How long do reverse total shoulder replacements last?

How long do reverse total shoulder replacements last?

Shoulder Q&A with Dr. Brent J. Morris, MD a shoulder and elbow specialist in Lexington, Kentucky at Baptist Health Lexington Orthopedics and Sports Medicine.  Dr. Morris has additional interest in shoulder replacement surgery and revision shoulder replacement surgery, including reverse total shoulder replacement surgery.

Who is Dr. Brent J. Morris?

Dr. Brent J. Morris is an orthopedic shoulder and elbow surgeon in Lexington, Kentucky at Baptist Health Lexington Orthopedics and Sports Medicine. Dr. Morris is a fellowship-trained shoulder and elbow specialist with additional interest in total shoulder replacement surgery and reverse total shoulder replacement surgery. Dr. Morris is co-author of a textbook devoted to total shoulder replacement surgery and reverse total shoulder replacement surgery, Shoulder Arthroplasty, 2^nd Edition.

How long will my reverse total shoulder replacement last?

Dr. Morris: That is a great question and something that shoulder replacement experts are constantly working on to improve the durability of reverse total shoulder replacements.  Shoulder replacement specialists have worked on different surgical techniques and new shoulder replacement implant designs to try to improve the longevity of implants and improve patient outcomes after reverse total shoulder replacement.

Current literature would indicate good implant survivorship with at least 10 years of follow-up after the original reverse total shoulder replacement surgery.

Dr. Gilles Walch and his team in Lyon, France reported 10- year minimum follow-up on 84 patients and showed an implant survivorship of 93% meaning that of the patients that were available for 10-year follow-up, 93% of them still had their reverse total shoulder replacement in place.

Dr. Mark Frankle and his team in Tampa, Florida reported on 10-year minimum follow-up on 42 patients and showed an implant survivorship of 90.7% meaning that of the patients that were available for 10-year follow-up, 90.7% of them still had their reverse total shoulder replacement in place.

These two very important studies date back to the early 2000s.  Fortunately, many improvements have been made over the years with regards to surgical preoperative planning, surgical technique, and implant design to hopefully improve patient results and improve implant durability.  The reverse total shoulder replacement was not approved by the FDA in the United States until November of 2003, so long-term results of reverse total shoulder replacement in the US are still sparse at this time.

Will my reverse total shoulder replacement be as good at 10 years as it was when it was first completed?

Dr. Morris: Some of the work cited above by Dr. Gilles Walch and his team would indicate that the outcomes could decrease some over time.  For example, his team noted that some patients did not have quite the same function with their shoulder after 10 years as they did at mid-term follow-up. 

The team attributed the findings to patient aging with bone erosion over time and deltoid muscle impairment over time.  Time will tell as more research reports emerge to chronicle data beyond 10 years.

What happens if my reverse total shoulder replacement has any issues – pain, etc.? What are my options? Can it be replaced again?

Dr. Morris: Surgery after a prior total shoulder or reverse total shoulder replacement is called a “revision” total shoulder replacement where the original parts are revised. 

Unfortunately, patients can sometimes run into challenges following total shoulder replacement or reverse total shoulder replacement surgery.  Persistent pain after a shoulder replacement needs to be evaluated by a shoulder replacement specialist to determine the cause of pain. 

Infection, instability (dislocation of the shoulder components), wearing of the shoulder components over time, fracture, rotator cuff tears, and shoulder component loosening are some of the potential causes of pain after shoulder replacement.  These more serious causes of pain may eventually lead to a second surgery or “revision” shoulder replacement surgery.

Fortunately, some pain after shoulder replacement can be attributed to muscle soreness (especially the deltoid muscle after reverse shoulder replacement) or scapular muscle soreness or scapular “dyskinesis” or abnormal scapular motion.  These muscular causes of pain can be treated very successfully with physical therapy exercises. 

How do I know if I need a revision shoulder replacement surgery?

Dr. Morris: My Revision Shoulder Replacement Pathway includes a thorough history, clinical examination, x-rays in the office, a CT scan or CT arthrogram, and an infection work-up.

Revision Shoulder Replacement Pathway:

1. History – thorough patient history to review prior surgical and clinical notes
2. Physical examination to determine the source of pain or dysfunction
3. X-rays in the office included templated films of both arms
4. CT scan or CT arthrogram
5. Infection work-up to rule out the presence of an infection – aspiration or the joint for fluid, blood work (ESR, CPR and CBC with differential)

For more information on “revision” shoulder replacement surgery visit:

https://www.brentmorrismd.com/blog/revision-shoulder-arthroplasty-an-introduction

https://www.brentmorrismd.com/blog/revision-shoulder-replacement-surgery

Are there alternatives to reverse total shoulder replacement if I want to avoid surgery?

Dr. Morris: Surgery with reverse total shoulder replacement is optional.  The decision-making process to pursue surgical or non-surgical treatment shoulder be undertaken with consultation with a shoulder replacement specialist and discussion with your family.   These steps are important to help make this important decision. 

Some alternatives to surgery include:

Selective rest and activity modifications are recommended while the shoulder recovers.  These measures are a reminder that you still have shoulder pain and “no pain, no gain” doesn’t apply.  You need time to allow your shoulder to recover.

Counseling is an important piece of the recovery process.  You have to have a good understanding of your diagnosis and treatment plan.  You need to be sure to have all of your questions answered and have a way to seek follow-up care or a way to have your questions answered along the way.  You should have a good idea of the upsides and downsides of both surgical and non-surgical treatment.

NSAIDs like all medications do have risks and side effects, but they can provide some relief of pain caused due to inflammation in the shoulder.  NSAIDs should be discussed with you shoulder specialist prior to taking these medications.  NSAIDs do not heal the tear, but can help relieve some of the pain and inflammation in the shoulder.

A corticosteroid injection is an option to consider, but I emphasize that this is a short-term pain relief option and generally NOT recommended if the patient does desire to proceed with surgical intervention.  If surgery is out the question then a single corticosteroid injection can be considered.

Physical therapy can be an option to help with pain.  We focus on scapular stabilization exercises and deltoid strengthening to recruit other muscles to assist in shoulder function.

Follow-up is generally recommended to closely monitor symptoms and progression of the symptoms over time and surgery may still need to be considered.

Surgery with a reverse total shoulder replacement was recommended.  Should I consider a second opinion before my reverse total shoulder replacement surgery? 

Dr. Morris: A second opinion is not always necessary, but it can be very helpful to seek a second opinion from a reverse total shoulder replacement specialist to gather more information to help you during this important decision.  A reverse total shoulder replacement is a particularly complex operation with a unique set of complications. 

The complications have been greatly diminished over the years with improved preoperative planning, newer surgical techniques and improved implant design; however, it is important that you seek out an orthopedic shoulder specialist with additional training with reverse total shoulder replacement.    

What if reverse shoulder replacement surgery is recommended, but I am not ready for surgery yet?

Dr. Morris: There are some conditions that are better served by proceeding with surgery more urgently and an orthopedic shoulder replacement specialist can help you to determine which conditions fit that category. Fortunately, many conditions that necessitate reverse total shoulder replacement are more chronic and the timing does provide some flexibility. 

Close follow-ups and symptom monitoring are critical and a repeat shoulder imaging would likely be needed depending upon how much you postpone the surgery.  A shoulder replacement specialist can help assist you when making these decisions.

For more information about reverse total shoulder replacement, visit online at https://www.brentmorrismd.com/services/reverse-shoulder-replacement