Revision Total Shoulder Arthroplasty: Surgical Technique
As shoulder arthroplasty is increasing, the expected amount of revisions is expected to increase accordingly. Revision shoulder arthroplasty is a complex procedure that requires precise planning and adequate strategy for effective treatment. The cause of revision in itself is essential as it may dictate the strategy of the procedure. Many aspects including patient expectations, prior procedures, physical examination and imaging, and laboratory findings will influence some of the decisions. The index arthroplasty may have become stiff, unstable, or loose, and the looming presence of infection can condition the procedure. Precise and careful handling of the soft tissues right from the skin incision is necessary in revision cases. While platform systems have facilitated revision, in many cases the humeral stem has to be revised, sometimes with the need of osteotomies. Bone loss may be augmented by strut grafting, impaction grafting, or allograft-prosthetic composite grafting. However, it is glenoid loosening the main problem after anatomic total shoulder arthroplasty, which can be revised to an anatomical implant or more typically to a reverse shoulder configuration. Glenoid bone loss can be peripheral or central, contained, or uncontained and this will guide decision-making regarding the reconstructive procedure.
KeywordsRevision Total shoulder Arthroplasty Loosening Glenoid bone loss
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