Revision Shoulder Arthroplasty
CHAPTER 35
Below are a few excerpts from Shoulder Arthroplasty 2nd Edition for a full read please download the E-edition or check out the complete version at https://www.elsevier.com/books/shoulder-arthroplasty/edwards/978-0-323-53164-1
Shoulder Arthroplasty 2nd Edition
Authors: T. Bradley Edwards and Brent J. Morris
Hardcover ISBN: 9780323529402
eBook ISBN: 9780323531641
eBook ISBN: 9780323531658
Imprint: Elsevier
Published Date: 5th February 2018
Page Count: 544
Revision Shoulder Arthroplasty
CHAPTER 35
Indications and Contraindications
Just as with hip and knee arthroplasty, as the volume of shoulder arthroplasties performed each year increases, so will the number of patients requiring revision shoulder arthroplasty. Indications for performing revision shoulder arthroplasty are variable and numerous and can include problems related to the glenoid, problems related to the humerus, and problems related to the soft tissues (rotator cuff, instability). Rarely, infection, either early postoperative or late-appearing hematogenous, is an indication for revision arthroplasty. Complications related to healing of the greater and lesser tuberosities can be observed after unconstrained shoulder arthroplasty performed for proximal humeral fractures. Finally, certain periprosthetic humeral fractures are an indication for revision shoulder arthroplasty. This chapter details our specific indications and contraindications for revision shoulder arthroplasty.
PROBLEMS RELATED TO THE GLENOID
Problems related to the glenoid are the most common indications for revision shoulder arthroplasty in our practice. One category consists of patients with problems of their native glenoid (glenoid erosion following hemiarthroplasty), and a second category includes patients who have problems with a previously placed glenoid component following total shoulder arthroplasty.
Glenoid Erosion
Glenoid Component Failure
Reverse Glenoid Component
PROBLEMS RELATED TO THE HUMERUS
Humeral component problems requiring revision surgery are much less common than glenoid problems. Specifically, aseptic loosening of both unconstrained and reverse humeral components is rare. More commonly, revision surgery for a humeral component problem results from positioning or size of the humeral component.
Unconstrained Humeral Components
Reverse Humeral Components
PROBLEMS RELATED TO SOFT TISSUE
Soft tissue problems necessitating revision shoulder arthroplasty can be divided into those related to instability and those related to the rotator cuff. These problems often occur concomitantly because rotator cuff insufficiency can lead to glenohumeral prosthetic instability.
Subscapularis Problems
Other Rotator Cuff Problems
Instability
INFECTION
Infections after shoulder arthroplasty can be divided into perioperative (within 6 weeks of surgery) and late (hematogenous) infections. Early perioperative infections are initially treated with two or three irrigation and débridement procedures, retention of the fixed components and exchange of any nonfixed modular components (i.e., polyethylene liner, humeral head). At the last planned irrigation and débridement procedure, absorbable antibiotic-impregnated beads (Stimulan, Biocomposites, Inc., Staffordshire, England) are placed in the soft tissues around the shoulder, and the final nonfixed components are replaced. Consultation with an infectious disease specialist is obtained, and a minimum of six weeks of intravenous antibiotics tailored to the specific organism causing the infection (or covering the most likely offending organisms, if cultures remain negative despite obvious infection) is usually recommended. If this regimen fails, prosthetic removal ensues followed by staged revision or resection arthroplasty depending on the specific circumstances of the patient.
Late-appearing infections are treated by removal of the prosthesis, placement of antibiotic spacer, and intravenous administration of antibiotics. The decision whether to place a revision shoulder arthroplasty or continue with a resection arthroplasty is patient specific. Revision arthroplasty can be considered as a second stage after appropriate treatment of the infection.
SPECIAL SITUATION—TUBEROSITY PROBLEMS AFTER UNCONSTRAINED ARTHROPLASTY FOR FRACTURE
Tuberosity malunion and nonunion after unconstrained shoulder arthroplasty for proximal humeral fracture are an indication for revision shoulder arthroplasty with a reverse-design prosthesis. Our experience in achieving reliable tuberosity union once tuberosity migration has occurred has not been favorable.
PERIPROSTHETIC FRACTURE
Displaced periprosthetic fractures not amenable to nonoperative treatment or treatment by open reduction and internal fixation because of inability to achieve adequate fixation proximally are an indication for revision shoulder arthroplasty. In this scenario, we believe it best to remove the existing humeral stem and revise to a long-stem humeral component to act as an intramedullary fixation device. This is combined with allograft struts placed peripherally at the fracture site and fixated with cerclage cables. In addition to this scenario, any periprosthetic fracture in which the humeral stem is loose is an indication for revision of the humeral component via the same technique.
Thank you for reading the excerpts from Shoulder Arthroplasty 2nd Edition for a full read please download the E-edition or check out the complete version at https://www.elsevier.com/books/shoulder-arthroplasty/edwards/978-0-323-53164-1
Shoulder Arthroplasty 2nd Edition
Authors: T. Bradley Edwards and Brent J. Morris
Imprint: Elsevier
Published Date: 5th February 2018
Page Count: 544
About Dr. Morris:
Dr. Brent J. Morris is a board-certified orthopedic surgeon and fellowship-trained shoulder and elbow specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine. Dr. Morris is a fellow of the American Academy of Orthopedic Surgeons (FAAOS) and an Active Member of American Shoulder and Elbow Surgeons (ASES). Dr. Morris and his research team have published extensively on shoulder surgery and ways to improve outcomes and patient satisfaction following surgery. He is co-author of a textbook devoted to total shoulder, reverse total shoulder replacement surgery, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2ndEdition (https://www.elsevier.com/books/shoulder-arthroplasty/edwards/978-0-323-53164-1).
For more information about Dr. Morris, visit online at www.brentmorrismd.com.
Brent J. Morris, MD
Board-Certified Orthopedic Surgeon
Orthopedic Shoulder and Elbow Surgeon
Shoulder Replacement and Revision Shoulder Replacement Specialist
Baptist Health Lexington – Orthopedics and Sports Medicine
Fellow American Academy of Orthopaedic Surgeons (FAAOS)
Active Member American Shoulder and Elbow Surgeons (ASES)
