Revision Shoulder Arthroplasty-How to Manage the Humerus?

Shoulder arthroplasty has been shown to be an effective treatment for both degenerative and traumatic pathology of the shoulder. Because of its proven efficacy, the use of arthroplasty has experienced rapid growth during the past 15 years, with the number of shoulder replacement surgeries expected to grow by more than 200% during the next 5 years. The rapid increase in primary shoulder replacement has generated a greater need for revision of failed components. Although the humeral component is rarely the source of failure, extraction is required in one-half of shoulder revisions. Revision shoulder arthroplasty can be an extremely challenging surgery, and careful preoperative planning is required. Thorough examination of the etiology of failure as well as knowledge of the characteristics of the prosthesis to be removed is essential before proceeding with revision. Management of the humeral component can be very difficult, especially in the instance of a well-fixed prosthesis. Techniques, such as osteotomies or humeral windows, are often needed in the removal of well-fixed components. The outcome after revision shoulder arthroplasty is dependent on the etiology of failure. The overall rate of satisfactory outcome for all revisions has been reported to be approximately 60% with functional limitation the main cause of unsatisfactory results. Revision for failure as the result of instability, infection, or soft-tissue deficiency is associated with higher rates of unsatisfactory results. Careful patient selection and preoperative counseling is required before performing revision of a shoulder arthroplasty. The primary indication for revision is for the treatment of a painful shoulder replacement with an identified source of failure. Caution should be taken when considering revision for functional improvement as the functional results are much less predictable. This article will review the indications, preoperative planning, surgical techniques, and results of revision of the humeral component following a failed shoulder arthroplasty. (c) 2011 Elsevier Inc. All rights reserved.