Early atraumatic recurrent dislocation after reverse total shoulder arthroplasty despite optimal implant positioning:...

Postoperative instability following reverse total shoulder arthroplasty (RTSA) is one of the most common complications and remains a significant clinical challenge. Although implant positioning, design, and surgical technique are known to influence stability, there is no universally accepted management strategy when dislocation recurs. This study reports two rare cases of early, atraumatic recurrent dislocation after RTSA, highlighting the complexity of this complication.

Between 2014 and 2023, 182 reverse total shoulder arthroplasties (RTSAs) were performed at our institution by a single surgeon using a consistent technique. We retrospectively identified two patients who developed recurrent dislocation. One patient underwent RTSA for an acute proximal humerus fracture, and the other for fracture malunion. Dislocation occurred at 2 and 3 weeks postoperatively, respectively, without any traumatic event. Both cases required operative reduction, as closed reduction in the emergency setting was unsuccessful. Despite upsizing to a thicker polyethylene liner, instability persisted. Ultimately, open reduction followed by immobilization in an abduction brace for six weeks was performed. During follow-up, no further dislocations occurred, and both patients retained their prosthesis with acceptable functional outcomes.

Early recurrent dislocation can occur despite correct implant orientation and satisfactory intraoperative stability testing. In such cases, open reduction followed by prolonged immobilization may offer a viable option to avoid revision or resection arthroplasty.