title: Revision for a failed reverse: a 12-year review of a lateralized implant.
abstract: BACKGROUND
  The purpose of this study was (1) to evaluate the rates of reverse shoulder arthroplasty (RSA) revisions during a 12-year period, (2) to assess the influence of primary diagnosis and the impact of implant modifications on revisions, (3) to describe surgical management of failed RSA, and (4) to analyze outcomes of patients with minimum 24-month follow-up.
  
  
  METHODS
  A retrospective database review identified primary diagnosis for 1418 patients who underwent RSA from 2000 to 2012. A subgroup of 85 patients required return to the operating room for removal or exchange of components. Indication to reoperate, intraoperative management, and outcomes were reviewed. Indications were grouped into 7 categories: baseplate failure, humeral component dissociation, glenosphere dissociation, glenohumeral dislocation, aseptic humeral loosening, periprosthetic fracture, and infection. During the study, design modifications were made to the baseplate, humeral socket, and glenosphere. Surgical strategies were analyzed through operative reports. Range of motion, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores were collected before and after surgery and compared for 58 patients with 2-year follow-up.
  
  
  RESULTS
  Overall revision rate was 6%. Patients undergoing RSA for failed hemiarthroplasty had the highest revision rate (10%). Indications for revision included baseplate failure (2.5%), infection (1.3%), humeral dissociation (0.7%), glenosphere dissociation (0.6%), periprosthetic fracture (0.4%), glenohumeral dislocation (0.4%), and aseptic humeral loosening (0.3%). Baseplate modifications reduced the incidence of baseplate failure to 0.3%. Range of motion and the Simple Shoulder Test and American Shoulder and Elbow Surgeons scores improved.
  
  
  CONCLUSIONS
  Although revision RSA is challenging, with higher risk for complications compared with primary RSA, patients still exhibit significant clinical improvements.
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Stephens
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Simon
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clark
authors.affiliation: Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
authors.forename: Kaitlyn N
authors.initials: KN
authors.lastname: Christmas
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Stone
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Lorenzetti
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frankle
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome
keywords: Reverse shoulder arthroplasty; baseplate failure; failed reverse shoulder arthroplasty; glenosphere dissociation; humeral loosening; revision shoulder arthroplasty