title: Failure after reverse total shoulder arthroplasty: what is the success of component revision?
abstract: BACKGROUND
  Complication rates remain high after reverse total shoulder arthroplasty (RTSA). Salvage options after implant failure have not been well defined. This study examines the role of reimplantation and revision RTSA after failed RTSA, reporting outcomes and complications of this salvage technique.
  
  
  METHODS
  Sixteen patients underwent component revision and reimplantation after a prior failed RTSA from 2004 to 2011. Indications included baseplate failure (7 patients, 43.8%), instability (6 patients, 37.5%), infection (2 patients, 12.5%), and humeral loosening (1 patient, 6.3%). The average age of the patient during revision surgery was 68.6 years. Outcomes information at follow-up was recorded, including visual analog scale score for pain, subjective shoulder value, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score, and these were compared with pre-revision values. Repeated surgeries and complications were noted.
  
  
  RESULTS
  Average time to follow-up from revision was 58.9 months (minimum, 2 years; range, 24-103 months). The average postoperative visual analog scale score for pain was 1.7/10 (7.5/10 preoperatively; P < .0001), and the subjective shoulder value was 62% (17% preoperatively; P < .0001). The average postoperative American Shoulder and Elbow Surgeons score was 66.7, and the Simple Shoulder Test score was 52.6. Fourteen patients (88%) noted that they felt "better" postoperatively than before their original RTSA and would go through the procedure again if given the option. Nine patients suffered major complications (56%), and 6 of these ultimately underwent further procedures (38% of cohort).
  
  
  CONCLUSIONS
  Salvage options after failure of RTSA remain limited. Component revision and reimplantation can effectively relieve pain and improve function compared with baseline values, and patient satisfaction levels are moderately high. However, complication rates and reoperation rates are significant.
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@mgh.harvard.edu.
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012086:Reoperation; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Reverse shoulder arthroplasty; complications; reimplantation; revision reverse shoulder arthroplasty; revision shoulder