Most surgeons who perform hip and knee arthroplasty procedures agree that there are significant risks and complications seen in patients with a high BMI >40. For the shoulder replacement surgery the anesthesia risks are the same with the hip and knee arthroplasty procedure, however there are significant risks of mechanical complications. These reoperations and complications, most of the time, have to do with difficulties reaming the glenoid or exposing the humerus to gain access to the endosteal canal. For the following case the difficulty was that the large size of the brachium made full adduction and 90 degree humeral external rotation challenging. The incomplete adduction was forcing the reaming and work in the endosteal canal away from the surgeons making the procedure difficult. Despite the challenges there was no malpositioning of the components and the outcome was good, as the patient was able to perform assistive forward elevation of the shoulder to 150 degrees on postoperative day one. However, patients with BMIs between 40-50 should be consulted that they there are high risks of wound infections and component malpositioning.
Suggested reading:
Wagner ER, Houdek MT, Schleck C, Harmsen WS, Sanchez-Sotelo J, Cofield R,
Sperling JW, Elhassan BT. Increasing Body Mass Index Is Associated with WorseOutcomes After Shoulder Arthroplasty. J Bone Joint Surg Am. 2017 Jun
7;99(11):929-937.
