Reverse shoulder replacements: When things go bad

Reverse shoulder replacements are generally a very successful operation. However, as with all surgeries things can go wrong. In my practice, I see a number of referrals for shoulder replacements that have failed and require a revision surgery. Over the past month, I have had the opportunity to revise three replacements which demonstrate some of the potential problems with reverse replacements and the challenges of revision shoulder replacement.

The most common modes of failure for reverse shoulder replacements are: dislocation, infection, implant loosening from bone, and dissociation (meaning the implant comes apart). Our recent cases demonstrate most of these problems.

In the first case, the implant had come loose from the bone. Sometimes this can be caused by a low level infection. A revision was performed by removing the implants, washing out the shoulder, replacing new well fixed implants and placing the patient on IV antibiotics.

In the second case, the implant had dissociated (come apart). The ball of the reverse had popped off from the baseplate, and also the implant had dislocated. This was addressed by changing the sizes of the implant to make it more secure.

The third case, is actually a partial replacement. In this case the ball of the implant had dislocated from the socket and was sitting against the patient’s rib cage. It had been in that position for over a year and causing tremendous pain. This was revised to a reverse replacement, but required an osteotomy (splitting the arm bone) to remove the old implant. Also, the socket had to be rebuilt with bone graft before the reverse could be placed.

Revision shoulder surgery can be a challenge, but these are often the most rewarding patients to care for.

Author
Brad Carofino, MD Dr. Brad Carofino is a board-certified (American Board of Orthopaedic Surgery), fellowship-trained orthopaedic surgeon who specializes in shoulder & upper extremity surgery. Dr. Carofino is an expert in shoulder replacement surgery, minimally invasive arthroscopic rotator cuff repair, and complex reconstructive procedures of the upper extremity.

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