Outcome and complications following revision shoulder arthroplasty

Abstract

Aims It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis. Results A total of 112 studies (5,379 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (601/3,041), instability 19% (577/3,041), rotator cuff failure 17% (528/3,041), and infection 16% (490/3,041). Intraoperative complication and postoperative complication and reoperation rates were 8% (230/2,915), 22% (825/3,843), and 13% (584/3,843) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (91/230, 40%) and instability (215/825, 26%). Revision to reverse total shoulder arthroplasty (TSA), rather than revision to anatomical TSA from any index prosthesis, resulted in lower complication rates and superior Constant scores, although there was no difference in American Shoulder and Elbow Surgeons scores. Conclusion Satisfactory improvement in patient-reported outcome measures are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA. Cite this article: Bone Jt Open 2021;2(8):618–630.

Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis

“…A previous review demonstrated superior shoulder scores following TSA revised to a RSA, compared to TSA revised to a TSA. 41 However it is unclear how the data synthesis was performed and broad inclusion criteria were used. No work could be found comparing implant choices when revising a hemiarthroplasty.…”

A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length

“…Anatomic TSA has increased in usage from 9.5 cases per 100,000 persons in 2012 to 12.5 cases per 100,000 in 2017, and reverse TSA has increased in usage from 7.3 cases per 100,000 persons in 2012 to 19.3 cases per 100,000 in 2017 [ 4 ]. However, the postoperative complication rate for revision shoulder arthroplasty has been shown to be high at 22% [ 5 ].…”

Arthroscopic Removal of the Polyethylene Glenoid Component After Total Shoulder Arthroplasty: A Systematic Review

“…Loosening of the glenoid component is the most common reason for revision after total shoulder arthroplasty (TSA) and may be responsible for 30% of revision procedures. 1 – 3 While TSA continues to be a frequently performed and effective treatment option for pain relief and improvement of function for degenerative shoulder conditions there remains concerns regarding implant longevity. 4 – 7 A recent population-based cohort study has estimated the lifetime revision rate for a failed primary TSA to be as high as 25%.…”

“… 11 However there is currently no consensus on the optimal surgical technique, as all of these proposed methods have been shown to have varying complication and reoperation rates. 1 , 12 – 15 Arthroscopic removal of the glenoid component (ARGC) after TSA has been proposed as an option for presumed aseptic polyethylene loosening ( Figures 1 and 2 ). 16 Proposed advantages of this technique include a less-invasive arthroscopic approach, which may be beneficial in older patients with multiple medical comorbidities due to the potential to avoid some complications associated with open revision.…”