Monday, March 14, 2016

The complications of revision arthroplasty - a cautionary tale

Revisions of total shoulder arthroplasty: Clinical results and complications of various modalities.

These authors reviewed thirty-seven patients having revision shoulder athroplasty, with a mean age of 68.3±11.8 years at time of implant replacement.  The mean interval between primary arthroplasty and revision was 78.4±59.7 months (range, 1-200 months). Mean follow-up was 41.5±32.0 months (range, 12-105 months).

While there was a modest clinical improvement, intraoperative complications occurred in 24.3% of patients (9/37) and postoperative complications in 29.7% (11/37). 21.6% (8/37) required re-operation for postoperative complications. Overall, 54% of patients (20/37) suffered from intra- or postoperative complications.

Comment: While this is not a large series, it is useful in pointing out the complexities and complications of revision arthroplasty. The intraoperative complications included greater tuberosity and diaphyseal fractures. The postoperative complications included instability, infection, periprosthetic fracture, fixation failure, and unexplained pain. There were also complications related to the harvest of iliac crest grafts.

Some examples are shown below
Infection and fracture

Infection and component loosening

Diaphyseal Fracture

Rotator cuff failure

Glenoid and humeral component loosening


Prosthesis failure