My husband just got the surgeon's report on his failed rotator cuff surgery. We were told if they can grab hold of the tendons and re-attach them it will be 8 weeks before hubby can do any physical therapy. If the surgeon can't fix the torn repair, then he will shave off the frayed edges do what they can before closing. He said the shoulder is a real mess with half of one muscle mass as scar tissue and another muscle that is about 40 per cent scar tissue. Our question is: is there really any point in doing more surgery?
It is a well-known fact that rotator cuff repairs aren't always successful. Revision surgery isn't always necessary after a failed rotator cuff repair. Some surgeons only recommend revision surgery when the patient continues to have chronic pain months to years after the original surgery.
It must be clear that the problem is a failed rotator cuff repair. The presence of pain and loss of motion doesn't always signal a failed surgery. There could be some other complication such as infection or systemic disease referring pain to the shoulder. A careful evaluation is needed to sort out the cause of shoulder pain and need for further surgery. The surgeon will need to perform various clinical tests, orders imaging studies, and decide if electrodiagnostic testing is needed (to evaluate nerve function).
Revision surgery is not routinely recommended for everyone. Efforts should be made to treat the problem conservatively (without surgery). Your husband may not be a good candidate for revision surgery if he has multiple risk factors for failure.
You were likely counseled that before having a revision surgery for failed rotator cuff repair there are some things you should know. For example, you should have been told that the results are likely not going to be as good as with a successful first repair procedure. But the improvements in pain, motion, and function will probably be better than without the revision surgery. It sounds like you were told that recovery and rehabilitation are likely going to take longer after a revision surgery compared with the primary (first) repair.
This information is based on evidence from many studies reporting final outcomes following rotator cuff revision surgery. Surgeons report a 64 per cent good-to-excellent result with a 93 per cent patient satisfaction rate following arthroscopic revision rotator cuff repairs.
All is not lost if a patient experiences a poor or failed result after rotator cuff repair surgery. Massive tears with poor recovery may be treated with a shoulder replacement procedure. But the hope and goal of primary and/or revision rotator cuff repair surgery is to preserve the patient's natural anatomy and function.
Patrick J. Denard, MD, and Stephen S. Burkhart, MD. Arthroscopic Revision Rotator Cuff Repair. In Journal of the American Academy of Orthopaedic Surgeons. November 2011. Vol. 19. No. 11. Pp. 657-666.
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