Revision Strategies in Reverse Total Shoulder Arthroplasty

Abstract

Background While initially developed to improve function in patients with chronic rotator cuff deficiency, the success of reverse total shoulder arthroplasty (RTSA) has led to expanding indications including fracture sequelae and revision of failed hemi- or total shoulder arthroplasty. While primary RTSA carries complication and revision rates of up to 75% and 2%–10%, respectively, these rates are higher in RTSA performed in a revision setting. Methods The current literature on RTSA and revision RTSA was reviewed to determine the most common complications and treatment strategies to address these complications. Results The most common complications leading to revision of RTSA are instability, infection, humeral implant loosening, and glenoid implant loosening. Each of these presents unique technical challenges for the surgeon. Retention or replacement of a reverse prosthesis affords high patient satisfaction and better functional outcomes than resection, but may require several additional surgeries. In cases in which reverse components cannot be implanted, salvage options, including resection arthroplasty and conversion to hemiarthroplasty, provide satisfactory pain relief but limited function. Discussion As the number of RTSA performed increase, so will the number of revisions. In this article, current treatment strategies for addressing the challenges of revision reverse shoulder arthroplasty are discussed.