Failed Shoulder Replacement and Revision

Shoulder joint replacement arthroplasty may fail to produce the desired result. Often these failures can be improved by rehabilitation or revision surgery

Edited By Frederick A. Matsen III, M.D., Professor, UW Orthopaedics & Sports Medicine

Last updated: December 12, 2013

For the most up to date information on shoulder arthritis, follow our blog:
http://shoulderarthritis.blogspot.com/

Or visit our online Shoulder Arthritis Book.

Contact
If you have questions regarding the failed shoulder replacement and revision procedure, feel free to email Frederick A. Matsen III M.D. at matsen@uw.edu.

Causes of failure of shoulder joint replacement

Shoulder joint replacement is a technically complex procedure. The results of shoulder joint replacement are often excellent, but failure of shoulder arthroplasty can result because of persistent pain, stiffness, infection, component loosening, fracture, component malposition, instability, rotator cuff failure or other causes.

We have had the opportunity to treat many individuals from around the U.S. who have had unsatisfactory results from prior shoulder joint replacement. Our approach is outlined on the shoulder blog.

A few examples of the specifics of this approach are shown here.

Failed Unsatisfactory Shoulder Joint Arthroplasty - stiffness

As noted above stiffness is a common feature among unsatisfactory shoulder joint replacements. By stiffness we mean that the shoulder is not capable even with the help of the other arm to move through a normal range of motion. Arthritic shoulders are usually stiff so it is not surprising that stiffness may remain a problem even after joint replacement.

This is why we are so interested in early post-surgical rehabilitation to maintain the range of motion achieved at surgery. In a technically well-done arthroplasty range of motion is usually restored and maintained by these rehabilitation exercises.

If a shoulder stays or becomes stiff after a shoulder arthroplasty and if it does not respond to a good rehabilitation program revision surgery may be considered to re-release the soft tissue check to make sure no blocking osteophytes are present and assure that the humeral head is of the proper size. There are several surgical principles that are important to re-establishing motion to a stiff arthritic shoulder. First is that the tight capsule around the joint must be released by sharp dissection as shown in figure 1.

Second is that the bone spurs (osteophytes) be removed to make sure they do not block motion. (See figure 2).

And finally the surgeon must avoid 'overstuffing' the joint by inserting such a large humeral head that the soft issues are put under excessive tension (bottom of the figure 3) rather than one that puts the soft tissues under normal tension (top of figure 3).

At surgery we optimize the shoulder range of motion by assuring that the joint is capable of 40 degrees of external rotation (See figure 4).

50% posterior translation (See figure 5).

And 60 degrees of internal rotation with the arm out to the side.

We refer to these as the 40 50 60 rules for achieving ideal soft tissue balance and avoiding an unsatisfactory arthroplasty because of intraoperative causes of stiffness. A good rehabilitation program is still essential to a good result.