These authors identified 28 patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty and had a minimum of 2 years’ follow-up after revision surgery.
The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants: mean American Shoulder and Elbow Surgeons score 78 ± 20, visual analog scale score for pain 2.3 ± 2.6,, and Single Assessment Numerical Evaluation score 71 ± 24.
There were 3 intraoperative complications (11%) at the time of conversion from failed HA to aTSA, including fracture (humeral shaft in 1 and greater tuberosity in 1) and iatrogenic rotator cuff tear (1). There were 10 postoperative complications (36%), including subscapularis failure (3), infection (1), humeral component loosening (1), hemarthrosis (1), lesser tuberosity nonunion (1), brachial plexus injury (1), glenoid loosening (1), and posterior-superior rotator cuff tear (1). Thus, in total, 13 intraoperative and postoperative complications occurred, giving an overall complication rate of 46%.
Following revision to aTSA, reoperation was required in 6 patients (21.4%). Reoperations involving component revision included humeral stem revision (2), arthroscopic glenoid excision (1), reverse shoulder arthroplasty (RSA) (1), and cement spacer placement (1).
Comment: This article points out that revision of a failed arthroplasty carries substantial risk of intraoperative and postoperative complications. Thus it is important to recognize and, when possible, avoid the need for revision as discussed in a recent article, "Primary Shoulder Hemiarthroplasty: What Can Be Learned From 359 Cases That Were Surgically Revised?" It is not always easy to determine the cause of a painful hemiarthroplasty. While it is tempting to attribute a hemiarthroplasty failure to "glenoid arthrosis", a painful hemiarthroplasty can also result from instability, stiffness, component malposition, subscapularis failure, cuff disease, and low grade infection. Each of these failure modes calls for different management strategies, so a careful preoperative assessment is essential to a successful revision.
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