Revision of an existing shoulder replacement was relatively uncommon in the past-- typically required in the setting of infection. This indication still exists (rarely--fortunately), but two different problems are far more common indications nowadays. These include glenoid wear due to a previously placed hemiarthroplasty---that is, only the ball was replaced, and now the cartilage on the socket has worn away; and, poor overhead function in the setting of a replacement that was performed for fracture. In this case, the tuberosity fragments may not heal, thus compromising the function of the rotator cuff.
Symptoms usually include stiffness, pain, weakness, and loss of overhead function. The videos below are of a case in which a malpositioned implant prevented motion, and led to glenoid wear with pain. Succesful revision to a Reverse shoulder is detailed at 8 months.
For these types of problems, the innovative development of the Reverse shoulder replacement design has revolutionized treatment.This nonanatomic design "replaces" the rotator cuff--by allowing the deltoid muscle to do all the work, provides stability via a more constrained implant, and allows single stage revision/bone-grafting of the glenoid, when necessary.
Further, newer surgical techniques have been devised to facilitate removal of well fixed stems to allow minimal morbidity. In cases where humeral bone loss has occurred, reconstruction may require the use of allograft bone. These revision procedures usually take between 2 and 4 hours to perform.
Although revision arthroplasty is a complicated procedure, our experience with these challenges as well as firsthand assessment of favorable outcomes thereafter, have led us to be one of the few preferred providers for revision shoulder arthroplasty in Upstate New York
Symptoms usually include stiffness, pain, weakness, and loss of overhead function. The videos below are of a case in which a malpositioned implant prevented motion, and led to glenoid wear with pain. Succesful revision to a Reverse shoulder is detailed at 8 months.
For these types of problems, the innovative development of the Reverse shoulder replacement design has revolutionized treatment.This nonanatomic design "replaces" the rotator cuff--by allowing the deltoid muscle to do all the work, provides stability via a more constrained implant, and allows single stage revision/bone-grafting of the glenoid, when necessary.
Further, newer surgical techniques have been devised to facilitate removal of well fixed stems to allow minimal morbidity. In cases where humeral bone loss has occurred, reconstruction may require the use of allograft bone. These revision procedures usually take between 2 and 4 hours to perform.
Although revision arthroplasty is a complicated procedure, our experience with these challenges as well as firsthand assessment of favorable outcomes thereafter, have led us to be one of the few preferred providers for revision shoulder arthroplasty in Upstate New York
2 comments
mtomaino 2/21/11 at 11:49 am
This past week I had to remove a well-fixed humeral implant that had been placed in 2004. Bone ingrowth to the metaphyseal porous coating necessitated an 8cm episiotomy (osteotomy). This technique allowed preservation of bone and obviated the need for allograft. As the number of revisions that I perform increase, my experience with "osteotomy" in order to remove the existing implant has been very favorable. I typically repair the osteotomy with supramid cables.
mtomaino 3/5/11 at 3:42 pm
Yesterday, March 4th, I evaluated a patient who required a revision surgery for painful glenoid wear following hemiarthroplasty. His pain and superior glenoid wear precluded revsion to an anatomic total shoulder (I did not think that I could securely fixate a conventional plastic genoid component), and at the same time, his young age caused understandable concern about "surviveability" of a "reverse shoulder" design.
But, he realy could not "live" with the pain and dysfucntion, so I revised him to a DJO Reverse because I felt that the more "anatomic" center of rotation and neck-shaft angle, and improved baseplate fixation, with this innovative prosthetic design, would provide better range of motion with a lower rate of scapular impingement. He was gracious enough to agree to provide an attestation for this website, and I have attached a video above entitled "10 week outcome following revision". The video runs out as I am acknowleging the potential that this, itself, may require revision at some point in the future.