Failed Shoulder Replacement and Revision

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Shoulder joint replacement arthroplasty may fail to produce the desired result. Often these failures can be improved by rehabilitation or revision surgery

Edited By Frederick A. Matsen III, M.D., Professor, UW Orthopaedics & Sports Medicine Frederick A. Matsen III, M.D.

Last updated: December 12, 2013

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Causes of failure of shoulder joint replacement

Shoulder joint replacement is a technically complex procedure. The results of shoulder joint replacement are often excellent, but failure of shoulder arthroplasty can result because of persistent pain, stiffness, infection, component loosening, fracture, component malposition, instability, rotator cuff failure or other causes.

We have had the opportunity to treat many individuals from around the U.S. who have had unsatisfactory results from prior shoulder joint replacement. Our approach is outlined on the shoulder blog.

A few examples of the specifics of this approach are shown here.

Failed Unsatisfactory Shoulder Joint Arthroplasty - stiffness

As noted above stiffness is a common feature among unsatisfactory shoulder joint replacements. By stiffness we mean that the shoulder is not capable even with the help of the other arm to move through a normal range of motion. Arthritic shoulders are usually stiff so it is not surprising that stiffness may remain a problem even after joint replacement.

This is why we are so interested in early post-surgical rehabilitation to maintain the range of motion achieved at surgery. In a technically well-done arthroplasty range of motion is usually restored and maintained by these rehabilitation exercises.

If a shoulder stays or becomes stiff after a shoulder arthroplasty and if it does not respond to a good rehabilitation program revision surgery may be considered to re-release the soft tissue check to make sure no blocking osteophytes are present and assure that the humeral head is of the proper size. There are several surgical principles that are important to re-establishing motion to a stiff arthritic shoulder. First is that the tight capsule around the joint must be released by sharp dissection as shown in figure 1.

Second is that the bone spurs (osteophytes) be removed to make sure they do not block motion. (See figure 2).

And finally the surgeon must avoid 'overstuffing' the joint by inserting such a large humeral head that the soft issues are put under excessive tension (bottom of the figure 3) rather than one that puts the soft tissues under normal tension (top of figure 3).

At surgery we optimize the shoulder range of motion by assuring that the joint is capable of 40 degrees of external rotation (See figure 4).

50% posterior translation (See figure 5).

And 60 degrees of internal rotation with the arm out to the side.

We refer to these as the 40 50 60 rules for achieving ideal soft tissue balance and avoiding an unsatisfactory arthroplasty because of intraoperative causes of stiffness. A good rehabilitation program is still essential to a good result.

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Figure 1
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Figure 2
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Figure 3
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Figure 4
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Figure 5

More on revision surgery
Revision surgery for failed total shoulder arthroplasty
Differential diagnosis of failure
Principles of revision surgery
Surgical considerations
Revision for stiffness
Revision for stiffness – part 2
Revision for weakness
Revision for infection
Revision for humeral fracture
Revision for glenoid failure
Revision for glenoid failure – part 2
Revision for glenoid failure – part 3
Revision for superior instability
Revision for humeral component failure

