Is Revision of a painful shoulder replacement feasible?

[mtomaino]

The simple answer is that revision is feasible---but what also needs to be addressed is whether it is adviseable. Historically, the only reasons for a shoulder replacement to be redone were 1. an infectious complication, which requires removal and then possible reimplantation after 6 weeks of treatment with antibiotics, and 2. if a fracture of the humerus occurs, which might require placement of a longer stem.

In 2010, however, revision is more commonly performed in patients who have had a previous hemiarthroplasty----replacement of the "Ball" but not the "socket". In these cases, the etiology was usually either arthritis (but the glenoid was not resurfaced,) or a bad fracture, which required replacement of only the humeral head.

Unfortunately, over time, the ball can wear away the cartilage on the socket---and this can lead to pain and loss of motion. For cases of previous fracture, the rotator cuff may never regain function (due in most cases to a failure of the greater tuberosity to heal), and poor overhead function results.

Revision can be performed by removing the old stem and then replacing the shoulder with a new total implant---most commonly a reverse prosthesis---since it can provide very satisfactory function and pain relief even in the absence of a functioning rotator cuff. In addition, a reverse design often allows "glenoid replacement" even when significant erosion has occurred. However, there are also cases when a standard "anatomic" total shoulder can be placed as well. Innovative surgical techniques exist for removing even the most secure of humeral stems, but such operations still require a significant amount of experience and expertise---and should be performed by a shoulder specialist.

I have attached a a set of pre and postop x-rays as well as before and after pictures which show the tremendous improvement in range of motion after revision to a reverse shoulder.

[mtomaino]

Visit this link for a recent video patient attestation following revision, and see my comments dated March 5,2011 :

http://www.rearmyourself.com/article...miarthroplasty