Risks & Complications
All surgical procedures are associated with a degree of risk. Your surgical team will do everything possible to minimise the risks and complications.
Your surgeon should discuss the risks and complications of the procedure, as well as alternative treatments before surgery with you. This is also part of the consent process. The consent document you sign should list the most frequent risks associated with the procedure you are having, even though these risks may be small.
Below is a list of some risks and complications associated with common shoulder surgical operations, but these may differ depending on the exact type of surgery you are having. Don't be afraid to ask your surgeon what their complication rates are for a procedure (even the best surgeons unfortunately do get complications!).
General complications of any operation:
- Pain, which happens with every operation. The healthcare team will try to reduce your pain. They will give you medication to control the pain and it is important that you take it as you are told, so you can move about as advised. Click here for more.
Complex Regional Pain Syndrome (CRPS) is an extremely rare complication of shoulder surgery and associated with long term disabling pain that can be difficult to treat, however this is extremely rare.
- Stiffness after shoulder surgery is not uncommon and can occur in approximately 10% of people. It is known as a 'Post-operative Frozen Shoulder'. It is more common after rotator cuff repairs and in older people. In most cases it improves with physiotherapy, but sometimes a steroid injection, hydrodilatation or surgery (MUA or capsular release) is required. Almost all stiffness is gone by one year after surgery.
- Bleeding during or after surgery (<1%). It is unusual to need a blood transfusion.
- Infection of the surgical site (wound)(<1%). This is rare, especially with arthroscopic surgery. Generally, many procedures are undertaken during your surgery to minimise the infection risk such as special clean air theatres, sterile environments, prophylactic antibiotics, etc. After your operation, you should let your surgeon know if you get a temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but occasionally the wound needs to be drained or you may need another operation.
Low Grade Infections are more common after shoulder surgery than other joints. It is characterised by a post-op frozen shoulder that does not improve with usual treatments. The incidence can range from 0.5 to 10%. It is more common in young, sporty males with acne.
- Unsightly scarring of the skin (<1%). Most surgical scars have disappeared to a thin pale line by one year after surgery. Before then they can look a bit red. If you are concerned about your scar you must discuss it with your surgeon, as there are many treatments to improve scar healing (such as Bio-oils, Silicone gels, massage, etc). Arthroscopy scars are usually very small and neat. Click here for more.
- Nerve Injury is rare (<0.5%) with most shoulder operations, but some larger operations have a higher risk, such as revision shoulder replacements, Latarjet procedure and complex fracture surgery.
- Blood clots (0.2%) - the risk of getting a blood clot in your leg (DVT) or lung (PE) are rare and more common after surgery on your leg. The overall published rate for shoulder surgery is 0.2%. Most surgeons use calf compression pumps during your operation to reduce the risk. The risk is higher in people who are overweight, older age, hormone therapy (eg. HRT and contraceptive pill) and smoking. The risk is also higher if surgery lasts more than 150 minutes. In high risk patients we usually use an anticoagulant to try reduce the risk of clots.
- Anaesthetic risks - please see Your Anaesthetic
Complications of Specific Procedures:
In addition to the complications above, some operations carry risks specific to the type of procedure. The more common ones are listed below:
- Rotator Cuff Repair - Recurrence of the tear or failed healing of the tear. Approximately 15-20% of repaired tendons don’t fully heal or retear. This is more likely in older people with older tears. Despite this the success rate of the surgical repair is still over 95%.
- Arthroscopic Shoulder Stabilisation - The risk of recurrent dislocation or instability after surgery is approximately 5-40%. The risk is higher in the following cases: young (under 20 years of age), male, contact sports, ALPSA lesion, bony Bankart, HAGL tear and non-compliance with post-operative rehabilitation.
- Latarjet Procedure - The risk of recurrent dislocation or instability after surgery is approximately 2-5%. The risks of infection, nerve injury and stiffness are higher than arthroscopic stabilisation, so it is mainly reserved for high risk cases (glenoid bone loss, revision surgery, etc.)
- Shoulder Replacement (Arthroplasty) - Loosening without infection, which may need further surgery to do the shoulder replacement again (risk: 1 in 20 over eight years).