Synopsis
A concern regarding shoulder arthroplasty are the possible intraoperat
ive and postoperative complications that can jeopardize and/or comprom
ize the functional results. The type and rate of complications depends
highly on the diagnosis, but also on the type of index implant
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 na
ture and rates of complications. Fortunately, revision surgery after p
rosthetic shoulder arthroplasty is rarely required. However, various c
omplications or combinations of complications can lead to the need for
revision surgery. For many of these, several treatment options are po
ssible. Recognizing all the problems that contributed to failure in an
individual patient may be difficult before revision surgery. Understa
nding the abnormality present at the time of surgery requires consider
able 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 infect
ion. In addition to the component loosening, all of these complication
s must also be treated if the revision procedure is to be successful.
When addressing glenoid loosening, it seems to be best to revise the c
omponent, 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 alm
ost always possible; it should be associated with reconstruction of th
e proximal humerus with the help of an allograft. In hemiarthroplastie
s with pain, conversion to a total shoulder arthroplasty by placing a
glenoid component is highly effective. In instability after shoulder a
rthroplasty, soft-tissue repair is not sufficient to create stability.
Unfortunately, for most patients, component revision is a necessary p
art of the revision surgery. When rotator-cuff tearing is acute, repai
r is indicated; for chronic rotator-cuff tearing, repair depends on th
e severity of the symptoms. When infection develops after shoulder art
hroplasty, implant removal is almost always necessary, but occasionall
y, in low-grade infections, a primary or secondary exchange procedure
may be possible. The Reverse Shoulder Arthroplasty has changed complet
ely the possibilities of revision surgery of shoulder arthroplasty sin
ce it allows to solve both the problems of bone and soft tissue insuff
iciencies. However, such constrained, or semi-constrained implant, bei
ng mechanically different, introduces new complications and possible m
ultiple 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, trea
t and prevent the problems and complications that contribute to failur
e and revision surgery of shoulder arthroplasty. We hope that the mate
rial presented here will help shoulder surgeons to provide the best ca
re for their patients and will serve as a basis for future studies and
research.
"About this title" may belong to another edition of this title.
