Back to ISAWE Scenarios
arthroplasty

Reverse Shoulder Arthroplasty Complications

advanced
6 min
22 marks
6 questions
Clinical Scenario
A 70-year-old female presents with acromial pain and difficulty with overhead activities 18 months post reverse shoulder arthroplasty for cuff tear arthropathy. Initial postoperative function was excellent with pain-free forward elevation to 140°. She now reports progressive weakness and aching over the lateral shoulder. On examination, there is tenderness over the acromial spine and pain with resisted abduction.
AP radiograph of left shoulder showing reverse shoulder arthroplasty with stress fracture visible at the acromion base. The baseplate appears well-fixed with no scapular notching. Humeral component well-positioned with appropriate distalization.
Open Full Size

AP radiograph of left shoulder showing reverse shoulder arthroplasty with stress fracture visible at the acromion base. The baseplate appears well-fixed with no scapular notching. Humeral component well-positioned with appropriate distalization.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (3 marks)

What are the complications specific to reverse shoulder arthroplasty?

Question 2 (4 marks)

What is the mechanism and classification of acromial fractures after RSA? How common is this complication?

Question 3 (4 marks)

How would you manage this patient's acromial stress fracture?

Question 4 (4 marks)

What is scapular notching, how is it graded, and what is its clinical significance?

Question 5 (4 marks)

What are the causes and management of instability after RSA?

Question 6 (3 marks)

What is the role of lateralized vs medialized RSA designs?

Exam Day Cheat Sheet

Must Mention

  • •Acromial fracture: Levy classification (I-III)
  • •Scapular notching: Sirveaux classification (1-4)
  • •Instability = most common complication (2-10%)
  • •Bone health optimization for stress fractures
  • •Lateralized designs reduce notching but increase baseplate stress
  • •Inferior baseplate position prevents notching

Common Pitfalls

  • •Operating on Type I acromial fractures
  • •Not optimizing bone health
  • •Missing osteoporosis as cause
  • •Over-constraining for first dislocation
  • •Not assessing subscapularis function