Irreparable Massive Rotator Cuff Tear (AANA20)-Complications of Reverse Total Shoulder Arthroplasty-Dr. Mark A. Mighell

Video Transcription

Video Summary

Dr. Mark Mile discusses complications following reverse total shoulder arthroplasty, focusing on three common issues: periprosthetic fractures, infection, and instability. He highlights limitations in fracture classification systems, stressing implant stability as key to guiding treatment—stable implants warrant internal fixation, loose implants require revision arthroplasty. For infections, diagnosis is challenging due to subtle symptoms; he advocates thorough debridement, functional antibiotic spacers, and usually two-stage revision surgery. Cutibacterium acnes is a prevalent infecting organism. Instability arises from loss of compression, containment, or impingement, with factors like implant positioning, soft tissue balance, and nerve injury influencing outcomes. Surgical strategies to restore stability include using deeper liners, increasing lateralization/distalization, and managing impingement sources. In cases with deltoid dysfunction or scapular fractures, converting to hemiarthroplasty may be preferable. Overall, understanding implant status, infection biology, and biomechanical factors is essential for managing post-reverse shoulder arthroplasty complications successfully.

Asset Caption

Instructional Course Lecture: My Patient Has an Irreparable Massive Rotator Cuff Tear: When Should I Use a Soft Tissue Reconstruction, When Should I Use an Arthroplasty, and How do I Get it Right?

Keywords

reverse total shoulder arthroplasty

periprosthetic fractures

implant stability

infection management

Cutibacterium acnes

instability treatment