These authors reviewed the published literature on revision arthroplasty. The indications for the index procedure and the revisions are shown below.
The most common revision indication overall was rotator cuff tear, deficiency, or arthropathy. The average time to revision was 4 years.
The complication rate for all revisions was 17%. There were a total of 465 complications, and of those, 74% lead to a reoperation.
Comment: These data require surgeons to examine their indications and technique for index arthroplasty, e.g. in the case of arthroplasty for fracture is it more appropriate to use a reverse total shoulder than a hemiarthroplasty, in the case of arthroplasty in the presence of a tenuous rotator cuff is it more appropriate to use a reverse total shoulder than an anatomic total shoulder? In cases of glenoid component failure, was the surgical technique good, was the failure secondary to cuff failure? When revising a failed arthroplasty, how can the risk of component loosening, fracture instability and infection be minimized?
Here's a related article
Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016
Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
Here's a related article
Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016
Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements.
These authors 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.
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%).
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%).
For anatomic shoulder arthroplasties, the failure modes have not appreciably changed over recent years
For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%).
For reverse shoulder arthroplasties, the failure modes have not appreciably changed over recent years
Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers.
The authors conclude that the Food and Drug Administration database reveals modes of shoulder arthroplasty failurethat 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. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
The authors conclude that the Food and Drug Administration database reveals modes of shoulder arthroplasty failurethat 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. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
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To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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