The risk of nerve injury during anatomical and reverse total shoulder arthroplasty: an intraoperative neuromonitoring study.
BACKGROUND
This study compared the incidence and pattern of potential nerve injuries between reverse shoulder (RSA) and total shoulder arthroplasty (TSA) using intraoperative neuromonitoring. Our hypothesis was that RSA has a greater risk of nerve injury than TSA due to arm lengthening.


METHODS
We reviewed 36 consecutive patients who underwent RSA (n = 12) or TSA (n = 24) with intraoperative neuromonitoring. The number of nerve alerts was recorded for each stage of surgery. Neurologic function was assessed preoperatively and postoperatively at routine follow-up visits. Predictive factors for increased intraoperative nerve alerts and clinically detectable neurologic deficits were determined.


RESULTS
There were nearly 5 times as many postreduction nerve alerts per patient in the RSA cohort compared with the TSA cohort (2.17 vs. 0.46). There were 17 unresolved nerve alerts postoperatively, with only 2 clinically detectable nerve injuries, which fully resolved by 6 months postoperatively. A preoperative decrease in active forward flexion and the diagnosis of rotator cuff arthropathy were independent predictors of intraoperative nerve alerts.


CONCLUSIONS
RSA has a higher incidence of intraoperative nerve alerts than TSA during the postreduction stage due to arm lengthening. Decreased preoperative active forward flexion and the diagnosis of rotator cuff arthropathy are predictors of more nerve alerts. The clinical utility of routine intraoperative nerve monitoring remains in question given the high level of nerve alerts and lack of persistent postoperative neurologic deficits.
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA.
Robert L
RL
Parisien
Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA.
Paul H
PH
Yi
Department of Orthopaedics, New England Baptist Hospital, Boston, MA, USA.
Laura
L
Hou
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA.
Xinning
X
Li
Department of Orthopaedics, New England Baptist Hospital, Boston, MA, USA. Electronic address: andrewjawa@gmail.com.
Andrew
A
Jawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D059348:Peripheral Nerve Injuries / Q000209:etiology* / Q000503:physiopathology*; D010525:Peripheral Nerves / Q000503:physiopathology*; D057234:Preoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D000070656:Rotator Cuff Tear Arthropathy / Q000150:complications / Q000175:diagnosis; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome
Anatomic; Arthroplasty; Motor evoked potential; Nerve injury; Nerve monitoring; Reverse; Somatosensory evoked potential