Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty

Abstract

Purpose of Review The incidence of shoulder arthroplasty is increasing dramatically for primary arthroplasty but also for revision arthroplasty. Revision to reverse total shoulder arthroplasty is increasingly the salvage operation for failed primary arthroplasty. The purpose of this review is to explore the indications for and results of revision reverse total shoulder arthroplasty. Recent Findings Despite relatively high complication and reoperation rates with revision shoulder replacement, revision of failed hemiarthroplasty or total shoulder arthroplasty to reverse total shoulder arthroplasty improves outcomes for many patients. A failed hemiarthroplasty or total shoulder arthroplasty is frequently disabling for the patient and because the surgical revision options are often limited only to reverse total shoulder arthroplasty, the potential improvement is often worth the higher surgical complication or reoperation rate. Summary Due to the challenges inherent in revision arthroplasty, revision of primary arthroplasty to reverse total shoulder arthroplasty, outcomes are poorer than primary reverse total shoulder arthroplasty. Despite these limitations, patient postoperative pain and function do increase from preoperative levels making conversion of hemiarthroplasty or anatomic total shoulder to reverse total shoulder arthroplasty an important option for a challenging problem.

Arthroscopic repair of traumatic rotator cuff tear following total shoulder arthroplasty: A case report and review of literature

“…In patients who have already undergone TSA, rotator cuff tearing is a relatively uncommon yet detrimental post‐operative complication that may significantly impair overall shoulder function 1,2,6 . Post‐TSA cuff tearing counteracts the functional improvements originally made by the TSA by decreasing shoulder range of motion, strength, and increasing pain 1,2,5,7 .…”

“…In patients who have already undergone TSA, rotator cuff tearing is a relatively uncommon yet detrimental post-operative complication that may significantly impair overall shoulder function. 1,2,6 Post-TSA cuff tearing counteracts the functional improvements originally made by the TSA by decreasing shoulder range of motion, strength, and increasing pain. 1,2,5,7 In addition to these mechanical issues, post-TSA cuff tearing may also compromise the stability of the TSA implants through proximal migration of the humeral component and loosening of the glenoid component.…”

“…5 Despite relatively high complication rates of revision rTSAs, shoulder function, and pain are successfully restored in most cases. 6,9 The less common alternative, a direct RCR, has been shown to be an effective treatment in certain situations, but more studies are necessary to better assess the clinical indications and outcomes for this option. Multiple factors such as the size of the cuff tear, location of the tear, quality of the torn tissue, and physical exam findings all contribute to determining whether the option for direct RCR is available.…”

“…Over the past two decades, the number of TSA cases performed each year within the United States has risen exponentially due to better prosthetics, more advanced surgical techniques, and research substantiating its clinical effectiveness in decreasing shoulder pain and restoring shoulder function 3,4 . As expected, accompanying this significant rise in TSA cases is an overall rise in the number of revision surgeries and postoperative complications, the most common of which are infection, instability, component loosening, neurologic defects, and rotator cuff tearing of both traumatic and non‐traumatic nature 3–6 . This case study analyzes the clinical success of an arthroscopic rotator cuff repair (RCR) performed in a patient with a pre‐existing TSA to further evaluate the effectiveness of this procedure in treating post‐TSA rotator cuff complications.…”

“…3,4 As expected, accompanying this significant rise in TSA cases is an overall rise in the number of revision surgeries and postoperative complications, the most common of which are infection, instability, component loosening, neurologic defects, and rotator cuff tearing of both traumatic and non-traumatic nature. [3][4][5][6] This case study analyzes the clinical success of an arthroscopic rotator cuff repair (RCR) performed in a patient with a preexisting TSA to further evaluate the effectiveness of this procedure in treating post-TSA rotator cuff complications.…”