Skip to main content
SpringerLink
Log in

Diagnosis, Management, and Prevention of the Unstable Shoulder Arthroplasty

  • Chapter
  • First Online:
Complex and Revision Shoulder Arthroplasty

  • 567 Accesses

Abstract

Instability after anatomic and reverse shoulder arthroplasty is one of the most common and challenging complications to manage. Understanding the risk factors for instability, its etiology, and management options is key to treating instability after arthroplasty. In this chapter we will discuss how to accurately diagnose and manage instability after anatomic and reverse total shoulder arthroplasty. Intraoperative assessments and techniques to prevent instability from occurring will also be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wirth M, Rockwood C. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg. 1996;78-A(4):603–16.

    Article  Google Scholar 

  2. Cofield RH, Edgerton BC. Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect. 1990;39:449–62.

    CAS  Google Scholar 

  3. Bohsali I, Wirth A, Rockwood C. Complications of total shoulder arthroplasty. J Bone Joint Surg. 2006;88:2279–92.

    PubMed  Google Scholar 

  4. Bohsali K, Bois A, Wirth M. Complications of shoulder arthroplasty. J Bone Joint Surg. 2017;99:256–69.

    Article  Google Scholar 

  5. Kohan EM, Chalmers PN, Salazar D, Keener JD, Yamaguchi K, Chamberlain AM. Dislocation following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2017;26:1238–45.

    Article  Google Scholar 

  6. Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2011;20:146–57.

    Article  Google Scholar 

  7. Sanchez-Sotello J, Sperling J, Rowland C, Cofield R. Instability after shoulder arthoplasty: results of surgical treatment. J Bone Joint Surg. 2003;85A(4):622–31.

    Article  Google Scholar 

  8. Cofield RH, Chang W, Sperling JW. Complications of shoulder arthroplasty. In: Iannotti JP, Williams GR, editors. Disorders of the shoulder. Philadelphia: Lippincott; 1999.

    Google Scholar 

  9. Kany J, Jose J, Katz D, Werthel J, Sekaran P, Amaravathi R, Valenti P. The main cause of instability after unconstrained shoulder prosthesis is soft tissue deficiency. J Shoulder Elb Surg. 2017;26:e243–51.

    Article  Google Scholar 

  10. Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016;102:S33–43.

    Article  CAS  Google Scholar 

  11. Walch G, Wall B, Mottier F. Complications and revision of the reverse pros-thesis: a multicenter study of 457 cases. Reverse shoulder arthroplasty. Montpellier: Sauramps Médical; 2006. p. 35–52.

    Google Scholar 

  12. Moeckel B, Altchek D, Warren R, Wickiewicz T, Dines D. Instability of the shoulder after arthroplasty. J Bone Joint Surg. 1993;75-A(4):492–7.

    Article  Google Scholar 

  13. Warren R, Coleman S, Dines J. Instability after arthroplasty: the shoulder. J Arthroplast. 2002;17(4-1):28–31.

    Article  Google Scholar 

  14. Sofka CM, Adler RS. Original report. Sonographic evaluation of shoulder arthroplasty. AJR Am J Roentgenol. 2003;180:1117–20.

    Article  Google Scholar 

  15. Wiater BP, Moravek JE, Wiater JM. The evaluation of the failed shoulder arthroplasty. J Shoulder Elb Surg. 2014;23:745–58.

    Article  Google Scholar 

  16. Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elb Surg. 2005;14:492–6.

    Article  Google Scholar 

  17. Iannotti JP, Antoniou J, Williams GR, Ramsey ML. Iliotibial band reconstruction for treatment of glenohumeral instability associated with irreparable capsular deficiency. J Shoulder Elb Surg. 2002;11(6):618–23.

    Article  Google Scholar 

  18. Konrad G, Sudkamp N, Kreuz P, Jolly J, McMahon P, Debski R. Pectoralis major tendon transfers above or underneath the conjoint tendon in subscapularis-deficient shoulder. J Bone Joint Surg Am. 2007;89:2477–84.

    PubMed  Google Scholar 

  19. Ahrens P, Boileau P, Walch G. Anterior and posterior instability after unconstrained shoulder arthroplasty. In: Walch G, Boileau P, Molé D, editors. 2000 shoulder prostheses: two to ten year follow-up. Montpellier: Sauramps Medical; 2001. p. 359–93.

    Google Scholar 

  20. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJP. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work? J Bone Joint Surg Br. 2008;90(8):1059–65.

    Article  CAS  Google Scholar 

  21. Kim H, Chacon A, Andrews S, Roush E, Cho E, Conaway W, Kunselman A, Lewis G. Biomechanical benefits of anterior offsetting humeral head component in posteriorly unstable total shoulder arthroplasty. J Orthop Res. 2016;34:666–74.

    Article  Google Scholar 

  22. Alentorn-Geli E, Assenmacher AT, Sperling JW, Cofield RH, Sanchez-Sotelo J. Plication of the posterior capsule for intraoperative posterior instability during anatomic total shoulder arthroplasty. J Shoulder Elb Surg. 2017;26:982–9.

    Article  Google Scholar 

  23. Gee A, Angeline M, Dines J, Dines D. Shoulder instability after total shoulder arthroplasty: a case of arthroscopic repair. Hosp Spec Surg J. 2014;10:88–91.

