Total shoulder replacement is the replacement of the head of the humerus (upper arm bone) and the glenoid cavity (cavity of the shoulder blade) into which the humerus fits, with artificial prostheses to relieve pain, swelling and stiffness caused due to damage of cartilage at the articulating surfaces. The procedure usually has good results, but a revision surgery may occasionally be necessary due to persistent pain, infection, stiffness, weakness, instability, hardware loosening, malposition or fracture.
These complications occur with the formation of osteophytes (bone spurs), scar tissue, deficits in the supporting muscles, injury to nerves during surgery, soft tissue imbalance, and loose bodies. Complications may also occur when the components are too large, become loose or misplaced. Inadequate participation in the rehabilitation program and overstraining the repaired tendons too early are other causes for surgical failure.
Before considering revision surgery, your doctor will review your history and perform a thorough physical examination to identify the cause of failure and decide on the best approach to treatment.
Revision surgery is usually performed under general anesthesia. You are 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 because of the previous surgery.