Hematoma Following Shoulder Arthroplasty: Incidence, Management, and Outcome

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

2 Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA

3 Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA


Background: A paucity of data regarding the implications of postoperative hematoma formation on outcomes after 
shoulder arthroplasty exists. Previous studies on major joint arthroplasty have associated postoperative hematoma 
formation with high rates of prosthetic joint infection (PJI) and reoperation. 
Methods: A total of 6,421 shoulder arthroplasty cases were retrospectively reviewed from an institutional database 
(5,941 primary cases, 480 revision) between December 2008 and July 2017. Patients who developed a postoperative 
hematoma were identified through direct chart review. Cases with a history of shoulder infection treated with explant and 
antibiotic spacer placement were excluded. Demographics, surgical characteristics, treatment course, and outcomes 
were collected. 
Results: Hematoma occurred in 105 (1.6%; 105/6421) cases within the first three postoperative weeks and was more 
common following revision (3.3%; 16/480) compared to primary cases (1.5 %; 89/5941; P=0.002). Overall, postoperative 
shoulder hematoma was successfully managed with nonoperative treatment in 87% of cases via observation (62%, 
62/105) and aspiration (25%, 26/105). A total of 14 patients (0.22%, 14/6421) underwent reoperation for hematoma. 
Eight patients (7.6%, 8/105) that required reoperation for hematoma were diagnosed with PJI.
Conclusion: Postoperative hematoma is a complication of shoulder arthroplasty. While many postoperative 
hematomas can be managed without operative intervention, this analysis reiterates the association between 
hematoma formation and the development of PJI. 
Level of evidence: IV


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