J Korean Orthop Assoc.  2019 Apr;54(2):100-109. 10.4055/jkoa.2019.54.2.100.

Etiology and Treatment of Revision Shoulder Arthroplasty

• Kim YK
• Jung KH

• KMID: 2444774
• DOI: http://doi.org/10.4055/jkoa.2019.54.2.100

Abstract

The rapidly increasing rate of shoulder arthroplasty is certain to increase the number of revision arthroplasties because of parallel increases in complication numbers. It has been widely reported that the causes of revision shoulder arthroplasty include rotator cuff deficiency, instability, glenoid or humeral component loosening, implant failure, periprosthetic fracture, and infection. Revision arthroplasty can be technically challenging, and surgical options available for failed shoulder arthroplasty are limited, especially in patients with glenoid bone loss or an irreparable rotator cuff tear. Furthermore, the outcomes of revision arthroplasty are consistently inferior to those of primary arthroplasty. Accordingly, surgical decision making requires a good understanding of the etiology of failure. Here, we provide a review of indications of revision arthroplasty and of the surgical techniques used by failure etiology.

Keyword

total shoulder replacement; revision surgery; complication; treatment failure; risk factors

MeSH Terms

Arthroplasty*
Decision Making
Humans
Periprosthetic Fractures
Risk Factors
Rotator Cuff
Shoulder*
Tears
Treatment Failure

Figure

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  Figure 1 (A) Bipolar humeral hemiarthroplasty complicated by superior migration of humeral head and erosion of superior glenoid due to cuff deficiency. (B) Revision to reverse arthroplasty.

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  Figure 2 (A) Loose glenoid component (arrow) after anatomical total shoulder arthroplasty. (B) Loosening and substantial subsidence of the humeral component (arrow) and loosening of the glenoid component.

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  Figure 3 Anterior instability after anatomical total shoulder arthroplasty. Anterior subluxation (arrow) visible on lateral axillary view is typically a sign of subscapularis rupture. Any signs of loosening of glenoid are not observed.

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  Figure 4 (A) Painful loosening of the glenoid component (arrow) without cuff deficiency. (B) Moderate bone loss in the glenoid cavity after removal of polyethylene-glenoid. (C) Glenoid cancellous bone grafting with an iliac crest. (D) A cemented polyethylene-glenoid is reimplanted with bone graft.

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  Figure 5 (A) Loose glenoid component (arrow) with rotator cuff deficiency and loose humeral component after anatomical total shoulder arthroplasty. (B, C) Cancellous and cortical bone grafts in the glenoid cavity for large bone defect after removal of polyethylene-glenoid and humeral component. (D) Revision to a reverse shoulder replacement.

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  Figure 6 (A) Fibrotic scar tissue is removed through the deltopectoral approach from the first approach. (B) Exposure of primary prosthesis after release of the subscapularis tendon from the lesser tuberosity. (C) Easy extraction of the humeral stem or cement removal and polyethylene-glenoid due to loose humeral stem. (D) Sufficient exposure of glenoid using retractors.

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  Figure 7 (A) If a cemented implant without any lucency or an uncemented implant with a long ingrowth surface has been placed, tensile forces imparted on the humerus during implant extraction may result in humeral fracture in areas of cortical thinning. (B) Osteotomy (arrow) or cortical window should be used in order to gain access to cement. (C) A high-speed burr and flexible osteotomes are used to disrupt implant fixation. Prosthesis can be malleted out with the use of long bone clamp placed underneath the implant collar.

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  Figure 8 (A) A central deficit (arrow) in the glenoid surface is grafted with cancellous bone graft from iliac crest. (B) If asymmetric defect of the peripheral aspect of the glenoid is existed, subchondral graft fixed with 2 screws (arrow) can be used for recontoured glenoid surface. (C) Then, anatomical total shoulder arthroplasty is reimplanted. (D) If bone deficit complicated in central and peripheral aspect is existed, glenoid cavity is filled with cortical-cancellous bone grafts (arrow). (E) Then, baseplate of reverse prosthesis is firmly reimplanted to stabilize the bone graft and increase the potential of healing bone.

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  Figure 9 (A) A periprosthetic fracture at the tip of a humeral component. (B) A plating and wiring for fixation. (C) A periprosthetic fracture at the distal portion of a humeral component. (D) Fixation using plate and screw with fibular strut allo-graft.

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  Figure 10 (A) A periprosthetic fracture at the tip of a humeral component and implant loosening (arrow) after reverse arthroplasty. (B) Comminuted fracture of humeral meta-diaphysis occurred during the extraction of humeral component. (C, D) Revision to a reverse shoulder replacement with a long-stem component to bypass the fracture and strut allo-graft.

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  Figure 11 (A) Late infection after rotator cuff repair. (B) Septic joint and osteomyelitis of the humeral head and the glenoid. (C) Insertion of PROSTALAC after resection of the humeral head and debridement. (D) Conversion to anatomical total shoulder arthroplasty.

