Complications after reverse total shoulder arthroplasty in the Korean population: a single center study of 299 cases

Knowledge regarding differences in the order of frequency of complications after reverse total shoulder arthroplasty (rTSA) between Asian and Western populations is limited. We therefore asked for (1) what is the order of frequency of complications after primary rTSA in the Korean population? (2) What are the rates of complication, reoperation, and revision, and clinical outcomes after index surgery?

We retrospectively reviewed the 299 consecutive cases who underwent primary rTSA with more than 1 year of follow-up over a period of 12 years. The mean age of the patients was 73.4 years (range, 58-88 years) and the mean follow-up period was 3.8 years (range, 1-11.5 years). Evaluation of the clinical outcomes, complications, and reinterventions was performed at the final follow-up.

The mean visual analog scale pain score, University of California at Los Angeles score, American Shoulder and Elbow Surgeons score, and subjective shoulder value improved from 6.7, 10.2, 30.7, and 27.7% before rTSA to 1.4, 26.4, 80.5, 77.2% after rTSA, respectively (P < .001). Overall, 45 complications (15.1%) were observed in 44 patients. The order of frequency of complications was as follows: 16 cases of scapular stress fracture (5.4%), 9 intraoperative or postoperative periprosthetic fracture (3.0%), 6 brachial plexus injury (2.0%), 4 instability (1.3%), 2 glenoid loosening (0.7%), 2 glenoid disassembly (0.7%), 2 periprosthetic joint infection (0.7%), 1 glenoid fixation failure (0.3%), 1 humeral stem fixation failure (0.3%), 1 hematoma (0.3%), and 1 complex regional pain syndrome (0.3%). Reintervention was performed in 15 cases (5.0%) including reoperation (8 cases; 2.7%) and revision surgery (7 cases; 2.3%).

At a mean follow-up period of 3.8 years, primary rTSA showed satisfactory clinical outcomes with a complication rate of 15.1%, a reoperation rate of 2.7%, and a revision rate of 2.3%. Scapular stress fracture appears to be the most common complication after rTSA in the Korean population.