Surgical Exposure in Revision Shoulder Arthroplasty

  • Jason S. Klein
  • Charles L. GetzEmail author


Revision shoulder arthroplasty is technically more demanding and inherently fraught with more complications than primary arthroplasty. This chapter will review the preoperative assessment of the painful arthroplasty to identify one of the many reasons for failure that will help direct future intervention. Once a decision to pursue revision shoulder arthroplasty has been made, we discuss the preoperative planning required to ensure all equipment and implants will be available on the day of surgery. Next, we present our preferred surgical exposure technique including deltopectoral interval development, adhesion take down, axillary nerve identification and protection, subscapularis management, humeral and glenoid exposure, and releases to accomplish improved exposure should osteotomies be required. Based on our experience, we highlight pearls that are key to successful revision shoulder arthroplasty in the setting of altered anatomy, scar tissue and adhesions, bone loss, and soft tissue deficiency.


Revision Total shoulder arthroplasty Surgical exposure Technique Pearls 


  1. 1.
    Lugli T. Artificial shoulder joint by Pean (1893): the facts of an exceptional intervention and the prosthetic method. Clin Orthop Relat Res. 1978;133:215–8.Google Scholar
  2. 2.
    Jain NB, Higgins LD, Guller U, et al. Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990–2000. Arthritis Rheum. 2006;55:591–7.CrossRefGoogle Scholar
  3. 3.
    Kim SH, Wise BW, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. JBJS. 2011;93:2249–54.CrossRefGoogle Scholar
  4. 4.
    Trofa D, Rajaee SS, Smith EL. Nationwide trends in total shoulder arthroplasty and hemiarthroplasty for osteoarthritis. Am J Orthop (Belle Mead NJ). 2014;43:166–72.Google Scholar
  5. 5.
    Fox TJ, Cil A, Sperling JW, et al. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elb Surg. 2009;18:859–63.CrossRefGoogle Scholar
  6. 6.
    Singh JA, Sperling JW, Cofield RH. Revision surgery following total shoulder arthroplasty. J Bone Joint Surg (Br). 2001;93-B:1513–7.CrossRefGoogle Scholar
  7. 7.
    Young A, Walch G, Boileau P, et al. A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis. J Bone Joint Surg (Br). 2011;93:210–6.CrossRefGoogle Scholar
  8. 8.
    Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Fumes O. Risk factors for revision after shoulder arthroplasty: 1825 shoulder arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop. 2009;80:83–91.CrossRefGoogle Scholar
  9. 9.
    Khan A, Bunker TD, Kitson JB. Clinical and radiological follow-up of the Aequalis third-generation cemented total shoulder replacement: a minimum ten-year study. J Bone Joint Surg (Br). 2009;91-B:1594–600.CrossRefGoogle Scholar
  10. 10.
    Martin SD, Zurakowski D, Thornhill TS. Uncemented glenoid component in total shoulder arthroplasty: survivorship and outcomes. J Bone Joint Surg Am. 2005;87-A:1284–92.Google Scholar
  11. 11.
    Sperling JW, Cofield RH, Rowland CM. Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less: long-term results. J Bone Joint Surg Am. 1998;80-A:464–73.CrossRefGoogle Scholar
  12. 12.
    Tammachote N, Sperling JW, Vathana T, et al. Long-term results of cemented metal-backed glenoid components for osteoarthritis of the shoulder. J Bone Joint Surg Am. 2009;91-A:160–6.CrossRefGoogle Scholar
  13. 13.
    Thomas SR, Wilson AJ, Chambler A, Harding I, Thomas M. Outcomes of Copeland surface replacement shoulder arthroplasty. J Shoulder Elb Surg. 2005;14:485–91.CrossRefGoogle Scholar
  14. 14.
    Schwartz BE, Savin DD, Youderian AR, Mossad D, Goldberg BA. National trends and perioperative outcomes in primary and revision total shoulder arthroplasty. Int Orthop. 2015;39:271–6.CrossRefGoogle Scholar
  15. 15.
    Hollatz MF, Stang A. Nationwide shoulder arthroplasty rates and revision burden in Germany: analysis of the national hospitalization data 2005 to 2006. J Shoulder Elb Surg. 2014;23(11):e267–74.CrossRefGoogle Scholar
