Revision Total Shoulder Replacement

When complications occur in the shoulder joint after total shoulder replacement surgery, sometimes a revision total shoulder arthroplasty is needed to reduce painful symptoms and help a patient regain mobility. In revision surgery, your doctor may repair any damage and remove some or all of the parts of the original prosthesis and replace them with new ones.

At OrthoBethesda, our team of highly trained surgeons provide quality care to the Bethesda, MD, community and offer both surgical and conservative treatments for a variety of musculoskeletal issues, including any problems you may be experiencing with your shoulder joint.

What Is Total Shoulder Replacement?

When a total shoulder replacement is needed, expert surgeons replace the head of the upper arm bone (humerus) as well as the cavity of the shoulder blade into which the humerus fits with artificial prosthetics. Once the total shoulder replacement is complete, it should relieve any pain, swelling, or stiffness caused by damage to the cartilage and joint.

When Do We Recommend a Revision Shoulder Replacement?

In general, total shoulder replacement has great results, allowing patients to move their shoulder joint freely without pain. However, over time, revision surgery may be necessary for a variety of reasons, such as:

• Persistent pain
• Difficulty performing everyday activities
• Infection
• Stiffness
• Instability
• Weakness
• Hardware loosening
• Malposition
• Fracture

These complications may occur for several different reasons, any of which can cause the failure of a total shoulder replacement, including:

• Formation of bone spurs
• Scar tissue
• Deficits in supporting muscles
• Nerve injuries during surgery
• Imbalance in the soft tissue
• Loose bodies
• Overly large components
• Components that become loose or misplaced
• Lack of participation in a rehab program
• Overstraining of repaired tendons too early

Considerations Before Revision Shoulder Replacement

When you come to OrthoBethesda, we’ll perform a thorough physical examination and review your medical history. This process will help us identify what caused your total shoulder replacement to fail. Only then will we consider the best treatment approach, which could include revision total shoulder arthroplasty.

How Is Revision Shoulder Replacement Performed?

If your OrthoBethesda orthopedic surgeon determines that revision surgery is the best option, we’ll work with you throughout the entire process. Revision surgery is performed under general anesthesia with the use of an arthroscope, which is a small, fiber-optic viewing instrument. This tool allows us to make smaller incisions while still gaining optimal access to the problem area. We’ll also strive to follow the previous incisions, making extensions only when necessary.

Revision shoulder surgery usually involves the following:

• Removal of scar tissue and other impeding structures
• The release of stiff muscles, tendons, and ligaments to improve range of motion
• Repair of injured parts using tendon grafts
• Replacement or alteration of ill-fitting components
• Stabilization of fractures using screws, plates or wires
• Treatment of any infections
• Removal of dead or infected tissue

Throughout the procedure, great care is taken to protect all muscular and neurovascular structures. However, their positions may be altered due to the failed previous surgery.

Recovery From Revision Total Shoulder Replacement

After revision shoulder replacement arthroplasty, you’ll stay in the recovery room for a few hours. Once you wake up from the anesthesia, you’ll be taken to your hospital ward. You need to breathe deeply and cough to clear your lungs and prevent any lung congestion.

The operated on arm may be numb because of the regional anesthesia, which will also help you enjoy pain relief. You may feel some numbness in your arm, wrist, and fingers on that side as well. After about 18 hours, the regional anesthesia will wear off, and you’ll have the normal sensation restored to your hand and arm.

You may need to stay in the hospital for up to three days, but your stay may be shorter if you start to recover quickly. After the revision total shoulder replacement, you may feel pain, which will be relieved through medication. It will usually be offered by injection. An icing device that controls pain may be placed on your shoulder. You may also use an ice pack to reduce discomfort in the area.

Your orthopedic doctor will put your arm in a sling after the operation. You’ll need to wear it for up to six weeks after the surgery. After you’re able to move your hand, you’ll be advised to move it and make it into a fist. Clenching your fist often will help you keep blood circulating in your arm until it heals completely.

Further Reading

Shoulder Pain – Frozen Shoulder

The Ultimate Guide For Shoulder Recovery Surgery