This retrospective case series describes the presentation, management, and outcome of early atraumatic dislocation after reverse total shoulder arthroplasty. It reviews 385 RTSAs to characterize which patients dislocate and how they fare after treatment. It addresses a complication that authors note had not been clinically described before.
When you see an obese man with a deficient subscapularis and prior shoulder surgery going into RTSA, flag him as high-risk for early instability and consider an abduction orthosis postoperatively.
The key teaching point is that most of these dislocations are silent. Patients present with a vague sense that the shoulder feels different after a mundane daily activity, not with acute trauma. Order radiographs during the first month even in patients doing clinically well.
Mechanistically, the paper reinforces that soft tissue tension outranks glenosphere size and polyethylene depth as the driver of RTSA stability. This is why a thicker polyethylene insert, not a bigger ball, is the usual surgical answer.
As a Level IV case series with no control group, it cannot prove risk factors, only describe the profile of patients who dislocate. Reassuringly, 82% retained the reverse prosthesis and still improved in pain and function.
This retrospective case series describes the presentation, management, and outcome of early atraumatic dislocation after reverse total shoulder arthroplasty. It reviews 385 RTSAs to characterize which patients dislocate and how they fare after treatment. It addresses a complication that authors note had not been clinically described before.
When you see an obese man with a deficient subscapularis and prior shoulder surgery going into RTSA, flag him as high-risk for early instability and consider an abduction orthosis postoperatively.
The key teaching point is that most of these dislocations are silent. Patients present with a vague sense that the shoulder feels different after a mundane daily activity, not with acute trauma. Order radiographs during the first month even in patients doing clinically well.
Mechanistically, the paper reinforces that soft tissue tension outranks glenosphere size and polyethylene depth as the driver of RTSA stability. This is why a thicker polyethylene insert, not a bigger ball, is the usual surgical answer.
As a Level IV case series with no control group, it cannot prove risk factors, only describe the profile of patients who dislocate. Reassuringly, 82% retained the reverse prosthesis and still improved in pain and function.