These authors reviewed 29 patients having revision surgery for failed reverse total shoulder arthroplasty.
The average time between index RSA and revision was 2.3 years (30 days – 7 years).
The most common indications for revision surgery were aseptic loosening (13/29, 44.8%), instability (7/29, 24.1%), fracture (5/29, 17.2%), and infection (4/29, 13.7%). An example of baseplate loosening is shown below.
The Simple Shoulder Test (SST) improved from 2 to 6. ROM improved both for forward elevation from 76 degrees to 131 degrees and external rotation from 26 to 42.
Complications were seen in 10/29 patients (34.5%).Three patients had postoperative stiffness. Two patients sustained humeral shaft fractures after falls that were managed with revision of the humeral component and open reduction and internal fixation. Of these 2 patients, one had subsequent periprosthetic joint infection and underwent reoperation with irrigation and débridement and resection arthroplasty. One patient sustained an acromial fracture after a fall, which was successfully treated nonoperatively. One patient had a radial nerve palsy with little improvement at 13 months after surgery. One patient had notching and loosening of their glenoid component and underwent a second revision. Finally, one patient sustained a non-displaced greater tuberosity fracture that was treated non-operatively.
An example of a post-revision humeral periprosthetic fracture is shown below.
Comment: This article illustrates some of the complications of reverse total shoulder and some of the complications from trying to revise failed reverse total shoulders. Issues are fractures and progressive loss of bone stock.
