Reverse shoulder replacement has gained popularity partly because it can be a solution for severe injury or deterioration of patients’ shoulder joints. But shoulder implants have suffered higher complication rates than other joint implants.
Reverse total shoulder replacement or arthroplasty (rTSA) gets its name from the way it “reverses the anatomy” of the human shoulder. A natural shoulder joint has a “ball” at the top of the upper arm bone and a “socket” in the shoulder. Reverse shoulder implants place an artificial ball on the shoulder and an artificial socket on the upper arm.
Reverse shoulder replacement remains a relatively new procedure and reports of complications have decreased as surgical techniques and implant designs have improved. But complication rates have been higher than for other joint implants over the history of the devices.
The most common complications of reverse shoulder implants include nerve damage, infection and dislocation.
The overall complication rate of rTSA may be as much as four times that of conventional shoulder replacement surgery. One study found that nearly 4 in 10 reverse shoulder implant patients younger than 65 experienced complications.
Age can also play a difference in a patient’s chances of suffering a complication. Researchers in a 2013 study of nearly 3,000 reverse shoulder replacement patients found those younger than 60 required revision surgeries at twice the rate as patients 60 or older.
In January 2018, a small study suggested reverse shoulder implants could reduce pain and increase range of motion. But researchers also found high complication rates associated with the devices. The study looked at 22 patients over 19 years. Thirteen of the patients reported one or more complications. Complications included infection, loosening and dislocation. Researchers published their findings in the Journal of Shoulder and Elbow Surgery.
Despite potential side effects, a surgeon may still recommend reverse shoulder replacement if it may improve a patient’s quality of life. Patients should be aware of the potential complications from this surgery.
Did You Know
2 out of 3 reverse shoulder dislocations happen within 3 months of receiving the implant.
A 2017 study of nearly 1,500 reverse shoulder replacements found 2 of every 3 dislocations happened in the first three months after surgery. Dislocations were also more frequent among people who had surgery to repair or replace an earlier implant.
A reverse shoulder implant can dislocate if a patient lifts something or puts other tension on the muscles. Dislocation can also happen if the parts of the implant are the wrong size from one another.
Doctors may be able to relocate the ball into the socket of the implant, and put the patient’s arm in a sling for a few weeks. If this does not work, or if it can’t be done, the patient may require surgery to relocate the implant.
Infection is a risk of any surgery and especially of implant surgeries. Some estimates suggest 1 in 10 people who receive a reverse shoulder implant may have to deal with infection. In most cases, it can be treated with antibiotics. If the drugs do not work, the patient will have to undergo another surgery to stop the infection.
Surgery may involve simply cleaning the device and removing any infected tissue the doctor finds. If it is a severe case of infection, the surgeon may have to remove parts of the implant and replace them.
A patient’s bone health can play a part in fractures or the implant coming loose. Fractures can occur even as a surgeon places a reverse shoulder implant into a patient for the first time. Patients receiving this reverse shoulder replacements may already have weak bones that are more prone to breaking.
If the patient’s bone fails to grow around the implant’s baseplate, it may remain loose and require further surgery to correct.
Reverse shoulder implants can cause a loss of feeling or control in the arm and hand.
The implant can affect a bundle of nerves called the brachial plexus. These nerves run down the neck, through the shoulder and continue down to the hand.
Reverse shoulder implants can put pressure on this nerve bundle or push it aside from its normal location. If this happens, a patient can lose feeling or even lose partial function of the arm and hand. Scar tissue from a shoulder replacement surgery can also cause similar nerve complications.
Researchers at Boston University Medical Center have found that the type of insurance coverage people have – or don’t have – is associated with the risk of complications in shoulder replacement surgery.
The researchers analyzed medical records for more than 100,000 patients who had shoulder replacements – both conventional and reverse shoulder replacement implants. Their 2017 study found that people with Medicare or Medicaid coverage and those with no insurance suffered “a significantly higher rate of medical, surgical, and overall complications” compared to patients with private insurance.
|Type of Insurance||How Many People Suffered Complications|
|Medicare||2 in 10 patients had complications|
|Medicaid or No Insurance||Almost 2 in 10 patients had complications|
|Private Insurance||1 in 10 patients had complications|
Those with Medicare, Medicaid or no insurance at all were twice as likely to suffer complications as those who had private insurance.
The researchers said the higher rates may be associated with income or education levels of the patients. They also found that people with private insurance tended to have shoulder replacement surgery in high volume hospitals where doctors would have done more surgeries and be more familiar with them. Patients on Medicaid and or who were uninsured tended to have their surgeries at hospitals and by surgeons that had performed fewer shoulder replacements.
Please seek the advice of a medical professional before making health care decisions.
Terry Turner is an Emmy-winning, former television journalist. He is an associate member of the American Bar Association, the ABA’s Health Law group and a member of the Alliance of Professional Health Advocates. He holds six certificates in Health Literacy for Healthcare Professionals from the Centers for Disease Control and Prevention. As a Washington-based investigative reporter, he routinely reported on health and medical policy issues before Congress, the FDA and other federal agencies. Terry received his B.A. in Media Arts from Lyon College.