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Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty

INTRODUCTION: Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurolo...

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Autores principales: Hruby, Laura A., Unterfrauner, I., Casari, F., Kriechling, P., Bouaicha, S., Wieser, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293408/
https://www.ncbi.nlm.nih.gov/pubmed/36245038
http://dx.doi.org/10.1007/s00402-022-04641-9
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author Hruby, Laura A.
Unterfrauner, I.
Casari, F.
Kriechling, P.
Bouaicha, S.
Wieser, K.
author_facet Hruby, Laura A.
Unterfrauner, I.
Casari, F.
Kriechling, P.
Bouaicha, S.
Wieser, K.
author_sort Hruby, Laura A.
collection PubMed
description INTRODUCTION: Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors. MATERIALS AND METHODS: A retrospective review of our institution’s internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (n = 34) and the remaining cohort without nerve injuries (n = 1275) were performed to identify patient- and surgery-related risk factors. RESULTS: Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (p = 0.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (p = 0.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72 years, p = 0.017). CONCLUSIONS: In specialists’ hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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spelling pubmed-102934082023-06-28 Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty Hruby, Laura A. Unterfrauner, I. Casari, F. Kriechling, P. Bouaicha, S. Wieser, K. Arch Orthop Trauma Surg Orthopaedic Surgery INTRODUCTION: Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors. MATERIALS AND METHODS: A retrospective review of our institution’s internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (n = 34) and the remaining cohort without nerve injuries (n = 1275) were performed to identify patient- and surgery-related risk factors. RESULTS: Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (p = 0.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (p = 0.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72 years, p = 0.017). CONCLUSIONS: In specialists’ hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury. LEVEL OF EVIDENCE: Level III, retrospective cohort study. Springer Berlin Heidelberg 2022-10-17 2023 /pmc/articles/PMC10293408/ /pubmed/36245038 http://dx.doi.org/10.1007/s00402-022-04641-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Orthopaedic Surgery
Hruby, Laura A.
Unterfrauner, I.
Casari, F.
Kriechling, P.
Bouaicha, S.
Wieser, K.
Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title_full Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title_fullStr Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title_full_unstemmed Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title_short Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
title_sort iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty
topic Orthopaedic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293408/
https://www.ncbi.nlm.nih.gov/pubmed/36245038
http://dx.doi.org/10.1007/s00402-022-04641-9
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