Lynch and colleagues examined how often neurologic complications follow total shoulder arthroplasty, which factors are associated with them, and how well they recover.
368 patients with 417 total shoulder arthroplasties performed 1975 to 1989. All but two affected patients were followed at least 2 years.
Methods
Patients
368 patients
417 total shoulder arthroplasties
Operated 1975 to 1989
Exposure
Approach: deltopectoral with the deltoid preserved (276), anterior deltoid detached (136) or posterior (5)
Methotrexate use at the time of surgery
Operative time
Follow-up
At least 2 years for all but 2 patients with a deficit
Outcomes
Lesion localization within the brachial plexus
Severity on the Weber, Daube, and Coventry nerve palsy scale
Neurologic recovery grade at 1 year
Arthroplasty clinical outcome at a minimum of 2 years
Key Findings
A neurologic deficit followed 18 of 417 arthroplasties (4%) in 17 patients, and 13 of the 18 shoulders had a brachial plexus lesion.
Of 16 shoulders assessed at 1 year, neurologic recovery was good in 11 and fair in 5, and none was poor.
Methotrexate at the time of surgery was associated with a deficit (p < 0.0001), though the authors called the link only possible given the small numbers.
Every deficit followed the long deltopectoral approach with the deltoid left attached (p = 0.003), and the association held (p = 0.01) after excluding 5 deficits unlikely to be mechanical.
Shorter operations were associated with deficits (mean 146 vs 170 minutes, p = 0.02), but the authors judged this of little clinical significance.
Despite the nerve injury, the arthroplasty result at 2 years or more was excellent or satisfactory in all but one case.
Board pearl
Most deficits were brachial plexus lesions, chiefly of the upper and middle trunks, and the authors presumed intraoperative traction on the plexus as the usual mechanism.
Authors' conclusion
In this series neurologic injury after total shoulder arthroplasty did not interfere with the long-term outcome of the arthroplasty itself.
Lynch and colleagues examined how often neurologic complications follow total shoulder arthroplasty, which factors are associated with them, and how well they recover.
368 patients with 417 total shoulder arthroplasties performed 1975 to 1989. All but two affected patients were followed at least 2 years.
Methods
Patients
368 patients
417 total shoulder arthroplasties
Operated 1975 to 1989
Exposure
Approach: deltopectoral with the deltoid preserved (276), anterior deltoid detached (136) or posterior (5)
Methotrexate use at the time of surgery
Operative time
Follow-up
At least 2 years for all but 2 patients with a deficit
Outcomes
Lesion localization within the brachial plexus
Severity on the Weber, Daube, and Coventry nerve palsy scale
Neurologic recovery grade at 1 year
Arthroplasty clinical outcome at a minimum of 2 years
Key Findings
A neurologic deficit followed 18 of 417 arthroplasties (4%) in 17 patients, and 13 of the 18 shoulders had a brachial plexus lesion.
Of 16 shoulders assessed at 1 year, neurologic recovery was good in 11 and fair in 5, and none was poor.
Methotrexate at the time of surgery was associated with a deficit (p < 0.0001), though the authors called the link only possible given the small numbers.
Every deficit followed the long deltopectoral approach with the deltoid left attached (p = 0.003), and the association held (p = 0.01) after excluding 5 deficits unlikely to be mechanical.
Shorter operations were associated with deficits (mean 146 vs 170 minutes, p = 0.02), but the authors judged this of little clinical significance.
Despite the nerve injury, the arthroplasty result at 2 years or more was excellent or satisfactory in all but one case.
Board pearl
Most deficits were brachial plexus lesions, chiefly of the upper and middle trunks, and the authors presumed intraoperative traction on the plexus as the usual mechanism.
Authors' conclusion
In this series neurologic injury after total shoulder arthroplasty did not interfere with the long-term outcome of the arthroplasty itself.