Revision Total Shoulder Arthroplasty: Epidemiology and Causes

Abstract

Total shoulder arthroplasty has gained remarkable popularity in the last few decades. Critical review of outcomes and large registries in different countries have led to newer designs and expanding indications, which have resulted in rapid growth around the world. Despite numerous advances in surgical techniques and implant designs, however, complications still occur, and with an active aging population and increasing popularity among upper extremity surgeons, we can expect those complications to increase both in volume and complexity. Recognition and timely diagnosis of adverse outcomes can help surgeons not only correct and salvage a poor outcome but understanding what leads to common complications may also help us to anticipate and avoid them altogether. Infection, component loosening, periprosthetic fracture, and instability are the major reasons for revision surgery. Though the diagnosis may be difficult, as many signs and symptoms may be subtle and nonspecific, a careful history and physical examination, critical review of radiographs, and a healthy level of suspicion may offer clues and guide the surgeon toward advanced imaging, laboratory studies, and other diagnostic measures. This chapter aims to provide the reader with the tools to successfully identify those patients who may need further surgical treatment in the setting of a total shoulder arthroplasty as well as to help avoid common pitfalls implicated in certain complications.