Revision Reverse Shoulder Arthroplasty

Peter N. Chalmers, MD; Pascal Boileau, MD, PhD; Anthony A. Romeo, MD; Robert Z. Tashjian, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(12):426-436. 

In This Article

Abstract and Introduction

Abstract

As shoulder arthroplasty becomes increasingly common, the burden of revision shoulder arthroplasty is also increasing. Revision reverse shoulder arthroplasty requires an understanding of the causes of failure and the evaluation of these causes and their sequelae, including infection, instability, component loosening, humeral bone loss, and glenoid bone loss. Revision reverse shoulder arthroplasty is technically complex. On the humeral side, corticotomy may be required for component removal, and bone grafting may be necessary to achieve rotational stability and to restore humeral length and avoid undertensioning and instability. On the glenoid side, bone loss is common, structural bone grafting is not infrequently required, and proper component positioning is required to avoid impingement and component loosening. Although the outcomes are generally inferior to primary reverse total shoulder arthroplasty and complications and revision surgeries are common, revision procedures still lead to notable improvements in pain, motion, and function.

Introduction

As shoulder arthroplasty becomes increasingly common, the burden of revision shoulder arthroplasty is also increasing. Shoulder arthroplasty is rapidly increasing in frequency, in part due to the growing popularity of reverse total shoulder arthroplasty (RTSA). From 2011 to 2012, more than 103,000 shoulder arthroplasties were performed.[1] Only few long-term outcomes studies are available, and they suggest that functional survival after RTSA at 10 years may only be 58% to 76%,[2,3] although component survival may be as high as 93%.[4] As surgeons become comfortable with RTSA and perform it in younger patients, revision rates may increase.[5] Orthopaedic surgeons thus need to understand the potential etiologies of RTSA failure, the evaluation and classification of causes of RTSA failure, the surgical technique for revision RTSA, and the outcomes and complications associated with revision RTSA.

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