Shoulder Surgery Failures: Even the Best Surgeons Are Still Learning
Examining why a shoulder replacement failed is “so emotionally painful,” said Mark A. Frankle, MD, during the session, Worst Case of My Career: What Went Wrong and What I Did, at ICJR’s 7th Annual Shoulder Course.
“But that’s where you learn, that’s where we become better. And it’s humbling.”
Dr. Frankle and 4 other highly experienced, respected shoulder surgeons – Joseph A. Abboud, MD; Evan S. Lederman, MD; John Itamura, MD; and Patrick St. Pierre, MD – agreed to lay bare some of their worst cases to share the lessons they’ve learned with attendees at ICJR’s Shoulder Course.
And a key point they made: Even the best surgeons are still learning.
Below are the cases they discussed.
Joseph A. Abboud, MD
The Rothman Institute, Philadelphia, Pennsylvania
- 57-year-old male patient who had undergone shoulder fusion in his 20s following an industrial accident
- Presents with complaints of scapular pain
- Undergoes a reverse total shoulder arthroplasty that repeatedly dislocates
Evan S. Lederman, MD
The Orthopedic Clinic Association, Phoenix, Arizona
- 53-year-old male patient who had undergone a bone block procedure for posterior instability at age 18
- Works as an airline baggage handler and high school football coach
- Injures his shoulder in a fall at work and successfully completes 3 weeks of conservative treatment
- Injures his shoulder in another fall at work 4 months later and fails 3 months of conservative treatment
- Undergoes hemiarthroplasty with a short-stem implant; revised to a reverse total shoulder arthroplasty 2 years later, but repeatedly dislocates
Mark A. Frankle, MD
Florida Orthopaedic Institute, Tampa
- 53-year-old female patient who underwent a hemiarthroplasty with a biopolar device in 2003
- Presents with right shoulder pain and is revised to reverse total shoulder arthroplasty
- Presents 1 year later with pain and early humeral-sided loosening
- Revised to a cemented implant with bone graft to support the implant
John M. Itamura, MD
Kerlan-Jobe Institute, Los Angeles, California
- 40-year-old female patient who sustained a 4-part proximal humerus fracture after falling off her horse
- Undergoes open reduction and internal fixation with a locked plate; subsequently develops avascular necrosis
- Converted to hemiarthroplasty with a cobalt chromium head, but develops severe pain
- Claims she told the fellow she had a nickel allergy but it is not documented on the chart
Patrick St. Pierre, MD
Desert Orthopedic Center, Rancho Mirage, California
- 69-year-old female with a fracture dislocation reduced in the emergency department after a fall on New Year’s Eve; patient develops incomplete axillary nerve palsy
- Surgery is indicated for a massive rotator cuff tear seen on MRI, but cannot be done immediately due to the axillary nerve palsy
- 3 months later, sensation is intact, all 3 heads of the deltoid are firing, strength is 3/5, still some nerve palsy
- Patient undergoes reverse total shoulder arthroplasty, but stem and head have loosened 2 months after surgery and is further revised
Click the image above to watch the presentation and find out how these cases were resolved.
Dr. Abboud has disclosed that that he receives royalties from and is a paid consultant for DJO Surgical; that he is paid presenter or speaker and receives research support from Tornier; that he receives royalties and research support from and is a paid consultant for Zimmer Biomet; and that he receives research support from Arthrex, Inc., and DePuy Synthes.
Dr. Lederman has disclosed that he receives royalties and research support from and is a paid consultant and paid presenter or speaker for Arthrex.
Dr. Frankle has disclosed that he receives royalties from and is a paid consultant for DJO Surgical.
Dr. Itamura has disclosed that he receives royalties from and is a paid consultant for Tornier and Acumed; that he is a paid speaker for Arthrex and DJO Surgical; and that he receives royalties from AOS and Shoulder Innovations.
Dr. St. Pierre has disclosed that he receives royalties from, has stock options in, is a paid consultant for, and is on the speakers’ panel for DJO Surgical; that he is a paid consultant for and is on the speakers’ panel for Cayenne; and that he is a paid consultant for Flexion.