Reference

1. Cofield RH, Edgerton BC. Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect. 1990; 39:449–462.

2. Bitzer A, Rojas J, Patten IS, Joseph J, McFarland EG. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27:2145–2152.

3. Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22:1359–1370.

4. Wirth MA, Rockwood CA Jr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996; 78:603–616.

5. Levine WN, Djurasovic M, Glasson JM, Pollock RG, Flatow EL, Bigliani LU. Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear. J Shoulder Elbow Surg. 1997; 6:449–454.

6. Rodosky MW, Weinstein DM, Pollock RG, Flatow EL, Bigliani LU, Neer CS 2nd. On the rarity of glenoid component failure. J Shoulder Elbow Surg. 1995; 4:Suppl 1. S13–S14.

7. Sanchez-Sotelo J, O'Driscoll SW, Torchia ME, Cofield RH, Rowland CM. Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg. 2001; 10:526–531.

8. Sanchez-Sotelo J, Wright TW, O'Driscoll SW, Cofield RH, Rowland CM. Radiographic assessment of uncemented humeral components in total shoulder arthroplasty. J Arthroplasty. 2001; 16:180–187.

9. Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001; (382):206–216.

10. Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am. 2009; 91:119–127.

11. Antuna SA, Sperling JW, Cofield RH, Rowland CM. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001; 10:217–224.

12. Sperling JW, Cofield RH. Revision total shoulder arthroplasty for the treatment of glenoid arthrosis. J Bone Joint Surg Am. 1998; 80:860–867.

13. Brems JJ. Complications of shoulder arthroplasty: infections, instability, and loosening. Instr Course Lect. 2002; 51:29–39.

14. Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K. Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elbow Surg. 2003; 12:1–5.

15. Dines JS, Fealy S, Strauss EJ, et al. Outcomes analysis of revision total shoulder replacement. J Bone Joint Surg Am. 2006; 88:1494–1500.

16. Favard L. Revision of total shoulder arthroplasty. Orthop Traumatol Surg Res. 2013; 99:S12–S21.

17. Neyton L, Sirveaux F, Roche O, Molé D, Boileau P, Walch G. [Results of revision surgery for glenoid loosening: a multicentric series of 37 shoulder prosthesis]. Rev Chir Orthop Reparatrice Appar Mot. 2004; 90:111–121.

18. Holcomb JO, Cuff D, Petersen SA, Pupello DR, Frankle MA. Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009; 18:717–723.

19. Donegan RP, Galatz LM. A review of humeral stem removal during revision shoulder arthroplasty. Semin Arthroplast. 2013; 24:33–38.

20. Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg. 2012; 21:342–349.

21. Bonnevialle N, Melis B, Neyton L, et al. Aseptic glenoid loosening or failure in total shoulder arthroplasty: revision with glenoid reimplantation. J Shoulder Elbow Surg. 2013; 22:745–751.

22. Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Instability after shoulder arthroplasty: results of surgical treatment. J Bone Joint Surg Am. 2003; 85:622–631.

23. Abboud JA, Anakwenze OA, Hsu JE. Soft-tissue management in revision total shoulder arthroplasty. J Am Acad Orthop Surg. 2013; 21:23–31.

24. Kumar S, Sperling JW, Haidukewych GH, Cofield RH. Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am. 2004; 86-A:680–689.

25. Cheung EV, Diaz R, Athwal GS, Sanchez-Sotelo J, Sperling JW. Shoulder arthroplasty: key steps to improve outcomes and minimize complications. Instr Course Lect. 2016; 65:109–126.

26. Horneff JG, Hsu JE, Huffman GR. Propionibacterium acnes infections in shoulder surgery. Orthop Clin North Am. 2014; 45:515–521.

27. Levy O, Iyer S, Atoun E, et al. Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg. 2013; 22:505–511.

28. Sabesan VJ, Ho JC, Kovacevic D, Iannotti JP. Two-stage reimplantation for treating prosthetic shoulder infections. Clin Orthop Relat Res. 2011; 469:2538–2543.

29. Abdel MP, Hattrup SJ, Sperling JW, Cofield RH, Kreofsky CR, Sanchez-Sotelo J. Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis. Bone Joint J. 2013; 95:668–672.

30. Wagner E, Houdek MT, Griffith T, et al. Glenoid bone-grafting in revision to a reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2015; 97:1653–1660.

31. Stephens BC, Simon P, Clark RE, et al. Revision for a failed reverse: a 12-year review of a lateralized implant. J Shoulder Elbow Surg. 2016; 25:e115–e124.

32. Elhassan B, Ozbaydar M, Higgins LD, Warner JJ. Glenoid reconstruction in revision shoulder arthroplasty. Clin Orthop Relat Res. 2008; 466:599–607.

33. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br. 2009; 91:75–81.

34. Valenti P, Kilinc AS, Sauzières P, Katz D. Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty. Eur J Orthop Surg Traumatol. 2014; 24:1375–1382.