Weakness may result from rotator cuff failure, subscapularis detachment, nerve injury, deltoid detachment, or disuse atrophy of the muscles. For example, a shoulder arthroplasty may be stiff because of adhesions (scar), blocking osteophytes (bone spurs), or overstuffing (too large prosthetic components).
Each of these mechanical characteristics provides clues to what may be going on with the joint. While pain is often a presenting complaint, we try to determine as well if the shoulder is stiff, unstable, weak, or crepitant. These have been well characterized by our shoulder fellows Hasan and Franta. It is always important to keep in mind the wide range of potential causes of joint replacement failure. When a shoulder replacement fails to result in satisfactory restoration of comfort and function the surgeon and the patient are challenged to determine the most likely causes and how the failure can be best managed. Revision surgery for failed total shoulder replacement arthroplasty Substantial thought should go into considering the pros and cons of additional surgery and when and where it can be best performed. Revision shoulder surgery is rarely an emergency. This evaluation enables the experienced revision shoulder surgeon to discuss the different treatment options with the patient, including the potential risks and benefits.
The evaluation begins with a history of the shoulder problem starting before the surgery, a review of the report from the surgery, a physical examination, high quality X-rays, and a complete assessment of the overall health of the patient. Finally, if surgery for a fracture has resulted in stiffness or non-healing of the bone, removal of scar tissue and re-fixation of the fracture may improve the result. If a conventional shoulder replacement for shoulder arthritis or a reverse total shoulder replacement has become stiff, unstable, or if the artificial components have become loose, a revision surgery to rebalance the tissues and to re-secure the humeral and glenoid replacement parts may restore comfort and function. If a Bankart repair or surgery for shoulder dislocations has resulted in persistent instability or limited motion, a revision repair or removal of adhesions may be of benefit. If a shoulder arthroscopy has resulted in stiffness, chondrolysis may have resulted. If a rotator cuff repair has resulted in weakness or catching and popping on shoulder movement, a ‘smooth and move,’ or possibly, a re-repair may be considered. If a shoulder surgery has resulted in stiffness or limited range of motion, stretching exercises or a second surgery to release adhesions may be helpful. Even though the problem may seem to be pain it is important to identify the likely mechanical causes of the failure in that a mechanical cause may be repairable. When a patient experiences a failure of shoulder surgery, patients should consult a surgeon experienced in the evaluation and management of these conditions. Because fracture fixation, Bankart repairs, rotator cuff repairs, shoulder joint replacements and reverse total shoulders are performed commonly, a substantial number of patients have experienced these failures. Every surgery has a risk of failure whether it is an operation for dislocation, rotator cuff tear, arthritis or fracture. Failure can result from stiffness, weakness, instability, pain or failure to heal, and from complications such as infection or nerve injury. Overview Basics of failed shoulder surgery and revision shoulder surgeryĪ shoulder surgery has failed when it does not achieve the expectations of the patient and the surgeon.
Revision Surgery due to Humeral Fracture.Revision Surgery due to Stiffness - Unwanted Bone and Overstuffing.Revision Surgery due to Stiffness - Soft Tissue Release.Types of Revision Surgery for Failed Shoulder Replacement Arthroplasty.Surgical Considerations and General Principles of Revision Surgery.Common Causes of Failed Shoulder Arthroplasty.Surgical revision for failed total shoulder replacement arthroplasty.Orthopaedics and Sports Medicine Bulletin.Resident Research - Intake and Travel Award Forms.Orthopaedic Surgery and Sports Medicine Interest Group.Residents Portal and Digital Curriculum.
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