title: Results of closed management of acute dislocation after reverse shoulder arthroplasty.
abstract: BACKGROUND
  Postoperative instability continues to be one of the most common complications limiting outcomes of reverse shoulder arthroplasty (RSA). The optimal management of this complication remains unknown. The purpose of this study was to evaluate the outcomes of patients with postoperative dislocation after RSA managed with closed reduction.
  
  
  METHODS
  All patients who were treated with a closed reduction for dislocation after RSA in the period between May 2002 and September 2011 were identified and retrospectively reviewed. Final outcomes including recurrent instability, need for revision surgery, American Shoulder and Elbow Surgeons outcome score, and range of motion were evaluated.
  
  
  RESULTS
  A total of 21 patients were identified. Nearly 50% of cases (10 of 21) had previous surgery, with 80% (8 of 10) of these being previous arthroplasty. The average time to first dislocation was 200 days, with 62% (13 of 21) occurring in the first 90 days. At average follow-up of 28 months, 62% of these shoulders remained stable (13 of 21), 29% required revision surgery (6 of 21), and 9% remained unstable (2 of 21). The average American Shoulder and Elbow Surgeons score was 68.0 for patients treated with closed reduction for instability and 62.7 for those treated with revision surgery (P = .64).
  
  
  CONCLUSIONS
  This study shows that an initial dislocation episode after RSA with use of this implant can be successfully managed with closed reduction and temporary immobilization in more than half of cases. Given that outcomes after revision surgery are not different from those after closed treatment, we would continue to recommend an initial attempt at closed reduction in the office setting in all cases of postoperative RSA dislocation.
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL, USA; University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Teusink
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL, USA.
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Pappou
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL, USA; The Sport Medicine Clinic, Seattle, WA, USA.
authors.forename: Daniel Grant
authors.initials: DG
authors.lastname: Schwartz
authors.affiliation: Foundation for Orthopaedic Research, Tampa, FL, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cottrell
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frankle
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Reverse shoulder arthroplasty; closed reduction; dislocation; nonoperative treatment; retrospective review; revision