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EMG with upper trunk fibrillations
0%
4/866
Bone scan with increased uptake around the humeral component
10%
87/866
Positive empty can test
74%
643/866
Arthroscopic shoulder cultures positive for gram-positive anaerobic bacteria
9%
78/866
Axial CT with fracture of the acromion process
6%
48/866
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Rotator cuff tears are one of the most common complications following anatomic total shoulder arthroplasties. Rotator cuff tears are a common complication following anatomic total shoulder arthroplasty. These tears can occur during the procedure (iatrogenic), presence of component malposition, or degeneration of the tendons with overuse and aging. In the late postoperative period, patients may experience progressively worsening shoulder pain and weakness in a previously well-functioning prosthesis. In select scenarios, the rotator cuff tear can be repaired to restore normal cuff mechanics. However, in cases of nonrepairable tendons a conversion to a reverse shoulder prosthesis may be necessary to establish a well-functioning joint. Chin et al. analyzed complications in 431 total shoulder arthroplasties performed between 1990 and 2000, with an average follow-up of 4.2 years. They found that 53 surgical complications occurred in 53 patients (12%), with 32 being major complications (7.4%). They concluded the most common complications were rotator cuff tearing, postoperative glenohumeral instability, and periprosthetic humeral fracture, with a near absence of component revision due to loosening or other mechanical factors. Hasan et al. evaluated a series of 139 patients who had dissatisfaction with the results of their shoulder arthroplasty to understand the characteristics of failed shoulder arthroplasties. They reported that primary osteoarthritis and proximal humeral fractures were the most common indications for the initial arthroplasty and that many shoulders had stiffness, instability, and malpositioned components. They concluded that greater attention to proper component positioning, postoperative motion, and fixation of the tuberosities may lead to increased patient satisfaction after shoulder arthroplasty. Incorrect answers Answer 1: Brachial plexus injuries are rare complications following anatomic total shoulder arthroplasty. Answer 2: Component loosening is not the most common complication following total shoulder arthroplasty. Glenoid component loosening is the most common reason for revision arthroplasty. Answer 4: Chronic prosthetic shoulder infections are not the most common complication. The most common offending organism is Cutibacterium acnes, which is an anaerobic air-tolerant gram-positive rod that is indolent and manifests late after infection. Answer 5: Acromion stress fractures do not commonly occur following anatomic total shoulder arthroplasty. They most often occur following reverse shoulder arthroplasty with over-tensioning of the soft tissues.
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