What is the most likely cause of an early anterior dislocation following a total shoulder replacement, and what is the treatment?
Assuming that the procedure is executed properly, the most likely cause of this complication, especially when it occurs early is failure of the subscapularis tendon repair. This is a very serious problem because if it is not diagnosed within a week or two, repair may not be possible. Further, pectoralis muscle transfer has not provided successful outcomes for subscapularis failure in the setting of arthroplasty. The only option for this complication may be revision to a Reverse shoulder design. So although failure may be a complication, without any de facto error on the part of the surgeon, failure to diagnose this in a timely fashion, particularly in the acute postoperative period, may make revision considerably more difficult if the implants have become well fixed due to bony ingrowth.
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