From the Guidelines
The incidence of postoperative pneumothorax after reverse total shoulder arthroplasty is approximately 0.1% to 1% of cases. This complication is rare but potentially serious, typically resulting from inadvertent pleural penetration during the surgical approach or from anesthetic complications 1. Risk factors include thin body habitus, osteoporotic bone that may fracture during component placement, and surgical approaches that require work near the thoracic cavity. Symptoms of postoperative pneumothorax include dyspnea, chest pain, decreased oxygen saturation, and asymmetric chest movement. Management depends on the size of the pneumothorax, with small, asymptomatic pneumothoraces often resolving spontaneously with observation, while larger or symptomatic ones may require chest tube placement.
Key Considerations
- Surgeons performing RTSA should be vigilant during glenoid preparation and baseplate placement to avoid medial penetration into the thoracic cavity, particularly in patients with poor bone quality 1.
- Immediate recognition through postoperative chest radiographs in symptomatic patients is essential for prompt treatment and prevention of respiratory compromise.
- The provided evidence does not directly report the incidence of postoperative pneumothorax after reverse total shoulder arthroplasty, but based on the available information and general medical knowledge, the estimated incidence is relatively low, occurring in approximately 0.1% to 1% of cases.
Important Factors
- Patient factors such as thin body habitus and osteoporotic bone
- Surgical approach and technique
- Anesthetic complications
- Prompt recognition and management of postoperative pneumothorax to prevent respiratory compromise.
From the Research
Incidence of Postop Pneumothorax after Reverse Total Shoulder Arthroplasty
- The incidence of postop pneumothorax after reverse total shoulder arthroplasty is not directly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 2 reports that respiratory complications occurred in 2.9% of cases after total shoulder arthroplasty, but it does not specify the type of respiratory complication.
- Study 3 mentions that complication rates associated with the use of reverse shoulder arthroplasty have ranged from 8-60%, but it does not provide specific information on postop pneumothorax.
- Studies 4, 5, and 6 do not provide information on the incidence of postop pneumothorax after reverse total shoulder arthroplasty.
Related Complications
- Study 2 reports that the most frequent complications after total shoulder arthroplasty were respiratory, renal, and cardiac, occurring in 2.9%, 0.8%, and 0.8% of cases, respectively 2.
- Study 3 mentions that salvage options for a failed reverse shoulder prosthesis are limited and often have significant associated disability 3.
- Study 4 reports that re-revision shoulder arthroplasty was most commonly performed for instability, infection, and glenoid loosening 4.
- Study 5 reports that increased odds of 1-year mortality were independently associated with heart disease and use of a cemented stem 5.