Revision (re-do) Shoulder Replacement Surgery:

Revision shoulder replacement surgery is a procedure performed to address issues or failures associated with a previous shoulder replacement (also known as shoulder arthroplasty). This surgery may involve replacing all or part of the original prosthetic components and aims to restore function, relieve pain, and address complications such as implant loosening, infection, or instability.

Reasons Why Patients May Need a Revision Shoulder Replacement

• Prosthesis loosening: Aseptic loosening due to bone loss or wear over time.

• Infection: Periprosthetic joint infection (PJI), which may necessitate implant removal and antibiotic treatment.

• Instability: Dislocation or abnormal movement of the joint.

• Prosthetic failure: Fracture or wear of components.

• Glenoid or humeral bone loss: From mechanical wear or osteolysis.

• Rotator cuff failure: Particularly in anatomic shoulder replacements.

• Stiffness or poor functional outcome: When the original replacement did not restore adequate motion or pain relief.

Surgical Options and Techniques

The surgical approach depends on the reason for revision and the condition of the soft tissue and bone. Options include:

• Component exchange: Replacing only failed parts (humeral or glenoid components).

• Conversion from anatomic to reverse shoulder arthroplasty: Common when rotator cuff dysfunction is present.

• Use of custom 3D printed or augmented implants: For major bone loss.

• Bone grafting or bone augmentation: To address bone deficiencies.

• Two-stage revision: Often for infections—removal of implants, placement of a spacer, followed by reimplantation after infection is cleared.

Surgical Options and Techniques

Outcomes vary based on the reason for revision, surgical technique, and patient factors (e.g., age, bone quality, overall health):

• Pain relief is often achieved, especially if the source was mechanical failure or loosening.

• Functional outcomes are generally improved, but are usually lower than first-time shoulder replacements.

• Reverse shoulder arthroplasty in revision settings often provides better function, particularly in patients with rotator cuff insufficiency.

Summary:

Revision shoulder replacement can address complications from previous shoulder arthroplasty. Success depends on accurate diagnosis, careful planning, and skilled surgical execution. While outcomes are generally less favorable than primary surgery, many patients experience significant pain relief and improved shoulder function. Dr. Harold would be happy to discuss revision surgery options with you.