Revision of Failed Shoulder Arthroplasty: Epidemiology, Etiology and Surgical Options

Abstract

To analyze the epidemiology, etiologies and revision options from two tertiary centers. Despite the increase in the number of revisions of failed shoulder arthroplasty there remains a paucity of information about them. From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% of women) by two experienced shoulder surgeons: 224 hemiarthroplasties (HAs=41%), 237 anatomical total shoulder arthroplasties (TSAs=44%) and 81 reverse shoulder arthroplasties (RSAs=15%). Data about patients, primary pathology, intraoperative data, and re-intervention procedures were analyzed. Patients were followed clinically and radiographically with an average follow up of 8.7 years (range 1 to 20). The revision rate for primary arthroplasty was 12.7% for HAs, 6.7% for TSAs, 3.9% for RSAs. HAs were revised earlier (33±40 months) than RSAs (47±150 months) and TSAs (69±61 months). Although reasons for reintervention were often multiple, glenoid failure was a major cause of reintervention: glenoid erosion in failed HAs (29%) or glenoid loosening in failed TSAs (37%) and RSAs (24%). Prosthetic instability was another major cause of reintervention: 32% in RSAs, 20% in TSA, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs and 6% of HAs and 6% of TSAs. Overall, 21% of patients required multiple reinterventions, mainly for instability (26%) and/or infection (25%). The final implant selection was RSA in 48%, specifically when associated cuff insufficiency, instability and/or bone loss. Final prosthesis re-implantation was possible in 90% of cases, with the remaining 10% treated with resection arthroplasty or a spacer. Glenoid failure (erosion, loosening) and instability are the two most common causes of revision. Soft-tissue insufficiency and/or low-grade infection results in multiple revisions. Surgeons must recognise all complications so they can be addressed at the first revision surgery and avoid further re-interventions. Overall, RSA was the most common final revision implant.