Revision Shoulder Arthroplasty

✍ Scribed by Francesco Franceschi (editor), George S. Athwal (editor), Alexandre Lädermann (editor), Edoardo Giovannetti de Sanctis (editor)

• Publisher: Springer
• Year: 2024
• Tongue: English
• Leaves: 393
• Category: Library

✦ Synopsis

Filling an unmet need this book covers all relevant aspects of Revision Shoulder Arthroplasty. Edited by internationally renowned experts in the field it offers the reader solid theoretical and practical knowledge to address this complex surgical procedure.

The chapters are grouped into seven sections each addressing a macro-topic: arthroplasty failure, pre-operative planning and operative techniques, the failed glenoid and humerus, infections, instability and soft tissue management, and surgical outcomes.

This book offers a timely and up-to-date resource for shoulder surgeons wishing to deepen their knowledge of this complex and challenging procedure.

✦ Table of Contents

Preface
Contents
About the Editors
Part I: Background
1: Why Do Total Shoulder Replacements Fail?
1.1 Background
1.2 Failure Mechanisms
1.3 Implant-Related Outcome
1.3.1 Design Evolution
1.3.2 Preimplantation Native Anatomy and Rotator Cuff Integrity
1.3.3 Glenoid Failure
1.3.3.1 Glenoid Design
1.3.3.2 The Glenoid Surgical Technique
1.3.4 Humeral Failure
1.3.4.1 Humeral Design
1.3.4.2 The Humeral Surgical Technique
1.4 Surgery-Related Outcome
1.5 Patient-Related Outcome
1.6 Summary
References
2: Why Reverse Shoulder Arthroplasties Fail
2.1 Introduction
2.2 Comparison in Failure Types and Rates between Anatomic Total Shoulder Arthroplasty and RSA
2.3 Early Etiologies for Implant Failure After an RSA
2.4 Late Etiologies of Implant Failure After an RSA
2.5 Conclusions
References
3: Shoulder Hemiarthroplasties: How Do They Fail
3.1 Introduction
3.2 Methods
3.2.1 Study Design
3.2.2 Search Strategy
3.2.3 Eligibility Criteria
3.2.4 Study Selection
3.2.5 Definitions
3.2.6 Method of Review and Data Extraction
3.2.7 Quality Assessment
3.2.8 Statistical Methods
3.3 Results
3.3.1 Search Results
3.3.2 Demographic Data
3.3.3 Technique
3.3.4 Early vs. Late Complications
3.3.5 Revision Procedures
3.3.6 Reoperation Procedures
3.3.7 The Glenoid Reaming Procedure
3.4 Discussion
3.4.1 Limitations
3.5 Conclusions
References
Part II: Planning and Operative Technique
4: Management of a Painful Shoulder Arthroplasty
4.1 Introduction
4.2 The Etiology of a Painful Shoulder Arthroplasty
4.3 Evaluation of a Painful Shoulder Arthroplasty
4.3.1 History
4.3.2 Examination
4.3.3 Imaging
4.3.4 Radiographs
4.3.5 Computed Tomography
4.3.6 Ultrasound
4.3.7 Magnetic Resonance Imaging
4.3.8 Nuclear Medicine
4.3.9 Laboratory Investigations
4.3.10 Joint Aspiration
4.3.11 Reconnaissance Shoulder Arthroscopy and Tissue Biopsy
4.3.12 Examination Under Anesthesia
4.3.13 Diagnostic Injections
4.3.14 Electromyography (EMG) and Nerve Conduction Studies
4.4 Summary
References
5: Preoperative Planning for Revision Arthroplasty: Imaging, Instruments, and Implants
5.1 Introduction
5.2 Clinical Diagnosis
5.3 Imaging
5.4 Soft Tissue Assessment
5.5 Instruments: Software
5.6 Implants
References
6: PSI, Navigation, AR, and MR in Revision Shoulder Arthroplasty
6.1 Introduction
6.2 Preoperative Planning
6.3 Patient-Specific Instrumentation
6.3.1 PSI: Single-Use PSI in the Literature
6.3.2 PSI: Reusable PSI in the Literature
