These authors analyzed the epidemiology, etiologies, and revision options for 540 failed shoulder arthroplasties: 224 hemiarthroplasties (HAs), 237 anatomic total shoulder arthroplasties (TSAs) and 81 reverse total arthroplasties (RSAs) .
The indications for the initial arthroplasties differed by type of arthroplasty as shown below.
The indications for the first revision differed by type of arthroplasty as shown below.
Glenoid failure was a major indication for reoperation: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs.
An important finding of this study was the high rate of multiple revisions (21%) performed in the same patients, mainly attributable to unresolved soft-tissue insufficiency (26%) and/or infections (25%) as well as humeral bone loss; these may coexist with mechanical complications (glenoid or humeral loosening, instability).
The final implant was often an RSA, which has the potential to address combined bone and soft-tissue deficiencies.
Comment: The study of implant failure is vital to our understanding how we can do a better job of shoulder arthroplasty. The findings of this study need to be compared to those in three recent large studies, not included in the reference list:
Primary Shoulder Hemiarthroplasty: What Can Be Learned From 359 Cases That Were Surgically Revised?
What can be learned from an analysis of 215 glenoid component failures?
Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016
The authors of the third of these articles point out that most of the literature on shoulder arthroplasty failure comes from high-volume centers and that these reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
They analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery.
The percentage distribution among the different failure modes was relatively consistent over the years of this study. Thus the question, "are we learning anything from these failures?"
For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%).
They concluded that the publicly available Food and Drug Administration database reveals modes of shoulder arthroplasty failure that are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty.
This study points to the utility of the freely accessible FDA MAUDE database as a resource for identifying failure modes for shoulder arthroplasty not readily identified in the published literature. Some modes of failure appear in the MAUDE data base long before they appear in the published literature, such as the dissociation of the glenosphere from the the baseplate as shown below.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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