    Google Scholar 

  24. Galvin J, Eichinger J, Boykin R, Szollosy G, Lafosse L. Posterior shoulder instability following anatomic total shoulder arthroplasty: a case report and review of management. Int J Should Surg. 2015;9(4):131–4.

    Article  Google Scholar 

  25. Keener JD. Subscapularis management in total shoulder arthroplasty. World Clin Orthoped. 2014;1(1):1–15.

    Google Scholar 

  26. Williams G, Yamaguchi K, Ramsey M, Galatz L. Complication of shoulder arthroplasty. Shoulder and elbow arthroplasty, vol. 16. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 235–42.

    Google Scholar 

  27. Lo E, Moen T, Burkhead W. Instability failure in total shoulder arthroplasty. Semin Arthroplast. 2013;24:28–32.

    Article  Google Scholar 

  28. Young A, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. The J Bone Joint Surg Am. 2012;94:685–93.

    Article  Google Scholar 

  29. Haines F, Trail IA, Nuttall D, Birch A, Barrow A. The results of arthroplasty in osteoarthritis of the shoulder. J Bone Joint Surg Br. 2006;88:496–501.

    Article  CAS  Google Scholar 

  30. Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K. Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elb Surg. 2003;12(1):1–5.

    Article  Google Scholar 

  31. Walker M, Willis MP, Brooks JP, Pupello D, Mulieri P, Frankle MA. The use of reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elb Surg. 2012;21(4):514–22.

    Article  Google Scholar 

  32. Hernandez NM, Chalmers BP, Wagner ER, Sperling JW, Cofield RH, Sanchez-Sotelo J. Revision to reverse total shoulder arthroplasty restores stability for patients with unstable shoulder prostheses. Clin Orthop Relat Res. 2017;475(11):2716–22.

    Article  Google Scholar 

  33. Abdel MP, Hattrup SJ, Sperling JW, Cofield RH, Kreofsky CR, Sanchez-Sotelo J. Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis. J Bone Joint Surg Am. 2013;95-B:668–72.

    Article  CAS  Google Scholar 

  34. Torrens C, Corrales M, Melendo E, Solano A, Rodríguez-Baeza A, Cáceres E. The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture. J Shoulder Elb Surg. 2008;17:947–50.

    Article  Google Scholar 

  35. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74:491–500.

    Article  CAS  Google Scholar 

  36. Gallo R, Gamradt S, Mattern C, et al.; Sports Medicine and Shoulder Service at the Hospital for Special Surgery, New York, NY. Instability after reverse total shoulder replacement. J Shoulder Elb Surg. 2011;20(4):584–90.

    Google Scholar 

  37. Chalmers P, Rahman Z, Romeo A, Nicholson G. Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(5):737–44.

    Article  Google Scholar 

  38. Padegimas E, Zmistowski B, Restrepo C, Abboud J, Lazarus M, Ramsey M, Williams G, Namdari S. Instability after reverse total shoulder arthoplasty: which patients dislocate? Am J Orthop. 2016;45(7):E444–50.

    PubMed  Google Scholar 

  39. Teusink M, Pappou I, Schwartz D, Cottrell B, Frankle M. Results of closed management of acute dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(4):621–7.

    Article  Google Scholar 

  40. Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res. 2011;469(9):2469–75.

    Article  Google Scholar 

  41. Kowalsky MS, Galatz LM, Shia DS, Steger-May K, Keener JD. The relationship between scapular notching and reverse shoulder arthroplasty prosthesis design. J Shoulder Elb Surg. 2012;21:1430–41.

    Article  Google Scholar 

  42. Huri G, Familiari F, Salari N, Petersen S, Doral M, McFarland E. Prosthetic design of reverse shoulder arthroplasty contributes to scapular notching and instability. World J Orthop. 2016;7(11):738–45.

    Article  Google Scholar 

  43. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O’Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2009;18(6):892–6. Epub 2009 Mar 17.

    Article  Google Scholar 

  44. Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hart ND, Hawkins RJ. Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elb Surg. 2012;21(1):36–41. Epub 2011 July 31.

    Article  Google Scholar 

  45. Thangarajah T, Higgs D, Bayley J, Lambert S. Constrained fixed-fulcrum reverse shoulder arthroplasty improves functional outcome in epileptic patients with recurrent shoulder instability. World J Orthop. 2016;7(7):434–41.

    Article  Google Scholar 

  46. Chalmers PN, Salazar D, Chamberlain A, Keener JD. Radiographic characterization of the B2 glenoid: the effect of computed tomographic axis orientation. J Shoulder Elb Surg. 2017;26(2):258–64.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    Alexander Martusiewicz MD & Aaron Chamberlain MD, MSc

Authors
  1. Alexander Martusiewicz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron Chamberlain MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron Chamberlain MD, MSc .

Editor information

Editors and Affiliations

  1. Department of Orthopedics, University of Utah, Salt Lake City, UT, USA

    Robert Z. Tashjian

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martusiewicz, A., Chamberlain, A. (2019). Diagnosis, Management, and Prevention of the Unstable Shoulder Arthroplasty. In: Tashjian, R. (eds) Complex and Revision Shoulder Arthroplasty . Springer, Cham. https://doi.org/10.1007/978-3-030-02756-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-02756-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-02755-1

  • Online ISBN: 978-3-030-02756-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation