title: Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger.
abstract: BACKGROUND
  This study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or hemiarthroplasty and compared them with those of an age-matched cohort undergoing primary RTSA.
  
  
  METHODS
  RTSA as a revision for failed shoulder arthroplasty was performed on 36 patients younger than 65 years. Follow-up was available for 32 patients at an average of 55.3 months. Results were compared with those of an age-matched cohort of 37 patients (33 available for follow-up; average, 54.7 months) undergoing primary RTSA. Average age for both groups was 59.3 years. Outcomes were compared before and after revision surgery and between cohorts.
  
  
  RESULTS
  Preoperative visual analog scale (VAS) for pain and subjective shoulder value (SSV) scores were similar in both groups, 7.3 of 10 and 24%, respectively, before revision, and 7.0 of 10 and 19% before primary RTSA (P = .3). Postrevision VAS and SSV scores improved to 1.4 of 10 and 60% (P < .0001). Average American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after revision were 69.7 and 58.8, with 9 complications (28.1%; 6 major and 3 minor). VAS and SSV scores improved to 2.1 of 10 and 76% after primary RTSA (P < .0001). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after primary RTSA were 74 and 67.3, with 6 complications (18.2%; 5 major and 1 minor). Only the postoperative SSV score was statistically different in comparing primary and revision RTSA (P < .05).
  
  
  CONCLUSIONS
  RTSA is effective in reducing pain and improving function after failed arthroplasty in young patients, but complication rates are high and expectations should be managed appropriately. Subjective outcome scores are worse than those for age-matched patients undergoing primary RTSA, but pain, functional scores, and complication rates are similar.
authors.affiliation: Department of Orthopaedic Surgery, The Summit Medical Group, Berkeley Heights, NJ, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Black
authors.affiliation: The Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Roberts
authors.affiliation: The Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Elana
authors.initials: E
authors.lastname: Siegel
authors.affiliation: The Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Yannopoulos
authors.affiliation: The Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
authors.affiliation: The Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: JWarner@partners.org.
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000379:methods; D019643:Arthroplasty, Replacement; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D012785:Shoulder Joint / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Revision; failed shoulder arthroplasty; reverse; reverse in young; reverse total shoulder arthroplasty