SHOULDER CONCEPTS 2014 : REVISION SURGERY OF SHOULDER ARTHROPLASTY

A concern regarding shoulder arthroplasty are the possible intraoperative and postoperative complications that can jeopardize and/or compromize the functional results. The type and rate of complications depends highly on the diagnosis, but also on the type of index implant used: Hemiarthroplasty (HA), anatomical Total Shoulder Arthroplasty (TSA) or Reverse Shoulder Arthroplasty (RSA). The type of prosthesis fixation (cemented, press-fit or uncemented implants) may also influence the nature and rates of complications. Fortunately, revision surgery after prosthetic shoulder arthroplasty is rarely required. However, various complications or combinations of complications can lead to the need for revision surgery. For many of these, several treatment options are possible. Recognizing all the problems that contributed to failure in an individual patient may be difficult before revision surgery. Understanding the abnormality present at the time of surgery requires considerable experience. For example, glenoid loosening, in addition to being accompanied by glenoid bone loss, may be associated with subscapularis tearing or insufficiency, rotatorcuff tearing, instability, or infection. In addition to the component loosening, all of these complications must also be treated if the revision procedure is to be successful. When addressing glenoid loosening, it seems to be best to revise the component, if possible. If there is extreme bone loss, one may have to bone graft the deficiencies in addition to a change of the components. Altough humeral loosening is rare, humeral bone loss is not so rare. When it occurs, revision of the humeral component is justified and almost always possible; it should be associated with reconstruction of the proximal humerus with the help of an allograft. In hemiarthroplasties with pain, conversion to a total shoulder arthroplasty by placing a glenoid component is highly effective. In instability after shoulder arthroplasty, soft-tissue repair is not sufficient to create stability. Unfortunately, for most patients, component revision is a necessary part of the revision surgery. When rotator-cuff tearing is acute, repair is indicated; for chronic rotator-cuff tearing, repair depends on the severity of the symptoms. When infection develops after shoulder arthroplasty, implant removal is almost always necessary, but occasionally, in low-grade infections, a primary or secondary exchange procedure may be possible. The Reverse Shoulder Arthroplasty has changed completely the possibilities of revision surgery of shoulder arthroplasty since it allows to solve both the problems of bone and soft tissue insufficiencies. However, such constrained, or semi-constrained implant, being mechanically different, introduces new complications and possible multiple revisions. The experience of the shoulder surgeon is, of course, one of the main factors that influence the results after revision surgery of shoulder arthroplasty. This is the reason why we have asked a group of shoulder experts to share their knowledge. Their extensive experience has been reported in Nice, France on June 5-7, 2014, during the Nice Shoulder Course-Currents concepts. The goal of this book is therefore to help surgeons to recognize, treat and prevent the problems and complications that contribute to failure and revision surgery of shoulder arthroplasty. We hope that the material presented here will help shoulder surgeons to provide the best care for their patients and will serve as a basis for future studies and research.