**Author details**

Although, as previously stated, this study implies 24 months as the short-term interval for outcomes following an RTSA, short-term complications have the potential to extend into the long-term if not addressed or managed appropriately—eventually affecting the longevity of the prosthesis. More commonly, long-term complications include glenoid and/or humeral component loosening, polyethylene component wear, and scapular notching. Less common long-term complications include deep SSI, dislocation, readmission, and fracture; which primarily occur within the first 2 years postoperatively. As mentioned above, glenoid or humeral loosening is the most common complication observed 2 years after RTSA, particularly with an increased risk following a previously failed shoulder arthroplasty and excess mechanical load related to increased BMI [15, 33]. Further, the incidence of component loosening doubles between the second and fifth year follow-up as reported by Alentorn-Geli and colleagues [29]. Particlization of the polyethylene component may be of concern with RTSA in younger patients due to necessary durability and lifespan of the implant. Riley and colleagues [34] investigated the outcomes following RTSA using a metal-on-metal design and concluded that it is not an acceptable alternative to RTSA in young patients; they maintain that the polyethylene component is the more suitable option. Ek and colleagues [28] conducted a study evaluating RTSA in patients younger than 65 years of age using two groups: revision RTSA and primary RTSA. This study observed an increased incidence of scapular notching at less than 12 months follow-up and greater than 10 years follow-up; with 56% of patients experiencing some degree of scapular notching overall [28]. Conversely, Mollon and colleagues [34] reported that only 10% of patients experienced scapular notching; noting that risk factors for scapular notching included lower body weight, lower BMI, and RTSA on the non-dominant upper extremity. It is also worth mentioning the correlation between longer-term follow-up and increasing incidence of scapular notching [34]; which may be attributed to variation in size and placement of the glenosphere, and center of rota-

Throughout this literature review, several limitations were encountered that include the following: unspecified "normal" postoperative physical rehabilitation protocols, risk factors pertinent to specific complications, and lack of research investigating the long term outcomes for RTSA. Additional research is needed to examine the aforementioned limitations to enhance

Scapular notching, dislocations, and infections lead the forefront of persistent complications for RTSA. As evidenced in this literature review, the vast majority of improvement plateaus around 6 to 24 months. Thus, patient optimization may be accomplished by implementing a short-term course of preoperative physical therapy focused on shoulder girdle strength. Further, numerous inconsistencies and contradictions were observed in the literature regarding the impact of BMI on RTSA outcomes. Research requires further confirmatory evidence before making any strong conclusions about limiting the use of RTSA in patients with increased BMI. On the other hand, tobacco use negatively impacts the outcomes following

tion of the prosthesis.

94 Advances in Shoulder Surgery

future outcomes following RTSA.

RTSA by nearly doubling the overall complication rate.

**7. Conclusion**

Sydney C. Cryder<sup>1</sup> \*, Samuel E. Perry2 and Elizabeth A. Beverly3

\*Address all correspondence to: sc323908@ohio.edu

1 Department of Medicine, Ohio University, Heritage College of Osteopathic Medicine, Athens, United States

2 Department of Graduate Medical Education, Adena Health System, Chillicothe, United States

3 Department of Family Medicine, Ohio University, Heritage College of Osteopathic Medicine, Athens, United States
