Prevention and management of reverse shoulder arthroplasty complications: A structured current concepts review

Figure 1 Center of rotation of native shoulder and Reverse shoulder arthroplasty. A: Orientation of subscapularis muscle fibers in the native shoulder crossing the native center of rotation (COR) (orange circle); B: Altered orientation of muscle fibers through the new medialized and distalized COR (yellow circle) of reverse shoulder arthroplasty.

Figure 2 Illustration image for periprosthetic humeral fracture as per the Wright and Cofield classification. A: Located at the tip of the prosthesis and extends proximally; B: Mimics A without proximal extension; C: Distal to the prosthetic tip.

Figure 3 Algorithm for recommended management of intraoperative fractures. BIO: Bony increase offset.

Figure 4 Algorithm for recommended management of postoperative instability. At-risk position: Adduction, extension, and internal rotation. RSA: Reverse shoulder arthroplasty.

Figure 5 Illustration image for the Nyffeler and Sirveaux grading system of scapular notching based upon the defect size. Grade 1 shows a defect within the inferior pillar of the scapular neck; grade 2 with defined bone defect under the level of the inferior screw within baseplate; grade 3 with defect extending over the inferior screw; and grade 4 with bone defect reaching the level of central peg.

Figure 6 Illustration image for humeral stem loosening defined by Gilot et al[100]. Bone adjacent to humeral stem is divided into 8 zones. Zones 1, 2, and 3 represent the lateral aspect of the stem at the proximal, middle, and distal thirds respectively. Zone 4 is the area around the distal stem tip. Zones 5, 6, 7, and 8 represent the medial portion of the stem from the distal, middle, proximal thirds, and base, respectively.

Figure 7 Timeline-based recommended algorithm for prevention and management of reverse shoulder arthroplasty complications. CT: Computed tomography; PSI: Patient specific instrumentation; PJI: Prosthetic joint infection; DAIR: Debridement, antibiotics, and implant retention; ORIF: Open reduction and internal fixation.