Nicholas Kusnezov, MD, John C. Dunn, MD, Stephen A. Parada, MD, Kelly Kilcoyne, MD, and Brian R. Waterman, MD
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. The authors are employees of the US government. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of Defense or the US government.
Nine patients had a total of 12 postoperative complications (46.2%): 6 component failures (23.1%), 2 neurologic injuries (7.7%; 1 permanent axillary nerve injury, 1 transient brachial plexus neuritis), 2 cases of adhesive capsulitis (7.7%), and 2 episodes of venous thrombosis (7.7%; 1 superficial, 1 deep) (Table 4). There were no documented infections. Six reoperations (23.1%) were performed for the 6 component failures (2 traumatic dislocations of prosthesis resulting in acute glenoid component failure, 3 cases of atraumatic glenoid loosening, 1 case of humeral stem loosening after periprosthetic fracture). Atraumatic glenoid component loosening occurred a mean (SD) of 40.6 (14.2) months after surgery (range, 20.8-54.2 months).
Surgical Failures
Eight service members underwent MEB. Six patients experienced component failure. Factors contributing to both clinical failure and separation from active duty by means of MEB were evaluated with univariate analysis (Table 5). No statistically significant risk factors, including surgical revision and presence of perioperative complications, were identified.
Discussion
We confirmed that our cohort of young service members (mean age, 45.8 years), who had undergone TSA for glenohumeral arthritis, had a relatively higher rate of component failure (23.1%) and a higher reoperation rate (23.1%) with low rates of return to military duty at short-term to midterm follow-up. Our results parallel those of a limited series with a younger cohort (Table 6).7,16,19,21,23,24 The high demand and increased life expectancy of the younger patients with glenohumeral arthritis potentiates the risk of complications, component loosening, and ultimate failure.29 To our knowledge, the present article is the first to report clinical and functional outcomes and perioperative risk profiles in a homogenously young, active military cohort after TSA.
