patients more often had impingement or soft tissue tension problems that led to dislocation.

Nearly half the patients experienced the dislocation while doing nothing to knowingly contribute to the complication. About a third were engaged in a physical activity like carrying a heavy weight or moving in an extreme manner when the dislocation occurred.

The researching doctors concluded that dislocation can occur at any time post operatively. They felt conservative attempts to repair the joint were quite successful whether the dislocation occurred early or late. The consensus was that anesthesia and surgical revision should be reserved for cases wherein dislocation occurred repeatedly or could not be properly repositioned in the office. But it was certainly worth a try to reposition the shoulder without resorting to surgery.

I am happy to be 201 days post op which puts me one day greater that the average to dislocate. I don't see me having a laxity problem. My complaint to my surgeon is always about how tight and sore the muscles are. Laxity means a slackness or loosenes on the joint. I read in the operative notes about all the trouble the surgeon had fitting the almost too large stem in my arm so I don't think my implant is too small. But carrying a heavy weight? That could be a problem. Dillards was having a BIG post Christmas sale today. Getting my packages to the car was all I could do! I'm not going to say the bargains were so good that it was worth a possible dislocation but it was a really good sale...just sayin'.  

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. -still in recovery, December-6 months and holding.