Revision Anatomic Total Shoulder Arthroplasty Surgical Technique/Tips and Tricks

Abstract

In the United States, the use of total shoulder arthroplasty has grown significantly over the past decade, leading to an increased need for revision total shoulder arthroplasty. The most common causes for revision include instability, rotator cuff deficiency, infection, fractures, and component loosening. Although revisions are sometimes unavoidable, thoughtful preoperative planning and proper implant positioning, among other mitigation strategies, can help reduce this risk. A comprehensive evaluation is essential for determining the appropriate treatment modality, with computed tomography arthrography and metal suppression magnetic resonance imaging being particularly helpful depending on the etiology. Initial treatments may include conservative approaches, such as analgesic medications and physical therapy, but more commonly, surgical intervention is required. This typically involves revision total shoulder arthroplasty or conversion to reverse total shoulder arthroplasty, and in rare cases diagnostic arthroscopy or arthroscopic rotator cuff repair. Surgeons should be prepared for all potential treatments and complications, and a thorough work-up ensures that all possible scenarios are accounted for.