Clinique Chirurgicale St Michel Toulon, Avenue Orient, 83100, Toulon, France.
Int Orthop. 2013 May;37(5):843-51. doi: 10.1007/s00264-013-1832-6. Epub 2013 Mar 3.
Since its description by Paul Grammont from Dijon, France, several tens of thousands of reverse total shoulder arthroplasties (RTSA) have been performed for diverse conditions. The purpose of this analysis is to identify the complications of this procedure in the literature and in clinical practice. A total of 240 papers concerning RTSA published between 1996 and 2012 have been identified. Over 80 papers describe complications associated with this type of implant. A list of prostheses satisfying European and US standards, CE and FDA approved, has been produced on the basis of information provided by the manufacturers. Data from the literature do not support a meta-analysis. The inventory of best practices shows excellent results in the short and medium term in specific indications, while the number of complications varies between 10 and 65 % in long-term series. Complications can be classified into (A) non-specific including infections (superficial and deep), phlebitis, haematoma, neurological complications of the suprascapular, radial and axillary nerves and (B) specific complications associated with RTSA including (1) on the glenoid side: intraoperative fracture of the glenoid and acromion, late fracture of the scapula, impingement at the scapular neck (notching), glenoid loosening, dissociation of the glenoid component (snatching of the glenosphere) and fractures of the glenoid baseplate; (2) on the humeral side: metaphyseal deterioration, humeral loosening, instability of the shoulder, stiffness with limitation of external and/or internal rotation; and (3) muscular complications with fatty degeneration of the deltoid. Additionally we have identified specific situations related to the type of implant such as the disassembly of the humeral or the glenoid component, dissociation of the polyethylene humeral plate, dissociation of the metaphysis and osteolysis of the tuberosities. The integration of results from different clinical series is difficult because of the lack of a database and the multitude of implants used.
自法国第戎的 Paul Grammont 医生描述以来，已经有几万个反向全肩关节置换术（RTSA）用于各种不同的情况。本分析旨在识别文献和临床实践中该手术的并发症。共确定了 1996 年至 2012 年间发表的 240 篇关于 RTSA 的论文。超过 80 篇论文描述了与这种植入物相关的并发症。根据制造商提供的信息，列出了满足欧洲和美国标准、CE 和 FDA 批准的假体。文献中的数据不支持进行荟萃分析。最佳实践清单显示，在特定适应证的短期和中期具有出色的结果，而长期系列中并发症的数量在 10%至 65%之间变化。并发症可分为（A）非特异性，包括感染（浅表和深部）、静脉炎、血肿、肩胛上神经、桡神经和腋神经的神经并发症，和（B）与 RTSA 相关的特异性并发症，包括（1）在肩胛侧：肩胛骨关节盂和肩峰术中骨折、肩胛骨晚期骨折、肩胛颈撞击（切迹）、肩胛骨关节盂松动、肩胛骨关节盂组件分离（抢夺肩胛下窝）和肩胛骨关节盂基底部骨折；（2）在肱骨侧：干骺端恶化、肱骨松动、肩部不稳定、肩部僵硬伴外旋和/或内旋受限；和（3）肌肉并发症，三角肌脂肪变性。此外，我们还确定了与植入物类型相关的特定情况，例如肱骨或肩胛骨关节盂组件的拆卸、聚乙烯肱骨板的分离、干骺端的分离和结节的骨溶解。由于缺乏数据库和使用的植入物种类繁多，不同临床系列的结果整合起来很困难。
