These authors compared the rate of (2nd) revision following aseptic 1st revision shoulder arthroplasty. They found an increased risk of 2nd revision in the 1st month only for the rTSA group (n = 700) compared with the non-rTSA group (n = 991); hazard ratio (HR) = 4.8 (95% CI 2.2–9). The cumulative percentage of 2nd revisions (CPR) was 24% in the rTSA group and 20% in the non-rTSA group at 8 years.
Collectively, the diagnoses of instability/dislocation, loosening, and infection accounted for 85% of 2nd revision procedures in the rTSA group, and 68% in the non-rTSA group.
Comment: It is indeed revealing that the re-revision rate is so high. As a result the cost to the patient and to society of revision arthroplasty is substantially higher that what would be estimated from the first revision. Surely some patients require re-re-revisions. Each repeat procedure risks further compromise of the bone and soft tissues and increases the risk of infection. There is a premium for getting it right the first time!
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