Revision Shoulder Arthroplasty



Rule out infection


Assess rotator cuff


Assess bone stock

- can you re-implant glenoid

- do you need bone graft


Removal of prosthesis

- glenoid typically simple

Revise to

- aTSA

- rTSA

- hemiarthroplasty




Ravi et al. Bone Joint Open 2021

- systematic review of 5379 revision aTSA

- multiple indications including loosening (20%), instability (19%), rotator cuff failure (17%) and infection (16%)

- 22% complication rate

- 8% reoperation rate

- revision to rTSA rather than aTSA resulted in fewer complications, better Constant score, but not ASES scores


Otte et al. JSES 2020

- revision aTSA to rTSA in 75 patients

- multiple indications for surgery

- major complications in 28% and reoperation in 12%

- improvements in patient reported outcome measures but did not reach that of primary aTSA


Sheth et al. JSES 2019

- revision of 110 failed hemiarthroplasties and aTSA to rTSA

- 92% 2 year survival

- 74% 5 year survival




Rule out infection


- ultrasound or xray guided aspiration

- arthroscopy for fluid and tissue sampling



- good for cuff integrity

- MRI often not useful due to large amount of metal artefact


CT scan

- glenoid bone stock




Verhoste et al. Int Orthop 2020

- clavicular osteotomy in revision TSA

- curved longitudinal osteotomy parallel to deltoid insertion, sutured back on at end of case

- improves exposure and preserves deltoid

- 40 patients, with 95% healed by 3 months

- 3 post op clavicle fractures after a fall, one loosening

- 3 surgical revisions required


Implant Removal



- often very loose

- easy to remove


Revision TSR Loose GlenoidRevision TSR Loose Glenoid


Humeral component

- most uncemented stems only proximally coated

- flexible osteotomes


Revision TSR


Glenoid bone stock restoration


1.  Cortical ring allograft

- napkin ring type

- take from calcar of a femoral neck

- cut so is thicker posteriorly to reconstitute the glenoid

- place onto freshened glenoid surface


2.  Bulk posterior allograft


 Revision Reverse TSR Glenoid Bulk Posterior Allograft



- use femoral head

- reconstitute posterior aspect of glenoid

- fix with 2 x cannulated 4mm screws via stab incisions posteriorly

- need to be able to fix glenoid component with screws still


Revision Humeral Component



- often need long stem

- often use cement in revision circumstance


Revision TSR Long Stem Cemented Humeral Component


May need proximal humerus allograft


Revision TSA proximal humerus allograft


Sanchez - Sotelo et al. JBJS Am 2017

- 26 patients undergoing revision to reverse with bulk proximal allograft

- average time to union 7 months

- one patient required bone grafting to obtain union