6.3.3 Patient-Specific Implants: Customized Glenoid Components
6.4 Navigation
6.5 Augmented and Mixed Reality
6.6 Conclusions
References
7: Surgical Approach in Shoulder Arthroplasty Revision
7.1 Introduction
7.2 Pre-operative Assessment
7.3 Surgical Technique [10–14]
7.4 Conclusion
References
8: Custom Glenoid Implants for Revision Shoulder Arthroplasty
8.1 Background
8.2 Classification and Incidence
8.3 Indications for Custom Glenoid Implant
8.4 Design Rationale
8.5 Case Examples
8.6 Outcomes
References
Part III: Glenoid
9: Classifying Bone Loss in Revision Arthroplasty
9.1 Introduction
9.2 Assessing Glenoid Bone Loss
9.3 Classification of Bone Loss in Primary Arthroplasty
9.4 Classification of Bone Loss in Revision Arthroplasty
9.5 Approach to Glenoid Bone Loss
References
10: The Convertible Glenoid in Revision Shoulder Arthroplasty
10.1 Introduction
10.2 The Convertible Glenoid
10.3 Outcomes for Revision with Convertible Glenoid
10.4 Future Perspectives
10.5 Conclusion
References
11: How to Remove a Well-Fixed Glenoid Component in a Failed Anatomic Total Shoulder Arthroplasty
11.1 Introduction
11.2 Background
11.3 Technique
11.3.1 Implant Design
11.3.2 Exposure
11.3.3 Removal
11.4 Arthroscopic Removal
11.5 Conclusion
References
12: Revising the Glenoid in Hemiarthroplasty
12.1 Introduction
12.2 Preoperative Evaluation
12.3 Surgical Technique
12.4 Outcomes
12.5 Conclusion
References
13: Revising the Failed Glenoid in TSA
13.1 Introduction
13.2 Preparing for Revision Shoulder Arthroplasty
13.3 Preoperative Examinations (Fig. 13.1)
13.3.1 Classification According to Sperling [9]
13.3.2 Classification According to Molé [10]
13.3.3 Classification According to Lazarus [11]
13.4 How to Revise an Anatomic Glenoid Component?
13.4.1 Intraoperative Analysis (Fig. 13.2)
13.4.2 Revision of the Glenoid Component
13.4.3 Simple Removal of the Loosened Implant
13.4.4 Bone Grafting Without Reimplantation
13.4.5 Conversion to Hemiarthroplasty
13.4.6 Central Cavitary Bone Loss
13.4.7 Combined Bone Loss (Central and Peripheral)
13.4.8 Anatomic Glenoid Revision
13.4.9 Reimplantation of a Cemented Glenoid and Cementoplasty
13.4.10 Reimplantation of a Cemented Glenoid with a Graft
13.4.11 Reimplantation of an Uncemented Metal-back Glenoid with or without Graft
13.4.12 Conversion to Reverse Shoulder Arthroplasty
13.4.13 Reconstruction in One-Stage
13.4.13.1 Without Associated Grafting
13.4.13.2 With Associated Graft
13.4.14 Customized Augmented Metal Base
13.4.15 Two-Stage Revision
13.5 Conversion to Reverse Hemiarthroplasty
13.6 Conclusion
References
14: Revising a Failed Glenoid in Reverse Total Shoulder Arthroplasty
14.1 Incidence of Glenoid Revision in rTSA
14.2 Imaging and Physical Exam Findings
14.3 Published Results of Reverse-to-Reverse Revision Shoulder Arthroplasty
14.4 Special Considerations: Surgical Exposure for Revising a Reverse Glenoid
14.5 Special Considerations: What to Do If the Glenoid Component Is Stuck
14.6 Special Considerations: Anticipate There Will Be Bone Loss
14.7 Conclusion
References
15: Options for Glenoid Reconstruction: Graft vs. Metal vs. Combined
15.1 Introduction
15.2 Biomechanics
15.3 Prevalence
15.4 Treatment Options
15.4.1 Local Autograft
15.4.1.1 Humeral Head
15.4.1.2 Distal Clavicle
15.4.1.3 Coracoid Process
15.4.2 Non-Local Autograft
15.4.2.1 Iliac Crest
