Shoulder

Failed Shoulder Replacements

What is a failed shoulder replacement?

Shoulder replacements are artificial parts made of metal and plastic, and can wear out or fail over time. Any shoulder replacement that is painful or not as functional as expected can be considered a failed shoulder replacement.

 

What causes a failed shoulder replacement?

Shoulder replacements can fail for a variety of reasons. They can wear out from a mechanical standpoint, including wear and damage to the plastic parts. They can loosen or become unstable over time. Infection can occur, causing a painful shoulder replacement. The rotator cuff is necessary for an anatomic shoulder replacement, and weakness or tearing of the rotator cuff can also cause a failed shoulder replacement.

 

How is a failed shoulder replacement diagnosed?

Diagnosis of a failed shoulder replacement may be as simple as an X-ray, depending on whether the parts are broken or loose. Sometimes, as in the case of infection, blood tests or cultures may provide the answer. Occasionally, it may be difficult to ascertain the cause of the pain/ failure until the time of revision (re-do) surgery.

 

How is a failed shoulder replacement treated?

Treatment depends on several factors, including the type of prosthesis (anatomic, reverse, or hemiarthroplasty) that is in place and the reason for the failure. Anatomic shoulder replacements that fail are typically revised (re-done) to a reverse shoulder replacement. Failed reverse shoulder replacements may be revised to another reverse or to a hemiarthroplasty. IV antibiotics may need to be given in the case of infection. For some patients, bone grafting or soft tissue grafts may be required.

 

When surgery is necessary?

Surgery is necessary when the shoulder replacement is persistently painful or non-functional due to infection or mechanical failure.

Examples of failed shoulder replacements:

Fig 1. Reverse shoulder replacement, broken screw is noted on x-ray.

Fig 2. Open sore overlying infected and dislocated reverse shoulder replacement.

Fig 3. Polyethylene glenoid  (plastic socket) with worn area marked in red. Thin peeling plastic can also be seen.

Fig 4. Infected dislocated reverse, exposed at the time of surgery. Fig 5. Blue spacer is temporary and made of antibiotic cement.

Further Reading

Experience Matters

Many people wonder how much experience matters when selecting a surgeon. Almost every advice column (including this one, 10 questions to ask your surgeon) puts surgeon experience near the top of the list. It is difficult to judge how much experience is adequate for a particular procedure. However, when it comes to shoulder replacement, there have been a few studies that try to measure how much experience is enough when evaluating a surgeon.