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Background: Reverse shoulder arthroplasty (RSA) has increased in popularity and its indications have subsequently been expanded. With its increased use, the complication rates have also increased. Complications requiring additional surgeries have the highest morbidity and cost. The aim of this study was to determine the indications for additional surgery following RSA. Methods: All the surgical and clinical notes of patients treated with an RSA at our institution over a nine-year period were retrospectively reviewed. Sixty-seven RSAs met the inclusion criteria and their records were reviewed to assess their indication for surgery, complications, as well as microbiology results if infection was present. Results: Surgical reintervention was required in 16 (23.9%) RSAs. The prevalence was lowest in rotator cuff arthropathy and glenohumeral arthritis (nine RSAs or 18.4%), followed by failed hemior total shoulder arthroplasty (four RSAs or 36.4%) and highest if performed for uncommon conditions (two RSAs or 66.7%). Instability was an early complication, occurring in 10.7% of cases and accounting for 37.8% of all reinterventions. Infection was a late complication, occurring in 6.0% of cases and accounting for 48.6% of all reinterventions. The most common organisms identified were Staphylococcus epididermidis (n=4), Escherichia coli (n=3), Staphylococcus aureus (n=2) and Klebsiella pneumonia (n=2). Conclusions: RSA has the most reliable outcomes if performed for rotator cuff arthropathy and glenohumeral osteoarthritis. Instability and infection are the most common indications for surgical reintervention, and once present, often require repeated surgeries to be successfully treated. These complications should be avoided, as they are major contributors to morbidity and cost. Level of evidence: Level 4

Indications for surgical reintervention following reverse shoulder arthroplasty: a retrospective audit from 2006 to 2015