15.4.3 Allograft
15.4.4 Metallic Augments and Custom Glenoids
15.4.5 Combined Bony and Metallic Augmentation
15.4.6 Graft Healing
15.4.7 Bony vs. Metallic Augmentation
15.4.8 Humeral Lateralization
15.4.9 One- or Two-stages
15.4.10 Rehabilitation Protocol
15.5 Author’s Preferred Treatment
15.6 Conclusion
References
16: Single-stage vs. Two-stage Reconstruction of Glenoid Defects in Revision Shoulder Arthroplasty
16.1 Introduction
16.2 Classification of Glenoid Defects in Revision Surgery
16.2.1 Antuna Classification
16.2.2 Seebauer-Gupta Classification
16.2.2.1 Characterization of the Types According to the Seebauer-Gupta Classification [11]
16.2.3 Gohlke and Werner Classification
16.2.4 Other Classifications
16.3 Assessment of Glenoid Defects
16.4 Preoperative Imaging Diagnostics and Computerized Planning
16.4.1 Imaging
16.4.2 Computerized Planning
16.4.2.1 Patient-Specific Instruments (PSI)
16.4.2.2 Mixed Reality and Navigation
16.4.3 Solutions to Metal Artifacts
16.5 Surgical Strategy and Technique
16.5.1 Restoration of the Joint Line
16.5.1.1 Centric—Contained Defects
16.5.1.2 Eccentric-Uncontained Defects
16.5.2 Surgical Technique Basic Principles for Revision Shoulder Arthroplasty
16.5.2.1 Debridement—Freshening—Jet Lavage
16.5.2.2 Positioning and Implantation Depth of the Central Anchorage in Native Glenoid/Scapular Bone
16.5.2.3 Screw Fixation of the Baseplate
16.5.2.4 One- vs Two-Stage Reconstruction
16.5.2.5 Autograft or Allograft
16.6 Discussion
16.7 Conclusion for Practice
References
17: Surgical Management of Periprosthetic Scapular Spine and Acromion Fractures
17.1 Introduction
17.2 Incidence
17.3 Diagnosis
17.3.1 History and Clinical Examination
17.3.2 X-Ray and CT Scan
17.3.3 SPECT-CT
17.4 Classification
17.5 Etiology
17.6 Treatment
17.6.1 Conservative Treatment
17.6.2 Operative Treatment
17.6.3 Based on Fracture Type
17.6.4 Double-Plate Osteosynthesis in Combination with Structural Bone Graft
17.7 Discussion
17.8 Conclusion
References
Part IV: Humerus
18: Humeral Stress Shielding and Bony Adaptations in Shoulder Arthroplasty
18.1 Introduction
18.2 Causes of Bone Loss
18.3 Radiographic Evaluation
18.4 Nonclinical Outcomes
18.4.1 Finite Element Analysis
18.5 Radiographic Outcomes
18.5.1 Traditional Length Stem
18.5.2 Short Stems (SS)
18.5.3 Stemless Implants
18.6 Clinical Outcomes
18.7 Conclusion
References
19: Classifying Humeral Bone Loss in Revision Shoulder Arthroplasty
19.1 Introduction
19.2 Classification Systems
19.3 Proximal Humeral Arthroplasty Revision Osseous in Sufficiency (PHAROS) Classification
19.3.1 Type 1
19.3.2 Type 2
19.3.3 Type 3
19.4 PHAROS Classification Overview
19.5 Conclusion
References
20: Convertible Humeral Component in Revision Shoulder Arthroplasty
20.1 Introduction
20.1.1 Preconditions for Humeral Stem Retention
20.1.2 Preparing Humeral Stem Retention
20.1.3 Surgical Techniques
20.1.4 Pros and Cons of Humeral Implant Retention Versus Exchange
20.1.5 The Success of Humeral Stem Retention
20.1.6 Clinical Outcome of the Convertible Humeral Implant
20.1.7 Humeral Implant Retention Case
20.2 Conclusion
References
21: How to Remove a Well Implanted Humeral Component and Complications Associated
21.1 Introduction
21.2 A Stepwise Approach
21.2.1 Pre-operative Planning
21.2.2 Equipment and Augments
21.2.3 Position and Draping in Theatre
21.2.4 Approach
