Shoulder joint replacement procedures are performed most successfully and they last about 20 years in 85% – 90% of well-selected patients. While shoulder replacement has a generally high success rate for most patients, complications and wear and tear to the prosthetic joint sometimes lead to failure and make it necessary for a second, or revision, shoulder surgery to repair the damage, or replace the joint with a new unit.
Causes
A shoulder surgery has failed when it does not achieve the expectations of the patient and the surgeon. Failure can result from stiffness, weakness, instability, pain, component malposition, or failure to heal, as well as from complications such as infection or nerve injury. Every surgery has a risk of failure, whether it is an operation for dislocation, rotator cuff tear, arthritis or fracture. Because fracture fixation, Bankart repairs, rotator cuff repairs, shoulder joint replacements and reverse total shoulder replacements are performed commonly, a substantial number of patients have experienced these failures.
Symptoms
The most common symptoms of complications with a primary shoulder replacement include:
- Pain
- Stiffness
- Weakness
- Instability
- Slow/limited healing
- Infections
- Nerve problems
- Limited range of motion
Shoulder Revision Procedure
Revision surgery is usually performed under general anesthesia. Patients will be positioned to allow all possible variations in the treatment plan. Incisions are made to gain optimal access to the problem, and usually follow previous incisions with extensions made as necessary. Revision involves removing any impeding structures such as scar tissue. Muscles, tendons and ligaments that are stiff are released to improve range of motion, and those that are injured are repaired using tendon grafts. Ill-fitting components are replaced or altered. Fractures are stabilized by plates, screws and wires. Infections are usually treated by debridement of soft tissue (removal of dead, infected tissue) and irrigation with antibiotic solution. In cases of chronic infections, components may need to be replaced. Care is taken to protect muscular and neurovascular structures whose positions may be altered as a result of the previous surgery.
After a revision surgery, the patient is restricted from performing certain activities for a few weeks and will undergo rehabilitation to regain shoulder strength.