What is revision shoulder replacement surgery?
The shoulder is a ball and socket joint with cartilage that lines the bones, allowing for easy, stable and smooth motion. The shoulder is also the most mobile joint in the body. The shoulder’s motion is what allows us to precisely use our arms for lifting, carrying, pushing and pulling. When the gliding surface of the ball and socket shoulder joint (also known as cartilage) begins to degenerate, the smooth surfaces become rough and the bones of the shoulder start to rub together. This abnormal rubbing and roughness manifests clinically as shoulder pain, grinding or catching, and shoulder stiffness. These clinical symptoms are those that patients experience when suffering from shoulder arthritis. In some cases of end-stage osteoarthritis, shoulder joint replacement (also known as shoulder arthroplasty) is done to alleveiate shoulder pain and shoulder stiffness. This procedure has a very reliable ability of relieving patients of the symptoms of shoulder pain, shoulder roughness and shoulder stiffness. The procedure has excellent results, however, in some cases a revision shoulder replacement may be necessary should recurrent shoulder pain, stiffness or instability develop. Should you require a shoulder replacement procedure, or should you require a revision shoulder replacement procedure, it is extremely important that you choose a physician who specializes in this particular operation. The orthopedic shoulder specialists at The Shoulder Clinic of Idaho are extremely skilled at revision shoulder replacement and have been helping patients in Boise, Meridian, Nampa, and the surrounding communities of the Treasure Valley return to their pain-free active lifestyles.
What causes a total shoulder replacement to fail?
The results of shoulder joint replacement are excellent. However, total shoulder arthroplasty is a technically complex procedure and can fail for several reasons. Complications can occur with the formation of osteophytes (bone spurs), scar tissue, weakening of supporting muscles or a new injury to the shoulder joint such as a fracture or loosening of the implant due to a fall. Overstraining the repaired tendons too early or poor participation in a stretching program can also cause surgical failure and the need for a revision shoulder replacement. In a few cases of total shoulder replacement failure, the shoulder prosthesis may loosen, become infected or dislocate, contributing to the failure of prior arthroplasty. To avoid these types of complications it is extremely important that you choose a surgeon who performs a large volume of these procedures. Surgeons who do not perform a large volume of shoulder replacement procedures will have a higher complication rate and those patients will be more likely to require a revision procedure, or result in a poorer outcome.
To revise or not to revise?
The decision to undergo revision total shoulder replacement surgery requires a thorough patient history and physical examination. The orthopedic shoulder specialists at The Shoulder Clinic of Idaho may request additional imaging, such as an MRI or CT Scan to accurately assess the shoulder joint problem. It is also common that laboratory studies will be obtained – and possibly a shoulder aspiration or biopsy – to rule out infection. The shoulder surgeons will take the following into consideration:
- Is an infection present in the shoulder joint?
- A shoulder infection in the setting of a shoulder replacement procedure is an important concern. This may require antibiotics and may or may not require a revision shoulder replacement. Removal of the prosthesis is not always necessary, but is common if the infection is deep and adjacent to the shoulder prosthesis. Some infections may require multiple surgeries to cure them. They may also some times require the provisional placement of a shoulder joint spacer – or temporary shoulder replacement – which is later removed once the infection has been adequately treated.
- Is the shoulder joint unstable?
- If the shoulder joint is unstable, the cause must be identified and rectified. Instability can be caused by poor alignment of the shoulder prosthesis, loosening of the shoulder prosthesis, fracture, torn tendons, or altered anatomy.
- Is the new joint worn?
- Wearing of the plastic bushing and prosthetic joint surface can occur over time which can lead to pain and loosening of the shoulder replacement. These concerns need to be evaluated by a shoulder specialist so that a mechanical solution to the problem can be identified.
- Has the joint loosened since the total shoulder replacement?
- If the shoulder joint has loosened after the shoulder replacement, the orthopedic shoulder surgeons at The Shoulder Clinic of Idaho will consider the patient’s age, rotator cuff status and available bone stock before deciding on the type of revision needed.
- How is the rotator cuff?
- A torn or damaged rotator cuff can cause pain, weakness or a catching sensation in the shoulder joint and may require a revision total shoulder replacement. A torn rotator cuff tendon – or nonhealing of a tendon – may also contribute to instability of the shoulder replacement which could contribute to the need for revision shoulder replacement.
The main goal of a revision total shoulder replacement is to alleviate pain, stiffness and increase range of motion. Patients who have had a total shoulder replacement but are experiencing pain, functional deficits or loss of range of motion should be evaluated by one of the orthopedic shoulder specialists at The Shoulder Clinic of Idaho. They can diagnose and treat shoulder pain and have been successfully treating patients in Boise, Meridian, Nampa, and the surrounding communities of the Treasure Valley.
If you are suffering from pain, stiffness and loss of motion after a total shoulder replacement, you may need a revision surgery. To discuss your unique case or to receive more information about revision total shoulder replacement, please contact the orthopedic shoulder surgeons at The Shoulder Clinic of Idaho, serving patients in Boise, Meridian, Nampa, and the surrounding communities of the Treasure Valley.