21.2.5 Removal of a Well-Fixed Stem
21.2.5.1 Head Removal
21.2.5.2 Soft Tissue Clearance
21.2.5.3 Initial Disruption of Bone/Implant Interface
21.2.5.4 Linear Humeral Osteotomy
21.2.5.5 Extension of Linear Humeral Osteotomy to Anterior Humeral Window
21.2.5.6 Canal Debridement
21.2.5.7 Osteotomy Fixation
21.3 Discussion
21.3.1 Summary of Steps
21.4 Conclusion
References
22: Revision of a Failed Humeral Stem with Sufficient Bone Stock
22.1 Introduction
22.2 Preoperative Planning
22.3 Treatment Strategies
22.4 Results
References
23: Revision of the Failed Stem Without Sufficient Bone Stock
23.1 Introduction
23.2 Preoperative Planning
23.3 Classification of Humeral Bone Loss in Revision Shoulder Arthroplasty
23.4 Reconstruction Strategies
23.4.1 Standard Humeral Components
23.4.2 Conical Tapered Fluted Modular Revision Components
23.4.3 Allograft Prosthetic Composites
23.4.4 Modular Segmental Metallic (Tumor) Prosthesis
23.5 Conclusion
References
24: Periprosthetic Humeral Fracture: Management and Outcomes
24.1 Background
24.2 Risk Factors
24.2.1 Patient-Related Risk Factors
24.2.2 Surgery-Related Risk Factors
24.3 Diagnosis
24.4 Classification
24.5 Treatment
24.5.1 Intraoperative Fractures
24.5.2 Postoperative Fractures
24.6 Outcomes
24.7 Conclusions
References
Part V: Infection
25: Diagnosing Shoulder Prosthetic Joint Infections
25.1 Introduction
25.2 Imaging
25.3 Serology
25.4 Synovial Fluid Culture and Analysis
25.5 Tissue Culture and Histopathology
25.6 Next-Generation Sequencing
25.7 International Consensus Meeting (ICM)
25.8 Conclusion
References
26: Managing the Infected Arthroplasty: Antibiotic Suppression, Debridement, One- Versus Two-Stage Revision
26.1 Antibiotic Suppression
26.2 Debridement, Antibiotics, and Implant ReteNTION (DAIR)
26.2.1 Indications for DAIR
26.2.2 Outcomes of DAIR
26.2.3 DAIR: Surgical Technique
26.2.4 Antibiotic Treatment
26.3 One- Versus Two-Stage Revision Arthroplasty
26.3.1 Indication
26.3.2 One-Stage Revision Arthroplasty: Surgical Technique
26.3.3 Two-Stage Revision Arthroplasty: Surgical Technique
26.3.4 Antibiotic Treatment
26.3.5 Outcomes After One- Versus Two-Stage Revision Arthroplasty
26.3.5.1 Infection Eradication
26.3.5.2 Clinical Outcomes
26.4 Summary and Outlook
Bibliography
27: Preventing Infection in Revision Shoulder Arthroplasty
27.1 Introduction
27.2 Risk Factors of Periprosthetic Joint Infections
27.3 Preoperative Measures and Skin Preparations
27.4 Intraoperative Measures
27.5 Oral Antibiotic Prophylaxis
27.6 Conclusion
References
Part VI: Instability and Soft Tissue Management
28: Defining Risk Factors for TSA and RSA Instability
28.1 Introduction
28.2 Patient Factors for Instability in TSA and RSA
28.3 Soft Tissue Factors in RSA
28.4 Bone/Implant Factors in RSA
28.4.1 The Glenosphere
28.4.2 The Humeral Component
28.5 Soft Tissue Factors in TSA
28.6 Bone/Implant Factors in TSA
28.7 Conclusion
References
29: Management of Shoulder Arthroplasty Instability
29.1 Introduction
29.2 Instability in Anatomic Total Shoulder Arthroplasty
29.2.1 Epidemiology
29.2.2 Evaluation of Instability in Shoulder Arthroplasty
29.2.3 Management
29.2.3.1 Anterior Instability
29.2.3.2 Posterior Instability
29.3 Instability in Reverse Total Shoulder Arthroplasty
29.3.1 Epidemiology
29.3.2 Management
29.3.2.1 Anterior Dislocation
29.3.2.2 Posterior Dislocation
