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Revision Shoulder Replacement Surgery

What is revision shoulder replacement surgery? 

Most of the time, shoulder replacements are successful the first time, and they last for many years. But sometimes, they need to be replaced. That procedure is called revision shoulder replacement surgery, and it is more complicated than the original shoulder replacement.

You might need revision surgery if your shoulder replacement is painful, infected or not working correctly. Shoulder joint replacements take the upper arm bone (the humeral head) and the cavity of the shoulder blade (glenoid cavity) and replace them with an artificial joint.

How does it differ from shoulder replacement surgery?

With shoulder replacement surgery, doctors replace your own diseased or damaged shoulder joint with an artificial joint. With revision shoulder replacement surgery, that artificial joint needs to be replaced. Your surgeon must remove it and then insert a new joint. Most shoulder replacements last for many years, so removing and replacing them is relatively uncommon.

Shoulder replacements have two components that replace the ball and socket joint of your shoulder. With a revision shoulder replacement, you might need one or both of those components replaced.

Revision shoulder replacement has a higher risk of complications than initial shoulder replacement surgery, and in some cases, you may need more than one revision surgery.

Reasons for revision shoulder replacement surgery 

You may need revision surgery if your original shoulder replacement fails. That could be due to:

  • Instability (prone to excessive movement or displacement)
  • Stiffness
  • Shoulder pain
  • Weakness
  • Loss of range of motion
  • Overstressing the original shoulder replacement
  • Poor compliance with rehabilitation
  • Bone spurs
  • Scar tissue
  • Nerve injury
  • Infection
  • Malpositioned  or worn components
  • Component loosening
  • Reaction to the components
  • Fracture
  • Rotator cuff tear or failure

Identifying what caused your original shoulder replacement to fail is crucial so those issues can be addressed.

What to know before having revision shoulder replacement surgery

Before undergoing shoulder revision surgery, it's crucial to have a clear understanding of the procedure, the potential risks involved, and the expected outcomes. Here are some important things to consider:

  • Prolonged Recovery: Compared to primary shoulder surgery, the recovery period for revision shoulder replacement surgery may be longer and may take several months to regain full shoulder function.
  • Higher Risk: Shoulder revision surgery carries a higher risk compared to primary surgery. This is primarily due to factors such as altered anatomy, compromised tissues and potential complications related to the previous surgery.
  • Potential Limitations: While the goal of shoulder revision surgery is to improve shoulder function and alleviate pain, it's essential to have realistic expectations. The outcomes of revision surgery may not be as good as those of primary surgery.
  • Rehabilitation and Physical Therapy: Rehabilitation and physical therapy play an important role in the recovery process following revision surgery. It's important to commit to your prescribed rehabilitation program to achieve optimal results.

Remember, each case is unique, and the specific details of your shoulder revision surgery will depend on your individual circumstances.

People who are in poor overall health, have certain neurological or psychological conditions or can’t comply with an extensive rehabilitation program may not be good candidates for revision shoulder replacement surgery.

How to prepare for shoulder revision surgery

Before you have surgery, your doctor will review your medical history and the report from your initial shoulder replacement surgery, ask you about your symptoms and perform a physical examination of your shoulder joint, neck and skin in the area where the incision will be made.

There are a few things you can do to support your recovery and reduce your risk of complications:

  • Beginning or maintaining exercise or physical activity can help you recover from the operation. Talk to your doctor before starting a new routine.
  • If you smoke, stopping can reduce your risk of post-surgical complications.
  • Try to maintain a healthy body weight, since your odds of complications after surgery are higher if you are overweight.
  • If you have diabetes, heart disease or certain other chronic conditions, your specialists may need to clear you for surgery.

You’ll want to make sure you have someone to help you at home in the days after surgery. You may be more comfortable sleeping in a recliner at first. You can stock up on prepared foods so meals are more manageable when you get home, and you can move the kitchen items you need most often to the countertops, so you don’t need to reach for them.

Your surgical team will give you instructions about taking medications such as blood thinners, and eating, drinking and bathing right before surgery.

Pre-surgery tests

Your doctor will probably recommend X-rays, MRI scans or CT scans to help identify the cause of the failure in your original shoulder replacement. If infection is suspected, your doctor may want to perform an aspiration or biopsy of your shoulder joint. They may also request nerve conduction studies and ultrasound exams.

These tests can help your surgeon decide which components will need to be replaced, but the final decision will be made during surgery.

What the surgical procedure is like

Since this procedure is more complicated than shoulder replacement surgery, it can take several hours. To replace your artificial shoulder joint, you’ll most likely have general anesthesia. Your surgeon will make one or more incisions, in the same location as your earlier incisions if possible.

They will remove the ball, socket, or both parts of your prosthetic joint and some or all cement from the original surgery. If they need to remove bone, you may need a bone graft. They may also need to remove scar tissue and repair soft tissues such as stiff muscles, tendons or ligaments. After that, they will prepare the joint surface and insert the replacement shoulder joint.

Often, surgeons will perform a reverse shoulder replacement. That means the ball and socket components are on opposite sides compared to how they are naturally in the body.

If you need a shoulder replacement revision because of a fracture, they may need to repair that area with plates, screws or wires. If you have an infection, they will remove the infected tissue and thoroughly wash the area. In addition, antibiotics will likely be required for multiple weeks. Infections sometimes require multiple surgeries.

When your procedure is finished, you’ll move to a recovery room to be monitored as you come out of the anesthesia. In the hospital, you’ll be given pain medication and you may start physical therapy.

Possible complications

There’s always some risk involved when you have any type of surgery. Those risks, which your surgeon probably discussed with you when you had your original shoulder replacement, are the same as your revision shoulder replacement. On top of that, there are risks of this procedure:

  • Infection
  • Loosening or dislocation of the implant
  • Torn rotator cuff
  • Nerve damage in or around your shoulder
  • Stiffness

Recovery at home

You should be able to leave the hospital one to two days after your surgery. Recovery from a shoulder replacement revision surgery usually takes longer than original shoulder replacement surgeries.

Your surgeon’s team will let you know how to care for the incision and dressing, and when to return to have any stitches removed.

You shouldn’t lift anything for the first two to four weeks after surgery and shouldn’t lift heavy objects for two months. You’ll need to avoid pushing yourself up out of a chair or bed with that arm. Avoid straightening your arm all the way out to the side or behind your back. Your care team will let you know when you can drive—it may be two to four weeks.

You will need to keep your arm in a sling for two to six weeks so you’re not straining the new joint. Rehabilitation will include physical therapy and home exercises so you can get the most function from your new joint. You’ll need to do your exercises several times a day at first. 

If you have a desk job, you can usually return to work in about two weeks. However, for jobs with a lot of lifting or overhead movements, make sure to talk to your care team. You should be able to return to activities that use your shoulder, such as swimming, tennis and golf, but full recovery can take six to 12 months.

Long-term outcomes

Most people recover well and succeed with their new replacement joints. While you may not regain your full range of motion and function, you should be able to move your shoulder and arm more comfortably and do more of your normal activities. You should see relief from pain.