Neurologic complications after total shoulder arthroplasty

Three hundred sixty-eight patients underwent 417 total shoulder arthroplasties between 1975 and 1989. Seventeen patients with 18 operated shoulders had a neurologic deficit after surgery. Osteoarthritis and rheumatoid arthritis were the most common diagnoses. Twelve patients (13 shoulders) had neurologic deficits localized to the brachial plexus; the upper and middle trunks were most commonly affected. Three patients had idiopathic brachial plexopathy. One patient had an exacerbation of preexisting dysesthesias in the lower trunk/medial cord distribution. Another patient had a median neuropathy at the wrist. Four patients had lesions that interfered significantly with shoulder rehabilitation and general activity; six had lesions that temporarily interfered with their scheduled rehabilitation program. All but two of these patients were monitored to a point of maximum improvement. Neurologic recovery at 1 year was graded as good in 11 shoulders and fair in five shoulders. The long deltopectoral approach leaving the deltoid attached to the clavicle and acromion was found to be significant in the development of a postoperative neurologic complication (p = 0.003). Use of methotrexate was also significant (p < 0.0001). A correlation was found between operative time and postarthroplasty neurologic complication (p = 0.02), with shorter operative times being associated with more neurologic complications. No other statistically significant risk factors were identified. In most cases the presumed mechanism of injury was traction on the plexus occurring during the operation. In most cases the prognosis for neurologic recovery was good. In this series neurologic injury after total shoulder arthroplasty did not interfere with the long-term outcome of the arthroplasty itself.