Complications associated with arthroscopic shoulder surgery

doi:10.1053/jars.2002.31801

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 18, Issue 2, Supplement 1, February 2002, Pages 88-95

https://doi.org/10.1053/jars.2002.31801 Get rights and content

Abstract

We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 2 (February, Suppl 1), 2002: pp 88–95

Section snippets

Review articles

Subsequent review publications on the topic complications of shoulder arthroscopy have been limited to eight articles or abstracts. None have been as inclusive as the articles published by Small. Bigliani et al.³ reviewed the literature in 1991, noting attention to detail obviated most complications. Intraarticular electrocautery had decreased the incidence of bleeding complications, and these authors felt that there was a decrease in traction-related neurologic injuries with beach chair

General surgical complications

While infection occurs with shoulder arthroscopy, the rate is low. Johnson¹¹ noted an infection rate of 0.04% with all types of arthroscopy using gluteraldehyde sterilization. DeAngelo and Olgivie-Harris¹² noted an infection rate of 0.23%, sufficient for them to recommend perioperative antibiotics. Most textbooks have emphasized a low rate of infection.13, 14 Review articles noted rates of from 0 (4) to 3.4% (3). McFarland notes the need for both arthroscopic and open incision and drainage,

Shoulder arthroscopy complications

Reported vascular injuries fortunately remain rare. Deep venous thrombosis in a patient with a subsequently identified hypercoagulable state was reported by Burkhart.²⁸ Cameron reported a single case of a venous pseudoaneurysm.²⁹ Cephalic vein laceration has also been reported, but without residual morbidity.⁴

Neurologic injury has remained of more concern. Neurologic injury has been reported to be as high as 30%.⁵ Neurologic complications were well reviewed by Rodeo et al.³⁰ Most of these

Subacromial surgery

Overall complication rates for subacromial surgery are the lowest of all procedures in the shoulder. Small noted a rate of 0.76%¹ and 0.25%.² Muller and Landsiedl¹⁰ noted a 2% rate of subacromial complications. Rupp et al. noted a higher complication rate of 6.5%.⁶ Inadequate acromial resection remains the most common reported cause of failure of arthroscopic acromioplasty.8, 52 Matthews and Blue⁵² review a thorough pre- and intraoperative plan to avoid this complication. Poor visualization

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Cited by (197)

