Shoulder arthroplasty—more commonly referred to as shoulder replacement—is a valuable solution for individuals suffering from shoulder arthritis, trauma, or chronic joint damage. However, even after undergoing a shoulder replacement, some patients may eventually require a second surgery, known as a revision shoulder arthroplasty.
A revision surgery is performed when the initial implant either wears out, fails, or results in complications. Though modern implants are designed to last 10 to 15 years, real-world experiences often show a need for revision much earlier. In fact, many patients require revision just a few years after their first procedure. This second surgery is more complex than the initial one and aims to restore comfort and function in the shoulder.
Why Do Shoulder Replacements Fail?
There are several reasons why a primary (first-time) shoulder replacement might fail. The most common causes include:
- Damage to the rotator cuff: The rotator cuff is a group of muscles and tendons that help move and stabilize the shoulder. When these tissues are torn or weakened, the shoulder becomes unstable, which can lead to pain and dysfunction.
- Component loosening: Over time, the artificial parts implanted during the first surgery can become loose due to wear or insufficient bone support.
- Infection: Although rare, infection is a serious complication that sometimes makes revision surgery necessary.
- Instability or dislocation: Sometimes, the implant may not remain in proper position, leading to instability or full dislocation of the joint.
- Bone loss or erosion: The bones around the shoulder implant may deteriorate or shift over time, especially if the initial alignment wasn’t ideal.
Who Needs a Revision?
Patients who have undergone shoulder replacement and are experiencing:
- Ongoing or worsening pain
- Reduced shoulder function
- Loosening or failure of implants seen on X-rays
- Recurrent dislocations
- Infection or drainage around the surgical site
…may be candidates for a revision arthroplasty.
The average age of patients undergoing revision shoulder arthroplasty is in the mid-60s, and both men and women are affected. Interestingly, this issue is becoming more frequent in younger patients as well, due to increasing demand for shoulder replacement in people under 55.
What Happens During a Revision?
The revision process is tailored to each patient’s specific problem. In many cases, the old implant is removed and replaced with a new type of implant that better suits the condition of the joint and surrounding tissues. For example, if the rotator cuff is severely damaged, a reverse shoulder arthroplasty may be used. This type of implant works even if the rotator cuff is not functional.
Some procedures also require rebuilding bone or correcting misaligned implants from the previous surgery. The goal is to improve shoulder stability and reduce pain while restoring as much function as possible.
Reverse Shoulder Arthroplasty in Revisions
Among the different types of revision surgeries, the reverse shoulder arthroplasty is the most commonly used technique. This design switches the ball and socket of the joint, allowing the deltoid muscle (instead of the damaged rotator cuff) to power shoulder movement. It’s particularly effective in patients with rotator cuff deficiency or poor bone support.
Whether in North America or Europe, surgeons have increasingly adopted this type of revision implant because of its effectiveness in improving outcomes after a failed primary surgery.
Risks and Complications
Revision surgeries carry a higher risk of complications compared to initial shoulder replacements. Some possible issues include:
- Re-infection or persistent infection
- Continued pain or stiffness
- Re-loosening of the new implant
- Fractures around the implant
- Weakness or nerve injury
Despite these risks, many patients still experience meaningful improvements in pain and mobility following a revision. It is worth noting that if complications occur, they often require yet another procedure, making surgical planning and postoperative care very important.
How Soon Are Revisions Needed?
Although implants are designed to last over a decade, revisions are often needed within 4 years after the first surgery. This could be due to patient-specific factors like bone quality, activity level, or underlying health conditions. Surgical technique and implant choice also play a significant role.
What Implants Are Used?
There are various implant systems and manufacturers available for shoulder replacement and revision surgeries. The choice of implant depends on:
- The condition of the shoulder
- The type of failure experienced
- Bone quality and availability
- Whether the previous implant can be partially retained
In most revisions, reverse shoulder systems are preferred, especially when bone loss or rotator cuff damage is present.
