Periprosthetic Fractures in Reverse Total Shoulder Arthroplasty: Current Concepts and Advances in Management

Abstract

Purpose of Review

Expanded indications for reverse total shoulder arthroplasty (RSA) have raised awareness of associated complications, including periprosthetic fractures. The purpose of this article was to provide a comprehensive update on how, when, and why RSA-related periprosthetic fractures occur, as well as to describe the current treatment strategies.

Recent Findings

Periprosthetic acromial and scapular spine fractures occur in up to 4.3% of cases and periprosthetic humeral fractures occur in approximately 3.5% of RSA procedures. Fractures of the coracoid process and clavicle have also been reported. Current literature has identified several risk factors for intraoperative or postoperative fracture, including underlying osteoporosis, revision arthroplasty, use of a superiorly placed screw during metaglene fixation, and disruption of the scapular ring by transection of the coracoacromial ligament.

Summary

Periprosthetic fracture associated with RSA is a clinically significant event that warrants prolonged postoperative vigilance, timely diagnosis, and shared patient decision-making regarding treatment. Further research is needed to identify optimal treatment strategies and characterize long-term clinical outcomes following RSA-related periprosthetic fracture.

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Correspondence to Samuel A. Taylor.

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Christopher Brusalis declares that he has no conflict of interest. Samuel Taylor declares that he has the following potential conflict of interest: paid consultant for DJO Global.

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Brusalis, C.M., Taylor, S.A. Periprosthetic Fractures in Reverse Total Shoulder Arthroplasty: Current Concepts and Advances in Management. Curr Rev Musculoskelet Med 13, 509–519 (2020). https://doi.org/10.1007/s12178-020-09654-8

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Keywords

  • Reverse shoulder arthroplasty
  • Humeral fracture
  • Scapular fracture
  • Acromion
  • Clavicle
  • Coracoid process