Failure of Anatomic Total Shoulder Arthroplasty with Revision to Another Anatomic Total Shoulder Arthroplasty

Document Type: RESEARCH PAPER

Authors

1 Sidney Kimmel Medical College, Thomas Jefferson University Hospitals. Philadelphia, PA, USA

2 Rothman Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

3 Department of Orthopaedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

Abstract

Background: While outcomes of primary anatomic total shoulder arthroplasty (aTSA) are generally favorable, results
after revision procedures are less reliable. This study examines the functional outcomes, complications, and implant
survival in patients who underwent revision of aTSA to aTSA.
Methods: Patients who underwent revision aTSA were identified from 2008-2015. Demographic, clinical, surgical,
and outcomes data were analyzed. Patient-reported outcomes including the American Shoulder and Elbow Surgeons
Score (ASES), Single Assessment Numerical Evaluation (SANE), Visual Analog Scale for pain (VAS), the Short Form-
12 Health Survey (SF-12), and patient satisfaction were recorded.
Results: Twenty patients underwent revision from a primary aTSA to aTSA (55% male, 62.0±6.8 years-old). Revision
aTSA occurred at 2.5±3.4 years after index surgery. Seven (35%) required future revision at 1.8±1.9 years after revision
aTSA. Among the 13 patients who did not undergo revision, twelve (92.3%) had over two-year follow-up (4.0±2.4
years). Average ASES score was 70.1±23.5, SANE 66.0±29.4, VAS 2.7±3.0, SF-12 Mental 52.4±10.5, SF-12 Physical
36.8±8.9, and satisfaction of 3.6±1.2.
Conclusion: Results of revision aTSA to aTSA were unpredictable and the revision rate was high. The cases that do
not undergo revision had satisfactory, but inconsistent functional results. Reverse arthroplasty may be more reliable in
this patient population.
Level of evidence: IV

Keywords

Main Subjects


1. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz
SM. Prevalence and projections of total shoulder and 

elbow arthroplasty in the United States to 2015. J
Shoulder Elbow Surg. 2010; 19(8):1115-20.

2. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing
incidence of shoulder arthroplasty in the United
States. J Bone Joint Surg Am. 2011; 93(24):2249-54.
3. Padegimas EM, Maltenfort M, Lazarus MD, Ramsey
ML, Williams GR, Namdari S. Future patient demand
for shoulder arthroplasty by younger patients:
national projections. Clin Orthop Relat Res. 2015;
473(6):1860-7.
4. Sperling JW, Cofield RH, Rowland CM. Minimum fifteenyear
follow-up of Neer hemiarthroplasty and total
shoulder arthroplasty in patients aged fifty years or
younger. J Shoulder Elbow Surg. 2004; 13(6):604-13.
5. Antuna SA, Sperling JW, Cofield RH, Rowland CM. Glenoid
revision surgery after total shoulder arthroplasty. J
Shoulder Elbow Surg. 2001; 10(3):217-24.
6. Carroll RM, Izquierdo R, Vazquez M, Blaine TA, Levine
WN, Bigliani LU. Conversion of painful hemiarthroplasty
to total shoulder arthroplasty: long-term results. J
Shoulder Elbow Surg. 2004; 13(6):599-603.
7. Cheung EV, Sperling JW, Cofield RH. Revision shoulder
arthroplasty for glenoid component loosening. J
Shoulder Elbow Surg. 2008; 17(3):371-5.
8. Dines JS, Fealy S, Strauss EJ, Allen A, Craig EV,
Warren RF, et al. Outcomes analysis of revision total
shoulder replacement. J Bone Joint Surg Am. 2006;
88(7):1494-500.
9. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch
G. Reverse total shoulder arthroplasty. Survivorship
analysis of eighty replacements followed for five to
ten years. J Bone Joint Surg Am. 2006; 88(8):1742-7.
10. Petersen SA, Hawkins RJ. Revision of failed total
shoulder arthroplasty. Orthop Clin North Am. 1998;
29(3):519-33.
11. Sajadi KR, Kwon YW, Zuckerman JD. Revision shoulder
arthroplasty: an analysis of indications and outcomes.
J Shoulder Elbow Surg. 2010; 19(2):308-13.
12. Khatib O, Onyekwelu I, Yu S, Zuckerman JD. Shoulder
arthroplasty in New York State, 1991 to 2010:
changing patterns of utilization. J Shoulder Elbow
Surg. 2015; 24(10):e286-91.
13. Schairer WW, Nwachukwu BU, Lyman S, Craig EV,
Gulotta LV. National utilization of reverse total
shoulder arthroplasty in the United States. J Shoulder
Elbow Surg. 2015; 24(1):91-7.
14. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I.
Neer Award 2005: the Grammont reverse shoulder
prosthesis: results in cuff tear arthritis, fracture
sequelae, and revision arthroplasty. J Shoulder Elbow
Surg. 2006; 15(5):527-40.
15. Chalmers PN, Keener JD. Expanding roles for reverse
shoulder arthroplasty. Curr Rev Musculoskelet Med.
2016; 9(1):40-8.
16. Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon
YW. Reverse total shoulder arthroplasty for failed
shoulder arthroplasty. J Shoulder Elbow Surg. 2012;
21(11):1478-83.
17. Wagner E, Houdek MT, Griffith T, Elhassan BT, Sanchez-
Sotelo J, Sperling JW, et al. Glenoid bone-grafting in
revision to a reverse total shoulder arthroplasty. J
Bone Joint Surg Am. 2015; 97(20):1653-60.
18. Guery J. Reverse total shoulder arthroplasty.
Survivorship analysis of eighty replacements followed
for five to ten years. J Bone Joint Surg Am. 2006;
88(8):1742-7.
19. Williams GN, Gangel TJ, Arciero RA, Uhorchak JM,
Taylor DC. Comparison of the single assessment
numeric evaluation method and two shoulder rating
scales. Outcomes measures after shoulder surgery.
Am J Sports Med. 1999; 27(2):214-21.
20. Michener LA, McClure PW, Sennett BJ. American
shoulder and elbow surgeons standardized shoulder
assessment form, patient self-report section:
reliability, validity, and responsiveness. J Shoulder
Elbow Surg. 2002; 11(6):587-94.
21. Ware J, Kosinski M, Keller SD. A 12-item short-form
health survey: construction of scales and preliminary
tests of reliability and validity. Med Care. 1996;
34(3):220-33.
22. Deutsch A, Abboud JA, Kelly J, Mody M, Norris T,
Ramsey ML, et al. Clinical results of revision shoulder
arthroplasty for glenoid component loosening. J
Shoulder Elbow Surg. 2007; 16(6):706-16.
23. Bonnevialle N, Melis B, Neyton L, Favard L, Molé D,
Walch G, et al. Aseptic glenoid loosening or failure
in total shoulder arthroplasty: revision with glenoid
reimplantation. J Shoulder Elbow Surg. 2013; 22(6):
745-51.