  16. 16.
    Ankem HK, Blaine TA. Revision shoulder arthroplasty. Tech Should Elbow Surg. 2005;6(4):189–98.CrossRefGoogle Scholar
  17. 17.
    Cofield RH, Edgerton BC. Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect. 1990;39:449–62.PubMedGoogle Scholar
  18. 18.
    Cofield RH. Revision procedures in shoulder arthroplasty. In: Morrey BF, editor. Reconstructive surgery of the joints. 2nd ed. New York: Churchill Livingstone; 1996. p. 789.Google Scholar
  19. 19.
    Hassan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen FA 3rd. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elb Surg. 2002;11:431–41.CrossRefGoogle Scholar
  20. 20.
    Kalandiak SP, Wirth MA, Rockwood CA. Complications of shoulder arthroplasty. In: Williams Jr GR, Yamaguchi K, Ramsey ML, Galatz M, editors. Shoulder and elbow arthroplasty. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 229–50.Google Scholar
  21. 21.
    Wirth MA, Rockwood CA Jr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996;78:603–16.CrossRefGoogle Scholar
  22. 22.
    Saltzman BM, Chalmer PN, Gupta AK, Romeo AA, Nicholson GP. Complication rates comparing primary with revision reverse total shoulder arthroplasty. J Should Elb Surg. 2014;23:1647–54.CrossRefGoogle Scholar
  23. 23.
    Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–95.PubMedGoogle Scholar
  24. 24.
    Deutsch A, Abboud JA, Kelly J, et al. Clinical results of revision shoulder arthroplasty for glenoid component loosening. J Shoulder Elb Surg. 2007;16:706–16.CrossRefGoogle Scholar
  25. 25.
    Melis B, Bonnevialle N, Neyton N, Walch G, Boileau P. Aseptic glenoid loosening or failure in total shoulder arthroplasty. In: Walch G, Boileau P, Mole D, Favard L, Levigne C, Sirveaux F, editors. Shoulder concepts 2010: the glenoid. Paris: Sauramps Medical; 2010. p. 299–312.Google Scholar
  26. 26.
    Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Should Elb Surg. 2012;21:514–22.CrossRefGoogle Scholar
  27. 27.
    Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86.PubMedGoogle Scholar
  28. 28.
    Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elb Surg. 2005;14:147S–61S.CrossRefGoogle Scholar
  29. 29.
    Dines JS, Fealy S, Strauss EJ, Allen A, Craig EV, Warren RF, Dines DM. Outcomes analysis of revision total shoulder replacement. J Bone Joint Surg Am. 2006;88:1494–500.CrossRefGoogle Scholar
  30. 30.
    Antuna SA, Sperling JW, Cofield RH, et al. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elb Surg. 2001;10:217–24.CrossRefGoogle Scholar
  31. 31.
    Carroll RM, Izquierdo R, Vazquez M, et al. Conversion of painful hemiarthroplasty to total shoulder arthroplasty: long-term results. J Shoulder Elb Surg. 2004;13:599–603.CrossRefGoogle Scholar
  32. 32.
    Cheung EV, Sperling JW, Cofield RH. Revision shoulder arthroplasty for glenoid component loosening. J Shoulder Elb Surg. 2008;17:371–5.CrossRefGoogle Scholar
  33. 33.
    Petersen SA, Hawkins RJ. Revision of failed total shoulder arthroplasty. Orthop Clin North Am. 1998;29:519–33.CrossRefGoogle Scholar
  34. 34.
    Strickland JP, Sperling JW, Cofield RH. The results of two-stage re-implantation for infected shoulder replacement. J Bone Joint Surg Br. 2008;90:460–5.CrossRefGoogle Scholar
  35. 35.
    Topolski MS, Chin PY, Sperling JW, Cofield RH. Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elb Surg. 2006;15(4):402–6.CrossRefGoogle Scholar
  36. 36.
    Wang B, Toye B, Desjardins M, Lapner P, Lee C. A7-year retrospective review from 2005 to 2011 of Propionibacterium acnes shoulder infections in Ottawa, Ontario, Canada. Diagn Microbiol Infect Dis. 2013;75:195–9.CrossRefGoogle Scholar
  37. 37.
    Sonnaband D, Mohammed KD. Revision shoulder arthroplasty. J Shoulder Elb Surg. 1999;8:553.Google Scholar
  38. 38.
    Moeckel BW, Warren RF, Dines DM, et al. The unstable shoulder arthroplasty. In: Freedman RJ, editor. Arthroplasty of the shoulder. New York: Thieme; 1994. p. 254–63.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations