Management of the dislocated reverse total shoulder arthroplasty: A tertiary centre experience

Background Instability is a major complication after reverse total shoulder arthroplasty (rTSA). This study reports a tertiary centre experience of managing this challenging complication. Methods We retrospectively reviewed a prospectively maintained database of patients treated surgically for a dislocated rTSA between 2013 and 2023, with a minimum follow-up of 12 months. Demographics, indication for the index procedure, timing and cause of dislocation, revision procedures, and persistence of instability were recorded. Results Forty-two dislocated rTSAs were identified. The mean age was 68 years. 30 cases were primary rTSAs and 12 cases were revision rTSAs. Most dislocations occurred early, with 34 of 42 (81%) within 6 weeks. Loss of compression was the commonest mechanism of instability, present in 33 of 42 cases (78.5%). Loss of containment occurred in 12% and impingement in 9.5%. Stability was achieved in 36 of 42 shoulders (86%). Modular component exchange was the most frequent successful revision strategy, used in 20 cases (47.5%). Discussion Dislocation after rTSA most commonly reflects the loss of compression, particularly in the early postoperative period. Modular component exchange restores stability in many cases, but a substantial proportion requires more extensive revision or salvage procedures. Careful identification of the mechanism of instability is essential for guiding treatment.