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Clinical Orthopaedics and Related Research®

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01-09-2011 | Symposium: Reverse Total Shoulder Arthroplasty

A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties

Authors: Laurence B. Kempton, MD, Elizabeth Ankerson, BS, J. Michael Wiater, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2011

Abstract

Background

Reported early complication rates in reverse total shoulder arthroplasty have widely varied from 0% to 75% in part due to a lack of standard inclusion criteria. In addition, it is unclear whether revision arthroplasty is associated with a higher rate of complications than primary arthroplasty.

Questions/purpose

We therefore (1) determined the types and rates of early complications in reverse total shoulder arthroplasty using defined criteria, (2) characterized an early complication-based learning curve for reverse total shoulder arthroplasty, and (3) determined whether revision arthroplasties result in a higher incidence of complications.

Patients and Methods

From October 2004 to May 2008, an initial series of 200 reverse total shoulder arthroplasties was performed in 191 patients by a single surgeon. Forty of the 200 arthroplasties were revision arthroplasties. Of these, 192 shoulders were available for minimum 6-month followup (mean, 19.4 months; range, 6–49.2 months). We determined local and systemic complications and distinguished major from minor complications.

Results

Nineteen shoulders involved local complications (9.9%), including seven major and 12 minor complications. Nine involved perioperative systemic complications (4.7%), including eight major complications and one minor complication. The local complication rate was higher in the first 40 shoulders (23.1%) versus the last 160 shoulders (6.5%). Seven of 40 (17.5%) revision arthroplasties involved local complications, including two major and five minor complications compared to 12 of 152 (7.9%) primary arthroplasties, including five major and seven minor complications. Nerve palsies occurred less frequently in primary arthroplasties (0.6%) compared to revisions (9.8%).

Conclusions

The early complication-based learning curve for reverse total shoulder arthroplasty is approximately 40 cases. There was a trend toward more complications in revision versus primary reverse total shoulder arthroplasty and more neuropathies in revisions.

Level of Evidence

Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.

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Title: A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties
Authors: Laurence B. Kempton, MD
Elizabeth Ankerson, BS
J. Michael Wiater, MD
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 9/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1811-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties

Abstract

Background

Questions/purpose

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purpose

Patients and Methods

Results

Conclusions

Level of Evidence

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