Reverse Shoulder Replacement Risks and Complications

The vast majority of shoulder replacement surgeries are successful. In fact, experts estimate that 91% of shoulder replacements last at least 10 years. However, complications can occur even when surgeries are done properly and go smoothly.

Below is a list of potential complications. In rare instances, some complications are life threatening. A small percentage of patients will require a second, or revision, surgery.

Blood Clots Involving Anesthesia

Any surgery that uses general anesthesia poses a low risk of strokes, heart attacks, pneumonia, and blood clots.

See Anesthesia for Orthopedic Surgery

Blood clots that occur in deep veins, called deep vein thrombosis (DVT), are of particular concern following joint replacement surgeries, but this complication is more common in lower extremity replacements, such as hip and knee replacements.

DVT can result in a life-threatening condition known as pulmonary embolism. When caught in time, pulmonary embolism is treatable with anti-clotting medication.

Shoulder surgery patients’ overall risk of post-surgical blood clots is low. Researchers estimate approximately .5% to 1% of all shoulder replacement patients experience either a blood clot or pulmonary embolism,¹Dattani R, Smith CD, Patel VR. The venous thromboembolic complications of shoulder and elbow surgery: a systematic review. Bone Joint J. 2013 Jan;95-B(1):70-4. doi: 10.1302/0301-620X.95B1.29854. Review. PubMed PMID: 23307676. and that the rate does not differ depending on whether a reverse or traditional replacement was performed.⁸Cofield RF, Chang W, Sperling JW, Complications of shoulder arhtroplasty in Disorders of the shoulder: diagnosis and management, J Iannottie and GR Williams, Editors. 1999, Lippincott, Williams & Wilkins: Philidelphia. 571-593.

Infection

Patients are required to take antibiotics at the time of surgery to reduce the risk of infection. Despite this and other precautions, wound infections affect a small percentage of reverse shoulder replacement patients. Most of these patients can be treated with additional antibiotics.

In rare cases, an infection may result in the removal of the artificial shoulder joint and can even be life threatening. After the infection resolves, it may be possible to surgically implant a new prosthetic.

See Total Shoulder Replacement Risks and Complications

Other Complications

Aside from risks associated with anesthesia and infection, there are potential complications specific to reverse shoulder replacement surgery:

Joint dislocation or partial dislocation (subluxation). The new ball and socket may dislocate from each other. This risk will decrease as the deltoid and the shoulder muscles are strengthened through physical therapy. However, the risk will never completely go away, which is why doctors recommend restricting activities that stress the shoulder joint, such as racquet sports.

Read more about Shoulder Dislocation Injury (Dislocated Shoulder) on Sports-health.com

Prosthetic misalignment, prosthetic loosening, or joint instability. Reverse shoulder replacement is a complicated surgery involving the patient’s natural bone, prosthetics, and soft tissue. If a prosthetic is not sufficiently secured into the natural bone, or if it is not well aligned with other parts of the shoulder, problems can occur.

Bone fracture. The patient’s natural bone tissue can break during or after surgery. The risk of fracture can be affected by the patient’s anatomy and bone density as well as the surgical placement of the prosthetics. Fractures that occur after shoulder replacement surgery may necessitate a second surgery.

Blood vessel or nerve injury. The surrounding nerves and blood vessels can be injured during surgery, though this risk is low. Little data exists that is specific to reverse shoulder replacements, but analysis of traditional shoulder replacements estimate that anywhere between 0.6 and 4.3% of shoulder replacement patients experience some nerve injury following surgery, though 80 to 85% of those cases resolve on their own.³Lynch, NM, et al, Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg, 1996. (5(1): 53-61.^,4Wirth MA, Rockwood CA Jr. Complications of shoulder arthroplasty. Clin Orthop Relat Res. 1994 Oct;(307):47-69. Review. PubMed PMID: 7924048.^,5Wirth MA, Rockwood CA Jr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996 Apr;78(4):603-16. Review. PubMed PMID: 8609143.^,6Boardman ND 3rd, Cofield RH. Neurologic complications of shoulder surgery. Clin Orthop Relat Res. 1999 Nov;(368):44-53. Review. PubMed PMID: 10613152.^,7Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg. 2006 Jan-Feb;15(1):19-22. PubMed PMID: 16414464.^,8Cofield RF, Chang W, Sperling JW, Complications of shoulder arhtroplasty in Disorders of the shoulder: diagnosis and management, J Iannottie and GR Williams, Editors. 1999, Lippincott, Williams & Wilkins: Philidelphia. 571-593.

Most complications are successfully treated. A surgery followed by complications may still be considered successful if pain is alleviated and function improves over the long term.

A patient can reduce the risk of complications by working with an experienced surgeon. Some studies have shown that complication rates are lower for surgeons and hospitals that do a lot of shoulder replacements.⁹Deshmukh AV, Koris M, Zurakowski D, Thornhill TS. Total shoulder arthroplasty: long-term survivorship, functional outcome and quality of life. J Shoulder Elbow Surg. 2005;14(5):471-9.^,10Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone joint Surg Am. 2003;85-A:2318-24.^,11Jain N, Pietrobon R, Hocker S, et al. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004:86-A:496-505.

Revision Surgery for Shoulder Replacement

If the artificial shoulder joint wears out or otherwise fails, a surgeon may recommend a revision surgery. During revision surgery, the surgeon will remove and replace the joint prostheses.

See Preparing for Shoulder Replacement Surgeries

Revision surgeries are often elective, meaning the patient can take time to decide whether to undergo another surgery. Rare but notable exceptions are infection and dislocations.

Shoulder revision surgeries are more complex than initial replacement surgeries, and carry a higher rate of risks and side effects.