Hematoma Following Shoulder Arthroplasty: Incidence, Management, and Outcome

Background: A paucity of data regarding the implications of postoperative hematoma formation on outcomes after shoulder arthroplasty exists. Previous studies on major joint arthroplasty have associated postoperative hematoma formation with high rates of prosthetic joint infection (PJI) and reoperation. Methods: A total of ۶,۴۲۱ shoulder arthroplasty cases were retrospectively reviewed from an institutional database (۵,۹۴۱ primary cases, ۴۸۰ revision) between December ۲۰۰۸ and July ۲۰۱۷. Patients who developed a postoperative hematoma were identified through direct chart review. Cases with a history of shoulder infection treated with explant and antibiotic spacer placement were excluded. Demographics, surgical characteristics, treatment course, and outcomes were collected. Results: Hematoma occurred in ۱۰۵ (۱.۶%; ۱۰۵/۶۴۲۱) cases within the first three postoperative weeks and was more common following revision (۳.۳%; ۱۶/۴۸۰) compared to primary cases (۱.۵ %; ۸۹/۵۹۴۱; P=۰.۰۰۲). Overall, postoperative shoulder hematoma was successfully managed with nonoperative treatment in ۸۷% of cases via observation (۶۲%, ۶۲/۱۰۵) and aspiration (۲۵%, ۲۶/۱۰۵). A total of ۱۴ patients (۰.۲۲%, ۱۴/۶۴۲۱) underwent reoperation for hematoma. Eight patients (۷.۶%, ۸/۱۰۵) that required reoperation for hematoma were diagnosed with PJI.Conclusion: Postoperative hematoma is a complication of shoulder arthroplasty. While many postoperative hematomas can be managed without operative intervention, this analysis reiterates the association between hematoma formation and the development of PJI. Level of evidence: IV

Keywords:

Aspiration , Complications , hematoma , Infection , Prosthetic Joint , reverse total shoulder arthroplasty , Shoulder Arthroplasty