Revision Shoulder Arthroplasty

What is Revision Shoulder Arthroplasty?

Shoulder arthroplasty, or shoulder replacement surgery, is a surgical procedure to replace the damaged parts of the shoulder joint with artificial components. It is typically performed to relieve pain and restore function in patients with severe arthritis, fractures, or rotator cuff tears.

Revision shoulder arthroplasty is a complex surgical procedure performed to address complications from a previous shoulder replacement. The procedure involves removing the failed implant and replacing it with a new one, often requiring bone grafting or specialized implants to restore function and stability.

Shoulder Anatomy

The shoulder is a ball-and-socket joint that allows various arm movements. The head of the upper arm bone (humerus) articulates with the glenoid cavity of the shoulder bone (scapula). The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The rotator cuff is a group of four tendons that join the head of the humerus to the deeper muscles and provide stability and mobility to the shoulder joint.

Indications for Revision Shoulder Arthroplasty

Common indications for revision shoulder arthroplasty include the following:

• Implant Loosening or Failure: Over time, the prosthetic components may loosen due to wear, stress, or bone resorption.
• Infection (Periprosthetic Joint Infection - PJI): Bacterial infection around the implant may require removal and staged revision.
• Instability or Dislocation: Improper positioning of implants or weakened soft tissues can cause recurrent dislocation.
• Fractures: A fracture around the implant (periprosthetic fracture) may necessitate revision.

Procedure for Revision Shoulder Arthroplasty

The specific surgical steps for a revision shoulder arthroplasty vary depending on the reason for revision, but a general outline of the procedure is as follows:

• The patient is typically administered general anesthesia and positioned in such a way as to allow optimal access to the operative area.
• Incisions are typically made over previous incisions to minimize tissue trauma and carefully expose the joint.
• If scar tissue is present, it is carefully dissected to improve joint mobility.
• The previous prosthesis (humeral head, glenoid, or both) is carefully removed.
• In cases of infection, a two-stage revision may be required, where the implant is removed, and an antibiotic spacer is placed before inserting a new prosthesis in a later surgery.
• If significant bone loss has occurred, bone grafts or metal augments may be used to rebuild support for the new implant.
• If the rotator cuff is torn or deficient, the surgeon may perform a tendon transfer or convert the implant to a reverse shoulder arthroplasty for better stability.
• A new implant is placed (either a standard total shoulder replacement or a reverse total shoulder replacement that reverses the natural ball-and-socket arrangement).
• The new components are either cemented in place or secured using a press-fit technique that encourages bone ingrowth.
• The soft tissues are tensioned properly to ensure joint stability and prevent future dislocation.
• The incision is closed with sutures or staples, and a sterile dressing is applied.

Postoperative Care and Recovery

Postoperative care for revision shoulder arthroplasty involves pain management, infection prevention, and structured rehabilitation. Patients typically wear a sling for several weeks to protect the joint and allow healing. Pain is managed with medications, including NSAIDs and opioids if necessary. Antibiotics may be prescribed to reduce infection risk. Early passive range-of-motion exercises begin under the guidance of a physical therapist, gradually progressing to active movements and strengthening exercises over several months. Regular follow-ups with imaging help monitor implant stability and bone healing. Full recovery may take 6–12 months, with the goal of restoring function and reducing pain.

Risks and Complications

Revision shoulder arthroplasty is more complex than primary shoulder replacement and carries a higher risk of complications. These include:

• Blood loss and need for transfusion
• Fractures (periprosthetic fractures) during implant removal or insertion
• Implant loosening or failure
• Dislocation
• Bone loss
• Periprosthetic joint injection (PJI)
• Persistent pain and stiffness
• Reduced strength and function
• Rotator cuff failure
• Nerve or blood vessel injury