Background: The number of total shoulder arthroplasties has
increased exponentially over the last ten years, creating a more prominent
role for revision shoulder arthroplasty in the future. The main reasons for
failure of shoulder arthroplasty can be classified as soft-tissue
deficiencies, osseous deficiencies, component wear, or infection. We
hypothesized that, despite appropriate surgical techniques, the outcome of
revision total shoulder replacement can be predicted on the basis of the
indication for the revision procedure.
Methods: We conducted a retrospective review of seventy-eight
shoulders that had undergone revision shoulder arthroplasty. The shoulders
were divided into two categories: (1) those with osseous or component-related
problems and (2) those with soft-tissue deficiency. Category 1 consisted of
four cohorts of shoulders: twenty-two treated with revision of the glenoid
component, sixteen treated with conversion of a hemiarthroplasty to a total
shoulder arthroplasty because of glenoid arthrosis, eight treated with
revision of the humeral stem, and four treated for a periprosthetic fracture.
Category 2 consisted of five cohorts of shoulders: ten treated with rotator
cuff repair following total shoulder replacement, four with a failed
tuberosity reconstruction, four with cuff tear arthropathy, five with
instability, and five with infection. Patients were evaluated with the UCLA
subjective outcome instrument, the L'Insalata shoulder questionnaire, and a
subjective satisfaction scale (maximum score of 5 points).
Results: The average UCLA score was 21.4 points and the average
L'Insalata score was 68.73 points for the seventy-eight shoulders that were
analyzed. The average score on the subjective satisfaction questionnaire was
2.91 points. According to the UCLA scores, twenty-four revisions were
considered to have had an excellent result; fifteen, a good result;
twenty-four, a fair result; and fifteen, a poor result. The average scores for
the category-1 shoulders were significantly better than those for the
category-2 shoulders (p < 0.05). Of the different types of operations,
revision or implantation of a glenoid component and open reduction and
internal fixation of a periprosthetic fracture provided the best outcomes.
Tuberosity reconstruction, hemiarthroplasty for treatment of cuff tear
arthropathy, and revision due to infection had uniformly poor outcomes.
Conclusions: In general, these results indicate that the outcome of
revision shoulder arthroplasty can be predicted on the basis of the indication
for the procedure. Component revisions, excluding humeral head revision for
salvage, provide the best results, whereas soft-tissue reconstructions can be
expected to yield poorer results overall.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.