Things to know:
- Shoulder joint is one of the most complex and largest joints of your body. There are several different bones, ligaments, tendons, and cartilages that may experience loss of functionality due to ageing, injury, or a medical condition.
- Shoulder replacement surgery helps in restoring the maximum function of a shoulder joint. It is a procedure in which the damaged parts of a shoulder joint are replaced with metal and hard plastic components called a prosthesis.
- Revision shoulder replacement is a surgery that is performed when the initial shoulder replacement fails. A shoulder arthroplasty may fail due to infection, loosening of the components of the prosthesis, fracture, and scar tissue.
Revision shoulder replacement surgery
Revision shoulder replacement (also known as shoulder arthroplasty) is a second surgery done to repair the effects of a shoulder replacement surgery.
Shoulder replacement is a surgical procedure in which your orthopaedic surgeon removes the damaged or diseased part of the shoulder joint (bones and cartilage) and replaces it with a new, artificial joint implant known as shoulder prosthesis. This surgery is indicated for long-term relief from a range of conditions including osteoarthritis, rotator cuff tear, avascular necrosis, and rheumatoid arthritis.
Shoulder replacement is an effective surgery, however, in some cases, a patient is unable to yield best possible outcomes. In these cases, a revision shoulder replacement surgery can be indicated.
Anatomy of the shoulder
Your shoulder is one of the largest and most complex joints in your body. There are two main joints in the shoulder – glenohumeral and acromioclavicular.
Glenohumeral joint is a ball and socket joint made up of the upper arm bone that fits into the shoulder blade. This joint is supported by a group of muscles and tendons known as the rotator cuff. The acromioclavicular joint is the junction of the collar bone with the shoulder blade.
The full range of motion of the shoulder joint occurs when the glenohumeral joint, acromioclavicular joint, rotator cuff, shoulder capsule and other muscles, tendons and ligaments function properly.
Why is a revision shoulder replacement needed?
Revision shoulder replacement surgery is required when the primary shoulder replacement has failed. The first surgery is deemed ineffective when the outcomes of the surgery are not in line with the expectations of the patient and the surgeon.
It is usually indicated when a patient experiences stiffness, weakness, instability, pain, and a delayed or failed healing from the shoulder replacement surgery. These symptoms can develop due to a range of complications and cause the shoulder replacement to fail.
Common causes for the failure of shoulder replacement leading to a revision replacement include:
- Nerve injury
- Loosening or mispositioning of the prosthesis
- Formation of scar tissue
- Progressive wear of the components
- Subsequent rotator cuff tear
Who can seek revision shoulder replacement?
Patients who have not benefited from a shoulder replacement surgery and continue to feel debilitating symptoms should seek evaluation from their orthopedic surgeon.
If you are experiencing shoulder pain, functional deficits like stiffness, reduced or loss of range of motion, and a negative impact on the quality of life after shoulder replacement, you should seek revision shoulder replacement surgery.
Preparing for revision shoulder replacement
Your healthcare provider will be able to detect your symptoms during follow-up care. Your doctor will thoroughly examine your overall health and discuss your symptoms.
He/she will review your medical history and order a few diagnostic tests and scans to understand the cause of your discomfort and hence the possible cause of replacement failure. Common tests done to diagnose the need for a revision shoulder replacement include blood tests, X-ray, bone density tests and CT scans. These tests will help your surgeon clearly visualize your prosthesis and watch for any wear or loosening.
Your surgeon will ask you a range of questions about your health after surgery such as about the onset of symptoms, and loss of function.
Based on the results of the tests and scans, your healthcare provider will evaluate the underlying cause of replacement failure.
What happens during the surgery
The steps of a revision shoulder replacement are dependent on the underlying cause of the failure. The objective of this surgery is to repair the components that led to the failure of a shoulder replacement surgery.
In some cases, your orthopedic surgeon may remove and replace the implant while at other times, he/she may implant a reverse shoulder prosthesis in order to maximize the function of the shoulder blade. In other cases, your orthopaedic surgeon may use a bone graft from your hip or donor to substitute the missing bone from previous surgery. A revision shoulder replacement may also be caused by an infection. In this case, your healthcare provider removes the components of shoulder prosthesis and treats the affected area with antibiotics.
Recovering from revision shoulder replacement
Your recovery will be based on your overall health, extremity of symptoms and cause of shoulder replacement failure. Your healthcare provider will guide you towards recovery with physical therapy and home exercises.
Yes, a reverse shoulder replacement surgery can be revised. A reverse shoulder replacement can cause varying complications including nerve damage, infection and dislocation. These complications can be corrected with reverse shoulder revision.
While shoulder replacement is a safe and effective surgery, sometimes, it can fail. A shoulder replacement surgery can cause stiffness, weakness, instability, pain, failure to heal, and loss of motion.
The time taken to perform a shoulder revision surgery is dependent on the cause of the surgery as well as the patient’s overall health. On average, a shoulder revision takes up to 3-6 hours.