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery
2023, Journal of Hand Surgery Global Online
Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery.
Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared.
Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities.
This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities.
Prognostic III.
Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).
Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result.
A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group.
Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores.
Level III, retrospective comparative study.
Management of shoulder stiffness following rotator cuff repair: a systematic review and meta-analysis
2023, JSES Reviews, Reports, and Techniques
The purpose was to systematically review and synthesize the literature on treatment modalities for shoulder stiffness following rotator cuff repair (RCR) and investigate which modality provides the greatest postoperative range of motion (ROM). A search was performed on PubMed, Embase, and Cochrane. Clinical case series and comparative studies that report pre- and posttreatment ROM of shoulder stiffness following RCR were included. Studies that exclusively assess idiopathic frozen shoulder or primary shoulder stiffness were excluded. Five eligible studies that reported on a total of 177 patients who underwent treatment for shoulder stiffness following RCR were included. The ranges of postoperative ROM following arthroscopic capsular release were 158°-166° for active forward elevation (AFE) and 53°-59° for external rotation (ER). The ranges of postoperative ROM following infiltration were 146°-163° for AFE and 34°-35° for ER. The ranges of postoperative ROM following rehabilitation were 166° for AFE and 62° for ER. For AFE, 4 studies (5 data sets) were eligible for meta-analysis, which indicated better AFE when treated with a mean difference (MD) of 5.10° with no heterogeneity (I² = 0%, CI, 0.83-9.38). For ER, 3 studies (4 data sets) were eligible for meta-analysis, which indicated better ER without treatment with an MD of 4.59° with no heterogeneity (I² = 0%, CI, −7.04 to −2.13). For the treatment of shoulder stiffness following RCR, all included treatments improved the ROM, resulting in comparable AFE and ER compared to the comparative group. Among the treatment modalities, arthroscopic capsular release granted the greatest posttreatment AFE, while rehabilitation granted the greatest posttreatment ER.
Does needle penetration of the shoulder joint prior to arthroscopy increase infection risk? The effect of preoperative magnetic resonance arthrogram or corticosteroid injection
2023, Journal of Shoulder and Elbow Surgery
Prior literature has associated preoperative corticosteroid shoulder injection (CSI) with infection following shoulder surgery. A recent study found an equally elevated risk of total knee arthroplasty infection with preoperative injection of either CSI or hyaluronic acid. The implication is that violation of a joint prior to surgery, even in the absence of corticosteroid, may pose an elevated risk of infection following orthopedic surgery. The aim of the present study was to determine whether violation of the shoulder joint for magnetic resonance arthrogram (MRA) poses an elevated risk of infection following shoulder arthroscopy, and to compare this risk to that introduced by preoperative CSI.
A national, all-payer database was queried to identify patients undergoing shoulder arthroscopy between January 2015 and October 2020. Patients were stratified into the following groups: (1) no CSI or MRA within 6 months of surgery (n = 5000), (2) CSI within 2 weeks of surgery (n = 1055), (3) CSI between 2 and 4 weeks prior to surgery (n = 2575), (4) MRA within 2 weeks of surgery (n = 414), and (5) MRA between 2 and 4 weeks prior to surgery (n = 1138). Postoperative infection (septic shoulder or surgical site infection) was analyzed at 90 days, 1 year, and 2 years, postoperatively. Multivariable logistic regression analysis controlled for differences among groups.
MRA within 2 weeks prior to shoulder surgery was associated with an increased risk of infection at 1 year (odds ratio [OR], 2.17; P = .007), while MRA 2-4 weeks preceding surgery was not associated with an increased risk of postoperative infection at any time point. By comparison, CSI within 2 weeks prior to surgery was associated with an increased risk of postoperative infection at 90 days (OR, 1.72; P = .022), 1 year (OR, 1.65; P = .005), and 2 years (OR, 1.63; P = .002) following surgery. Similarly, CSI 2-4 weeks prior to surgery was associated with an increased risk of postoperative infection at 90 days (OR, 1.83; P < .001), 1 year (OR, 1.62; P < .001), and 2 years (OR, 1.79; P < .001).
Preoperative CSI within 4 weeks of shoulder arthroscopy elevates the risk of postoperative infection. Needle arthrotomy for shoulder MRA elevates the risk of infection in a more limited fashion. Avoidance of MRA within 2 weeks of shoulder arthroscopy may mitigate postoperative infection risk. Additionally, the association between preoperative CSI and postoperative infection may be more attributed to medication profile than to needle arthrotomy.
Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears
2023, Arthroscopy, Sports Medicine, and Rehabilitation
The purpose of this review was to systematically evaluate the literature on pediatric shoulder arthroscopy and outline its indications, outcomes, and complications.
This systematic review was carried out in accordance with PRISMA guidelines. PubMed, Cochrane Library, ScienceDirect, and OVID Medline were searched for studies reporting the indications, outcomes, or complications in patients undergoing shoulder arthroscopy under the age of 18 years. Reviews, case reports, and letters to the editor were excluded. Data extracted included surgical techniques, indications, preoperative and postoperative functional and radiographic outcomes, and complications. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool.
Eighteen studies, with a mean MINORS score of 11.4/16, were identified, including a total of 761 shoulders (754 patients). Weighted average age was 13.6 years (range, 0.83-18.8 years) with a mean follow-up time of 34.6 months (range, 6-115). As part of their inclusion criteria, 6 studies (230 patients) recruited patients with anterior shoulder instability and 3 studies recruited patients with posterior shoulder instability (80 patients). Other indications for shoulder arthroscopy included obstetric brachial plexus palsy (157 patients) and rotator cuff tears (30 patients). Studies reported a significant improvement in functional outcomes for arthroscopy indicated for shoulder instability and obstetric brachial plexus palsy. A significant improvement was also noted in radiographic outcomes and range of motion for obstetric brachial plexus palsy patients. The overall rate of complication ranged from 0% to 25%, with 2 studies reporting no complications. The most common complication was recurrent instability (38 patients of 228 [16.7%]). Fourteen of the 38 patients (36.8%) underwent reoperation.
Among pediatric patients, shoulder arthroscopy was indicated most commonly for instability, followed by brachial plexus birth palsy, and partial rotator cuff tears. Its use resulted in good clinical and radiographic outcomes with limited complications.
Systematic review of Level II to IV studies.
Pre-existing Mental Health Diagnoses Are Associated With Higher Rates of Postoperative Complications, Readmissions, and Reoperations Following Arthroscopic Rotator Cuff Repair
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
To investigate the association between preoperative mental health disorders and postoperative complications, readmissions, and ipsilateral revision procedures among patients undergoing arthroscopic rotator cuff repair (RCR).
A retrospective cohort study from 2010 to 2020 was performed using the PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without mental health disorders who underwent arthroscopic RCR. Mental health disorders evaluated in this study include depressive disorder, major depressive disorder, major depressive affective disorder, bipolar disorder, dysthymic disorder, adjustment disorder, separation anxiety disorder, and posttraumatic stress disorder. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Rates of complications and subsequent surgeries were compared between patients with and without a preoperative diagnosis of a mental health disorder.
The 1-year preoperative prevalence of a mental health disorder from 2010 to 2020 was 14.6%. After 1:1 matching, patients with a mental health disorder who underwent arthroscopic RCR were nearly twice as likely to undergo a revision procedure (odds ratio 1.94, 95% confidence interval 1.76-2.14, P < .001) and more than twice as likely to experience conversion to shoulder arthroplasty (odds ratio 2.29, 95% confidence interval 1.88-2.80, P < .001) within 2 years of initial arthroscopy when compared with patients without a mental disorder. Patients with a mental disorder also experienced increased risk for 90-day readmission (1.9% vs 0%, P < .001) as well as multiple postoperative medical complications.
Patients with pre-existing mental health diagnoses experience increased rates of 90-day postoperative complications and readmissions following arthroscopic RCR. In addition, patients with mental health diagnoses are more likely to undergo revision repair and conversion to shoulder arthroplasty within 2 years of the index procedure.
Level III.

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^☆: Address correspondence to Stephen C. Weber, M.D., Sacramento Knee and Sports Medicine, 2801 K St. #310, Sacramento, CA 95816, U.S.A. E -mail: [email protected]

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Instructional Course LecturesComplications associated with arthroscopic shoulder surgery☆

Abstract

Section snippets

Review articles

General surgical complications

Shoulder arthroscopy complications

Subacromial surgery

Arthroscopy

Arthroscopy

Clin Sports Med

J Shoulder and Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Chest

Chest

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Orthop Clin N Am

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder and Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Complications of shoulder arthroscopy

Orthop Rev

Complications of shoulder arthroscopy

Arthroscopy

Complications of shoulder arthroscopy

J South Orthop Assoc

Complications after subacromial decompression

Arthroscopy

Instructional Course Lectures
Complications associated with arthroscopic shoulder surgery☆