Revision Shoulder Replacement Surgery

What is Revision Total Shoulder Replacement Surgery?

What are your options if you have already had a shoulder replacement and you are having trouble with it? Are you having pain after a total shoulder replacement?

Shoulder Q&A with Dr. Brent J. Morris, MD a shoulder replacement specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine.

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 primary and revision total shoulder replacement surgery.

Dr. Morris is co-author of a textbook devoted to total shoulder, reverse total shoulder, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2^ndEdition.

Question: What are some potential causes of pain following total shoulder or reverse total shoulder replacement surgery?

Dr. Morris: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.

Some potential sources of pain after shoulder replacement surgery:

Instability (dislocation of the shoulder components)
Infection (this can happen early after the surgery or even years later)
Wearing of the shoulder components over time
Fracture (a subtle stress fracture or a more severe fracture after a fall)
Rotator cuff tear
Shoulder component loosening
Muscle soreness or scapular muscle sore/imbalance (“scapular dyskinesis”)

Question: 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:

History – thorough patient history to review prior surgical and clinical notes
Physical examination to determine the source of pain or dysfunction
X-rays in the office included templated films of both arms
CT scan or CT arthrogram
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)

Question: What are my options if I need surgery after a prior total shoulder replacement?

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.

Question: Do all of the prior total shoulder replacement parts have to come out/be replaced?

Dr. Morris:Often the prior shoulder replacement parts do need to be removed and replaced with newer components, but some of the newer designed components are “convertible” and do not have to be removed. A shoulder specialist will be able to review your x-rays and often determine whether the parts will need to be removed/replaced, but sometimes the decision needs to be made at the time of surgery.

Question: How does a revision shoulder replacement compare to the first replacement or the “primary” surgery?

Dr. Morris: Revision shoulder replacement surgery is much more complicated than the first surgery or “primary” surgery and requires a lot more planning before, during, and after the surgery. Primary surgeries are much more common and straightforward.

Revision surgeries are much more complicated and have a higher risk of complications. Sometimes more than one revision surgery will be needed depending upon the severity of the problem. It is important to seek out a revision shoulder replacement specialist to perform your revision shoulder replacement surgery.

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, 2^ndEdition (https://www.elsevier.com/books/shoulder-arthroplasty/edwards/978-0-323-53164-1).