Results of Shoulder Replacement Revision OperationsShoulder joint replacement is becoming more common all the time. As more people have a total shoulder arthroplasty (TSA) the number of revision surgeries is also increasing. TSA failure is usually because of infection, implant wear, or bone or soft tissue problems. In this study, 78 patients who had TSA revision surgery were reviewed and reported.
Patients ranged in age from 26 to 82 years old. Arthritis from trauma or instability was the main cause of shoulder problems requiring a TSA. In some cases cancer, fracture that didn't heal, or rotator cuff tear was the underlying problem.
Results were measured in terms of patient satisfaction, pain, motion, and function. Revision operation either repaired the problem or removed the implant. The authors provide details of types of surgeries done for each problem requiring revision. Factors such as patient age, condition of the bone, and general health were considered when planning the revision operation.
The authors report better results were obtained in patients who had a loose implant or bone deficiency. There were more problems with the glenoid component (socket side of the replacement). Problems with the humeral side were less common. The humeral component consists of a stem fitting down into the shaft of the humerus (upper arm bone). There's a round ball or new head of the humerus at the top of the stem.
Patients who needed soft tissue reconstructions had only fair results. Most of the reconstruction surgeries were done to stabilize the shoulder or repair rotator cuff problems. Patients who had a new glenoid component were most satisfied with the results.
The authors conclude shoulder revision surgery can be difficult and complex. Results are often based on the reason the surgery was needed in the first place. Better ways to treat TSA patients who have infection or soft-tissue problems are needed and should be the focus of future research efforts.
Joshua S. Dines, MD, et al. Outcomes Analysis of Revision Total Shoulder Replacement. In The Journal of Bone and Joint Surgery. July 2006. Vol. 88-A. No. 7. Pp. 1494-1500.
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