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Neurologic complications after total shoulder arthroplasty
N M Lynch1, R H Cofield, P L Silbert
1Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Journal of Shoulder and Elbow Surgery
|January 1, 1996
Summary
Post-surgery neurologic deficits after total shoulder arthroplasty are uncommon but can occur. While the long deltopectoral approach and methotrexate use were linked to complications, most patients experienced good neurologic recovery without affecting the arthroplasty outcome.
Area of Science:
- Orthopedic Surgery
- Neurology
- Rheumatology
Background:
- Total shoulder arthroplasty (TSA) is a common procedure for severe shoulder joint damage.
- Neurologic complications following TSA are a concern, potentially impacting patient recovery and function.
Purpose of the Study:
- To investigate the incidence, characteristics, and risk factors of neurologic deficits after TSA.
- To evaluate the recovery and long-term impact of these neurologic complications on TSA outcomes.
Main Methods:
- Retrospective review of 417 TSAs performed between 1975 and 1989.
- Analysis of 18 cases with postoperative neurologic deficits, focusing on diagnosis, affected nerves, and recovery.
- Statistical analysis to identify risk factors, including surgical approach, medication use, and operative time.
Main Results:
- Seventeen patients (18 shoulders) developed neurologic deficits, most commonly brachial plexus injuries.
- The long deltopectoral approach (p = 0.003) and methotrexate use (p < 0.0001) were significant risk factors.
- Shorter operative times correlated with more neurologic complications (p = 0.02).
- Good or fair neurologic recovery was observed in 16 shoulders at 1 year.
- Neurologic injury did not negatively impact the long-term outcome of the arthroplasty itself.
Conclusions:
- Neurologic complications after TSA, though infrequent, are associated with specific surgical approaches and medications.
- Traction during surgery is the presumed cause of most brachial plexus injuries.
- Prognosis for neurologic recovery is generally good, and these complications do not compromise the overall success of the total shoulder arthroplasty.