Failed Shoulder Replacement (Failed Shoulder Arthroplasty)

Understanding Failed Shoulder Replacement (Failed Shoulder Arthroplasty)

Most shoulder replacements last a long time: about 90% are still working more than 10 years after surgery ^[1]. When one fails, patients usually notice new or returning pain, loss of motion or strength, or a feeling that the shoulder is unstable, sometimes years after a good result.

The most common causes are loosening or wear of the implants, especially the plastic socket component of an anatomic replacement; failure of the rotator cuff, which an anatomic replacement depends on; instability or dislocation; infection, which can be low-grade and hard to detect; and fracture of the bone around the implant after a fall ^{[2, 3]}.

Finding the cause is the most important step, because the right treatment depends on it. Dr. Joshi evaluates failed and painful shoulder replacements, including second opinions on replacements done elsewhere, and performs revision surgery when it is needed. Revision is more complex than a first-time replacement and is often done by converting to a reverse shoulder replacement, sometimes with bone grafting or specialized components when bone has been lost.

Causes & Risk Factors

• Loosening or wear of the socket (glenoid) or arm-bone (humeral) component
• Rotator cuff tear or wear after an anatomic replacement
• Instability or dislocation from component position, soft-tissue failure or deltoid weakness
• Infection, often from the slow-growing skin bacterium Cutibacterium acnes
• Fracture of the bone around the implant (periprosthetic fracture)
• Wear of the natural socket after a partial replacement (hemiarthroplasty)

Symptoms

Common signs and symptoms of Failed Shoulder Replacement include:

• New or increasing pain after a period of doing well
• Pain that never improved after the original surgery
• Loss of motion or strength, especially difficulty lifting the arm
• Clicking, clunking or a feeling of the shoulder giving way, or a dislocation
• Swelling, warmth, wound drainage, fever or chills, which can signal infection
• Changes on X-ray at a routine follow-up visit, even without symptoms

Treatment Options

Treatment for Failed Shoulder Replacement depends on the severity of your condition and may include:

• Careful workup: exam, X-rays compared with prior films, CT scan, blood tests and, when needed, joint aspiration or biopsy to rule out infection
• Observation and therapy when imaging changes are mild and symptoms are limited
• Revision surgery to replace a loose or worn component
• Conversion of an anatomic replacement or hemiarthroplasty to a reverse shoulder replacement
• Treatment of infection with a one-stage or two-stage exchange, depending on the organism and tissues
• Bone grafting or augmented components when bone has been lost
• Fixation or revision for fractures around the implant

References

1. Evans JP, Evans JT, Craig RS, et al. How long does a shoulder replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up. Lancet Rheumatol. 2020;2(9):e539-e548. doi.org/10.1016/S2665-9913(20)30226-5
2. Bohsali KI, Bois AJ, Wirth MA. Complications of Shoulder Arthroplasty. J Bone Joint Surg Am. 2017;99(3):256-269. doi.org/10.2106/JBJS.16.00935
3. Young AA, Walch G, Pape G, et al. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am. 2012;94(8):685-93. doi.org/10.2106/JBJS.J.00727