Revision Arthroplasty Procedures

November 9th, 2008

Shoulder arthroplasty may be performed for arthritis, following fracture, to treat rotator cuff arthropathy or avascular necrosis. In some cases only the humerus is replaced--"hemiarthroplasty". When arthritis involves the glenoid as well, a totol shoulder is typically performed.

When a hemiarthroplasty has been peformed, the glenoid cartilage may wear out with time, necessitating revision--glenoid replacement--that is, revision to a total shoulder. If a total shoulder has been performed already, and the glenoid component loosens, this may need to be revised.

In cases following hemiarthroplasty for fracture, component malpositioning may result in stiffness, poor function and pain. In cases where a shoulder replacment is unstable or where function of the rotator cuff deteriorates due to tears or atrophy, revison may be needed.

Now that reversed shoulder designs are available, these allow revison for cases where pain relief and functional improvement are desired. These nonanatomic prostheses "replace" the rotator cuff, provide stability via a more constrained implant, and allow single stage revision/bone-grafting of the glenoid, when necessary. In cases where humeral bone loss has occurred, reconstruction may require the use of allograft bone.

In summary, when one's 1st shoulder arthroplasty has not been successful in restoring function, revision may be feasible.

Related Photos:

This patient had 7 operations and has no forward elevation, instability, an in tact deltoid only, and significant bone loss.

Axillary lateral shows a chronically dislocated prosthesis. Revision to a reversed prosthesis was recommended with single stage glenoid reconstruction using the "Norris" technique and humeral allograft reinforced with tibial struts.

Postoperative xray

Intraoperative photo after placement of reversed prosthesis into humeral allograft bone

Related Videos:

Intraoperative video shows stability of the reversed shoulder before repair of the deltoid to the humeral allograft