Intraoperative complications during revision shoulder arthroplasty: a study using the National Joint Registry dataset

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Abstract
The surgical options for revision shoulder arthroplasty and the number of procedures performed are increasing. However, little is known about the risk factors for intraoperative complications associated with this complex surgery. The National Joint Registry (NJR) is a surgeon reported database recording information on major joint replacements including revision shoulder arthroplasty. Using multivariable binary logistic regression modelling, we analyzed 1445 revision shoulder arthroplasties reported to the NJR between April 2012 and 2015. The risk of developing a complication during revision surgery was greater than primary arthroplasty (5% versus 2.5%). An intraoperative fracture was the most common complication occurring in 50 (3.5%) cases. Nerve injuries were recorded for two (0.1%) patients and vascular injuries for one (0.1%) patient. The incidence of intraoperative fractures was higher in females than males (relative risk = 3.25; p = 0.005). Periprosthetic fracture as an indication for revision carried the highest risk for any complication (relative risk = 3.00, p = 0.06). This is the largest registry study to date investigating the incidence and risk factors for intraoperative complications during revision shoulder arthroplasty. Females have over three times the risk of intraoperative fractures compared to males. This study will help inform surgeons to accurately counsel patients.

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