Infections that do not clear up with antibiotics may have to be treated surgically. When these efforts fail and the patient develops an infection, then antibiotics specifically for the bacteria present are the treatment of choice. The other is to use cement that has antibiotic in it. One is to give the patient antibiotics just before the procedure. Surgeons use two methods of prevention for infections. Risk factors include multiple previous surgeries, a large-sized dead space, poor sterile technique, and revision (second) surgeries on the reverse implant. Up to 10 per cent of all patients receiving a reverse shoulder arthroplasty develop a serious infection. Studies have also shown that infection and hematoma are linked. Sometimes patients develop pathways of drainage called sinus tracts at the incision site where blood and fluid can pool causing a hematoma. Proper placement of the implant is necessary to avoid fluid collection in empty areas or what are called dead spaces. Hematoma (blood trapped in the joint) is another common complication that doesn't have a single cause but many possible causes. Extreme shoulder positions in a patient with weak or brittle bones can contribute to bone fractures. The surgeon must be careful when handling the patient's arm during the procedure. The surgeon must be very familiar with the implant itself, its design and how it's supposed to work, as well as the best way to hold the implant in place. Most of these fractures occur during the surgical procedure as the surgeon prepares the bone to receive the implant. Periprosthetic fracture is a break in the bone around the implant. One other cause of nerve damage is scar tissue that can press (compress or impinge) nerves of the brachial plexus causing similar problems with sensation and movement. In other cases, the implant can displace (push aside) the nerve plexus creating loss of sensory and/or motor function of the arm. Sometimes the reverse shoulder implant puts strain on the group of nerves to the arm called the brachial plexus. Cutting or pulling (traction) on the nerves to the arm can cause loss of sensation of the arm, hand, and/or fingers. The first and potentially most damaging is neurologic injury. Let's take a closer look at some of the more common problems. For now, it seems an understanding of implant design, shoulder anatomy, and common complications will help the surgeon avoid problems and avoid failed surgeries.

Likewise, the long-term results in patients who have a reverse shoulder arthroplasty are not available yet. The best way to handle these problems (referred to by surgeons as best practice) has not yet been determined. Other reported problems include infection, dislocation, baseplate failure, and fracture of the acromion (piece of bone from the shoulder blade that curves over the top of the shoulder). The three most common problems with reverse shoulder replacements are neurologic injury, bone fracture around the implant, and hematoma (pocket of blood or other fluid trapped inside the joint).

There are some problems that are unique to the reverse total shoulder replacement. The result is a shoulder that functions better, is less painful, and can last for years without loosening. This simple change allows the large deltoid muscle that covers the shoulder to lift the arm. Shear forces are transformed into compressive forces. The artificial joint itself provides more stability by creating a deeper socket that prevents the ball from sliding up and down as the shoulder is raised. This new design gives a much more stable shoulder joint that can function without an intact rotator cuff.

The reverse shoulder replacement does exactly as the name suggests: reverses the socket and the ball, placing the ball portion of the shoulder where the socket used to be and putting the socket where the ball or humeral head would normally be. And it has worked so well, surgeons have expanded the number and types of patients who can qualify for this type. Instead, a different type of shoulder replacement, called reverse shoulder replacement has been developed. But patients who don't have enough muscle function to stabilize the joint may not be able to benefit from the traditional implant design - one that mimics the normal anatomic shoulder. Shoulder joint replacement surgery (also called shoulder arthroplasty) is a great treatment for many people with shoulder pain from arthritis.

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