Revision Reverse Total Shoulder Arthroplasty: Current Concepts and Operative Strategies

As the number of reverse total shoulder arthroplasties (rTSA) in the United States continues to increase, so will the number of revisions rTSAs conducted. Common indications for revision rTSA include instability, infection, humeral or glenoid component loosening or periprosthetic humeral fracture, and each indication for revision warrants specific preoperative management and intraoperative strategies. Accurate diagnosis and management of the patient is key, as failure to recognize the correct indication for revision may result in failure of the revision surgery. Revision rTSA is a technically challenging procedure. However, with diligent preoperative planning including serologic evaluation for infection, evaluation of bone loss and implant stability with computed tomography, anticipating need for bone grafting, and detailed identification of implanted components to plan for explantation, surgeons can avoid common pitfalls in the operating room. This review article will discuss the major indications for revision rTSA and provide insight and technical tips to assist with the surgical management of these challenging cases.