29.4 Summary
References
30: Pectoralis Transfer for Deltoid Deficiency After Reverse Shoulder Arthroplasty
30.1 Deltoid Deficiency Etiologies
30.2 Relevant Surgical Anatomy
30.2.1 The Deltoid Muscle
30.2.2 The Pectoralis Major Muscle
30.2.3 Brachial Plexus Anatomy
30.2.4 The Axillary Nerve
30.2.5 The Lateral and Medial Pectoral Nerves
30.2.6 Pectoralis Major Blood Supply and Pedicle Anatomy
30.3 Evaluation of Deltoid-deficient Shoulders
30.4 Physical Examination
30.5 Imaging and Neurophysiologic Evaluation
30.6 Deltoid Deficiency
30.7 Pectoralis Major Transfer Technique
References
31: Tendon Transfers in Shoulder Arthroplasty
31.1 Introduction
31.2 Tendon Transfers in Reverse Shoulder Arthroplasty
31.2.1 Indications and Decision-Making
31.2.1.1 Anamnesis
31.2.1.2 Physical Examination
31.2.1.3 Imaging
31.2.1.4 Surgical Options
31.2.2 Techniques
31.2.2.1 Latissimus Dorsi Transfer to Restore Active External Rotation
31.2.2.2 Combination of Latissimus Dorsi and Teres Major Transfers to Restore Active External Rotation
31.2.2.3 Combination of Latissimus Dorsi and Teres Major Transfers to Restore Active Internal Rotation
31.2.2.4 Lower Trapezius Transfer to Restore Active External Rotation
31.2.2.5 Pectoralis Major Transfer to Reconstruct the Deltoid Muscle
31.2.3 Outcome
31.2.3.1 Latissimus Dorsi to Restore Active External Rotation
31.2.3.2 Combination Teres Major and Latissimus Dorsi to Restore Active External Rotation
31.2.3.3 Combination Teres Major and Latissimus Dorsi to Restore Active Internal Rotation
31.2.3.4 Pectoralis Major Transfer to Reconstruct the Deltoid Muscle
31.3 Tendon Transfers in Anatomic Total Shoulder Arthroplasty
31.3.1 Latissimus Dorsi
31.3.2 Pectoralis Major
31.4 Tendon Transfers in the Case of Proximal Humerus Bone Deficiency Using Allograft Prosthetic Composites
31.5 Conclusion
References
Part VII: Others
32: The Role of Arthroscopy After Shoulder Replacement
32.1 Introduction
32.2 Algorithm for Consideration of Arthroscopy
32.3 Evaluation for Infection
32.4 Lysis of Adhesions
32.4.1 Surgical Technique Post-TSA
32.4.2 Surgical Technique Post-RSA
32.5 Total Shoulder Arthroplasty: Specific Uses
32.5.1 Glenoid Implant Loosening
32.5.2 Rotator Cuff Tears
32.5.3 Biceps Tendon Treatment
32.6 Reverse Shoulder Arthroplasty: Specific Uses
32.6.1 Suprascapular Nerve Injury
32.6.2 Subcoracoid Impingement
32.6.3 Acromial Stress Fractures
32.7 Complications
32.8 Conclusion
References
33: The Role of Resection and Hemiarthroplasty After RSA
33.1 Introduction
33.2 Resection Arthroplasty After RSA
33.3 Hemiarthroplasty After RSA
33.4 Summary
References
34: The Role of Hemireverse in Revision Shoulder Arthroplasty
34.1 Introduction
34.2 History and Concept
34.3 Indications
34.4 Surgical Technique
34.4.1 Installation and Preparation of the Joint
34.4.2 Postoperative Protocol
34.4.3 Totalization to RSA
34.5 Results
34.5.1 Patients Totalized to RSA
34.5.2 Patients Remained as Hemireverse
34.5.3 Complications
34.6 Key Points
34.6.1 Totalization or Not?
34.6.2 Graft Selection
34.6.3 Implant Selection
34.6.4 Lateralization
34.6.5 GT Fracture
34.6.6 Humeral Wear
34.7 Conclusion
References
35: What Is the Value of Revision Shoulder Arthroplasty?
35.1 Tier 1: Outcome of Revision Shoulder Arthroplasties
35.2 Tier 2: Recovery Arc
35.3 Tier 3: Durability
35.4 Future Directions
35.5 Summary
References