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Current Reviews in Musculoskeletal Medicine

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01-02-2020 | Periprosthetic Fracture | Reverse Shoulder Arthroplasty (C Chambers and E Craig, Section Editors)

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

Authors: Alexander R. Markes, Edward Cheung, C. Benjamin Ma

Published in: Current Reviews in Musculoskeletal Medicine | Issue 1/2020

Abstract

Purpose of Review

The most common complications warranting revision consideration in reverse shoulder arthroplasty (RSA) include instability and its associated causes: infection, periprosthetic fracture, and glenoid baseplate loosening. Management of complications can be challenging and the nuances of treatment are still being elucidated. The focus of this paper is to review the treatment of the failed RSA and discuss evidence-based recommendations for revision.

Recent Findings

The most common complications requiring revision RSA are instability and infection. The causes for instability can be subdivided into three main subcategories: loss of compression, loss of containment, and impingement. Loss of compression is further broken down into 6 subcategories revolving around abnormal prosthesis positioning, undersized prostheses, or intrinsic soft-tissue tension loss leading to instability. Periprosthetic infection can also lead to instability, yet the most appropriate management for infected RSA remains controversial.

Summary

Restoring stability by maximizing deltoid and soft tissue tension while avoiding impingement revolves around three basic methods: (1) lateralizing and/or upsizing the glenosphere to an inferior position on the glenoid, (2) use of a more constrained polyethylene insert, and (3) distalizing the humerus by increasing the polyethylene thickness and/or the thickness of the humeral tray. Management of periprosthetic joint infection can be performed in one-stage, two-stage, or “three-stage” procedures all showing good outcomes with two-stage procedures being the most commonly performed. However, persistent positive culture with propriobacterium acnes can occur in up to 25% of cases. In order to limit the associated morbidity from failed revision reverse shoulder arthroplasty, continued research on best management of associated complications is warranted.

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Title: Failed Reverse Shoulder Arthroplasty and Recommendations for Revision
Authors: Alexander R. Markes
Edward Cheung
C. Benjamin Ma
Publication date: 01-02-2020
Publisher: Springer US
Keywords: Periprosthetic Fracture
Femuroacetabular Impingement
Joint Infection
Published in: Current Reviews in Musculoskeletal Medicine / Issue 1/2020
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09602-6

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Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

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Purpose of Review

Recent Findings

Summary

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