Brachial plexopathy following shoulder arthroplasty

Background: Anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are being performed with increasing frequency. While rare, postoperative brachial plexopathy can occur, and its incidence and natural history remain poorly defined. The purpose of this study is to report the epidemiology, patient characteristics, and clinical course of postoperative brachial plexopathies following shoulder arthroplasty. Methods: All patients undergoing TSA or RSA at a single institution from April 2017 to May 2019 were included. Patients with postoperative brachial plexus sensorimotor deficits were identified based on postoperative physical examination, imaging, and/or electrodiagnostic data. Patient data including age, body mass index (BMI), medical comorbidities, surgery performed, surgical indications, sensorimotor deficits, and date of onset and resolution of sensorimotor deficits were recorded. Results: Twelve of 881 patients (1.4%; 8 female, 4 male) who underwent shoulder arthroplasty during the study period were identified with postoperative brachial plexopathy. The median age was 65 years, and median BMI was 24.4 kg/m². The index procedure included 8 anatomic TSA and 4 RSA in patients with brachial plexopathy. Surgical indications included glenohumeral arthritis (8 patients), rotator cuff arthropathy (2 patients), avascular necrosis (1 patient), and proximal humerus fracture (1 patient). Nine of 12 patients recovered fully at a mean of 8.2 months, 2 patients had incomplete recovery with persistent sensory symptoms at a mean 12.4-month follow-up, and 1 patient was lost to follow-up at 1.3 months and, thus, recovery status is unknown. Patients who received a combination of general anesthesia and brachial plexus block experienced a higher rate of brachial plexopathy than those who received general anesthesia or brachial plexus block alone. Conclusions: This institutional registry study provides a descriptive analysis of the patient demographics and course of recovery for patients with postoperative brachial plexopathy following shoulder arthroplasty. For this institutional cohort, patients with brachial plexus deficits had a significantly lower BMI and higher rate of receiving a combination of brachial plexus block and general anesthesia than the institutional registry cohort as a whole.