Joint replacement surgery, in general, has improved the mobility and quality of life for countless numbers of people who suffer from the effects of advanced, or end-stage, arthritis. The most commonly replaced joints are the knee, hip and shoulder. Similar to knee and hip replacement procedures, shoulder replacement surgery can have its share of complications. Individuals who are contemplating shoulder replacement surgery would do well to become educated about the potential complications of such a procedure.
Infection
Infection can be a catastrophic complication in any surgical procedure, but particularly so when it involves joint replacements. Bacteria that normal inhabit the skin and are typically non-problematic can produce serious infection in a joint. Because joint replacement involves the use of artificial components, normal blood supply is altered after surgery, thereby limiting accessibility of antibiotics to the area. According to the Centers for Disease Control, surgical site infections account for approximately 25 percent of all hospital acquired infections.
Component Loosening
In a comprehensive, retrospective analysis of a multitude of orthopedic information regarding component loosening as a complication of shoulder replacement, authors Dr. Kamal Bohsali, Dr. Michael Wirth and Dr. Charles Rockwood reviewed articles that were published between 1996 and 2005 regarding various complications and rates. This analysis revealed an overall complication rate involving component loosening of 414 in 2,810 shoulder replacement procedures, or just over 14 percent.
Inadvertent/Periprosthetic Fracture of the Humerus
Periprosthetic---meaning around the prosthesis---fracture of the humerus, or upper arm bone, can occur during shoulder replacement surgery. According to the American Academy of Orthopaedic Surgeons, the most common cause of this fracture type is from retraction of the humerus to gain access to the glenoid, or socket. Fractures can also arise from trying to insert the humeral stem prosthesis too tightly into the humeral canal, causing a blow-out type fracture.
Nerve/Artery Injury
Two major nerves that exist near the surgical site of a shoulder replacement are the axillary and radial nerves. The axillary nerve runs under the humerus in the armpit area and the radial nerve winds around the humerus and crosses over the lateral, or outer, aspect of the upper arm as it travels down the extremity. These nerves, together with the main arteries that course down the arm, combine to make up a structure known as the brachial plexus. This blood vessel/nerve combination can be injured from excessive pull, or traction, on the arm during surgery, or from retraction using surgical instruments. Injury can also arise from the administration of localized anesthetic blocks in the neck, called scalene nerve blocks, which are typically used for postoperative pain control.
References
- "Journal of Bone and Joint Surgery"; Complications of Total Shoulder Arthroplasty; Kamal I. Bohsali, M.D., et al.; 2006
- CDC: Preventing Surgical Site Infections
- "Journal of the American Academy of Orthopaedic Surgeons"; Treatment of Periprosthetic Humerus Fractures; Scott P. Steinmann, M.D., and Emilie V. Cheung, M.D.; April 2008
- Seacoast Orthopedics: Total Shoulder Replacement for Arthritis