What to Expect After Surgery
Recovery from revision shoulder arthroplasty may take longer than a primary surgery. It typically involves:
- A period of immobilization using a sling
- Physical therapy to gradually restore strength and mobility
- Regular follow-up visits and imaging to monitor healing and implant position
Outcomes vary based on the complexity of the case, the patient’s overall health, and the extent of damage to bone or soft tissue.
Long-Term Outlook
While not all revision surgeries produce perfect results, many patients report significant pain relief and improved function. Success is more likely when the cause of the initial failure is clearly understood and properly addressed.
It is essential to work closely with an orthopedic surgeon who has experience in complex shoulder cases. The surgeon will evaluate imaging, review surgical history, and develop a personalized plan to give you the best chance at a successful outcome.
Final Thoughts
Revision shoulder arthroplasty is a technically demanding but necessary procedure for many patients who experience complications after a primary shoulder replacement. Whether due to rotator cuff failure, implant loosening, or infection, revision surgery offers a second chance at restoring function and reducing pain.
With careful planning, appropriate implant choice, and expert surgical care, many patients regain the ability to perform everyday activities and improve their quality of life.
If you’ve had a shoulder replacement and are still experiencing discomfort or instability, talk to your orthopedic surgeon about whether revision surgery might be right for you.
Do you have more questions?
Q. What is revision shoulder arthroplasty?
A. Revision shoulder arthroplasty is a surgical procedure performed to replace or repair a failed shoulder replacement.
Q. Why might a patient need revision shoulder arthroplasty?
A. A patient may need revision shoulder arthroplasty due to persistent pain, implant loosening, infection, instability, or wear and tear of the original implant.
Q. How is the diagnosis made for needing a revision shoulder replacement?
A. The diagnosis is made through a thorough clinical evaluation, medical history, physical examination, and imaging studies like X-rays, CT scans, or MRIs.
Q. What are the types of implants used in revision shoulder arthroplasty?
A. The implants used in revision shoulder arthroplasty can include reverse shoulder implants or specially designed revision components.
Q. How is infection evaluated in cases requiring revision surgery?
A. Infection is evaluated through clinical signs, laboratory tests, joint aspiration, and sometimes intraoperative cultures.
Q. What imaging tests are used before revision shoulder arthroplasty?
A. Imaging tests such as X-rays, CT scans, and MRIs are used to assess bone loss, implant position, and overall joint condition.
Q. What are the surgical options for revision shoulder arthroplasty?
A. Surgical options may include removal and replacement of implants, use of bone grafts, or conversion to a reverse shoulder arthroplasty.
Q. What complications can arise from revision shoulder surgery?
A. Complications can include infection, nerve injury, implant loosening, instability, and reduced range of motion.
Q. How long is the recovery after revision shoulder arthroplasty?
A. Recovery can take several months and typically includes physical therapy to regain strength and motion.
Q. What is the goal of revision shoulder arthroplasty?
A. The goal is to relieve pain, restore function, and improve the quality of life for the patient.
Q. How is bone loss managed during revision surgery?
A. Bone loss is managed using bone grafts or specialized implants designed to compensate for the missing bone.
Q. What is reverse shoulder arthroplasty and when is it used in revision cases?
A. Reverse shoulder arthroplasty is a type of implant used when rotator cuff function is compromised, commonly used in revision cases with bone loss or soft tissue damage.
Q. Can revision shoulder arthroplasty be done after infection from a previous implant?
A. Yes, but it may require a staged procedure, starting with removal of the implant, infection control, and later re-implantation.
Q. What are signs that a previous shoulder replacement may be failing?
A. Signs include persistent pain, limited movement, swelling, instability, or symptoms of infection.
Q. What role does physical therapy play after revision shoulder arthroplasty?
A. Physical therapy is essential to help restore shoulder motion, strength, and function after surgery.