Shoulder & Elbow Articles

  1. About the Mechanics of Shoulder Stability.
  2. Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.
  3. Arthroplasty in Cuff Tear Arthropathy: Surgery for shoulders with a rotator cuff tear and arthritis can lessen shoulder pain and improve function with joint replacement.
  4. Atraumatic Shoulder Instability.
  5. Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals.
  6. Basics of failed shoulder surgery, complications of shoulder surgery and revision shoulder surgery
  7. Chondrolysis
  8. Clinical Presentation and Evaluation of Glenohumeral Arthritis.
  9. Clinical Presentation of Glenohumeral Instability.
  10. Compartmental Syndromes.
  11. Diagnosis of Capsulorraphy Arthropathy.
  12. Diagnosis of the Frozen Shoulder.
  13. Evaluation of Recurrent Instability.
  14. Evaluation of the Rough Shoulder.
  15. Evaluation of the Stiff Shoulder.
  16. Evaluation of the Weak Shoulder.
  17. Examination Under Anesthesia.
  18. Failed Shoulder Replacement and Revision.
  19. Glenohumeral Arthritis References.
  20. Home Exercises for the Rough Shoulder.
  21. Home Exercises for Stiff Shoulder
  22. Home Exercises for the Unstable Shoulder.
  23. Home Exercises for the Weak Shoulder.
  24. Humeroscapular Positions and Motion.
  25. Humerothoracic Positions and Motion.
  26. Injuries Associated with Anterior Dislocations.
  27. Intermediate Shoulder Instability.
  28. Management of Glenohumeral Arthritis.
  29. Mechanics of Glenohumeral Arthritis.
  30. Mechanics of Glenohumeral Arthroplasty.
  31. Mechanics of Glenohumeral Instability.
  32. Mechanics of Shoulder Strength.
  33. More Information on Rotator Cuff Surgery.
  34. Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.
  35. Ream and Run for Shoulder Arthritis: Conservative Reconstructive Surgery for Selected Individuals Desiring Higher Levels of Activity than Recommended for Traditional Total Shoulder Joint Replacement
  36. Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
  37. Rehabilitation after Shoulder Arthroplasty.
  38. Rehabilitation following shoulder joint replacement arthroplasty
  39. Relevant Anatomy of Glenohumeral Instability.
  40. Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
  41. Reverse Shoulder Replacement (Delta joint replacement) for arthritis: Surgery with a reverse prosthesis can lessen shoulder pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability.
  42. Reverse Total Shoulder or Delta Shoulder for Shoulder Arthritis Combined with Massive Rotator Cuff Tear and for Failed Conventional Total Shoulder Replacement
  43. Rotator Cuff Clinical Presentation.
  44. Rotator Cuff Differential Diagnosis.
  45. Rotator Cuff Failure.
  46. Rotator Cuff Historical Review.
  47. Rotator Cuff Imaging Techniques.
  48. Rotator Cuff Relevant Anatomy and Mechanics.
  49. Rotator Cuff Tear: When to Repair and When to Smooth and Move the Shoulder
  50. Rotator Cuff Treatment.
  51. SF 36 and Health Status.
  52. Scapulothoracic Positions and Motion.
  53. Shoulder Arthritis
  54. Shoulder Arthritis Book
  55. Shoulder and Elbow Cases to Consider.
  56. Shoulder arthritis and rotator cuff tears: The combination of arthritis and rotator cuff tears is called rotator cuff tear arthropathy. The management of this condition requires thought and experience.
  57. Shoulder arthritis: Osteoarthritis, Chondrolysis, Rheumatoid Arthritis, Degenerative joint disease, and arthritis after shoulder surgery.
  58. Shoulder joint replacement arthroplasty for shoulder arthritis pain and stiffness: two options: total shoulder and ream and run
  59. Shoulder osteoarthritis, chondrolysis, rheumatoid arthritis, degenerative joint disease, and arthritis after shoulder arthroscopy and open surgery
  60. Simple Shoulder Test.
  61. Subacromial Smoothing.
  62. Surface replacement for shoulder arthritis: Surgery with a CAP, a special type of conservative resurfacing joint replacement that resurfaces the ball of the ball and socket joint, can lessen pain and improve function.
  63. Surgery for Atraumatic Instability of the Shoulder.
  64. Surgical release for stiff frozen shoulders: Surgery to remove scar tissue and release contractures can lessen pain and improve function for stiff shoulders that have not responded to rehabilitation or physical therapy.
  65. Total Shoulder Replacement Arthroplasty for Shoulder Arthritis
  66. Total elbow joint replacement for elbow arthritis: Surgery with a dependable, time-tested prosthesis can lessen pain and improve function in elbows, especially in rheumatoid arthritis of the elbow
  67. Total shoulder joint replacement for shoulder arthritis: Surgery with a dependable, time-tested conservative prosthesis and accelerated rehabilitation can lessen pain and improve function in shoulders with arthritis.
  68. Traumatic Shoulder Instability.
  69. Treating Shoulder Dislocation / Subluxation (Instability) and Associated Pain with Minimally Invasive Arthroscopy
  70. Treatment of Recurrent Instability.
  71. Types of Glenohumeral Instability.