Complications: Infection, Subscapularis Insufficiency, Periprosthetic Fracture, and Instability

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Complications following shoulder arthroplasty result in substantial compromise of ultimate outcome. Proper management is critical to preserve bone and soft tissue in order to maximize pain relief and range of motion. The most prevalent complications include infection, instability, subscapularis failure, and periprosthetic fracture. Incidence of infection has been reported from 0.4 % to 4 %, Propionibacterium acnes being the most commonly reported pathogen. Unexplained or new onset of pain after shoulder arthroplasty should prompt suspicion of infection. The gold standard for diagnosis of infection is culture-positive open biopsy of multiple tissue samples; however P. acnes can be difficult to isolate. Two-stage revision arthroplasty is the preferred method for treating prosthetic joint infections of the shoulder. Periprosthetic humerus fractures are rare with an incidence of 0.6–3 % of all shoulder arthroplasties. Fracture treatment is dictated according to fracture location and stability of the implant. Nonoperative management is preferred for minimally displaced, stable fractures. Surgical treatment is recommended for patients with grossly unstable fractures, with loose stems, or with fractures that have failed nonsurgical treatment. Instability after shoulder arthroplasty occurs in approximately 5 % of all replacements. Depending on the type of dislocation, initial closed reduction can be an effective treatment. Surgical treatment for recurrent instability targets the specific cause. Subscapularis failure following total shoulder arthroplasty can lead to pain, weakness, and instability. Ideal treatment consists of early repair with or without supplementation with a pectoralis major transfer.