What is a revision total shoulder replacement?

A revision total shoulder replacement is an operation to take out your old shoulder replacement and put in a new one.

A shoulder replacement can fail for the following reasons.

• wearing out of the artificial joint
• infection in your shoulder replacement
• dislocation (coming out of joint)
• fracture (break) around your shoulder replacement

What are the benefits of surgery?

You should be able to move your shoulder more comfortably and do more of your normal activities.

Are there any alternatives to surgery?

Surgery is the only treatment for a shoulder replacement that is failing.

If you have an infection in your shoulder replacement, using antibiotics over the long term can sometimes prevent your shoulder replacement from failing.

If your shoulder replacement keeps coming out of joint, you can wear a brace to try to keep your shoulder in place.

What will happen if I decide not to have the operation?

The bone around a loose shoulder replacement can get thin and it may break (fracture). You will need to have a major operation to fix the fracture and do your shoulder replacement again.

If you have an infection in your shoulder replacement, it can spread to other places around your body.

What does the operation involve?

Various anaesthetic techniques are possible.

Your surgeon will make a cut on the front of your shoulder.

If the joint surfaces have become worn or your shoulder replacement itself is coming loose, your surgeon will usually remove your shoulder replacement and any cement.

Your surgeon will put in a new shoulder replacement.

The type of surgery you need can be more complicated if the bone is thin or broken, or if you have an infection.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.
• Heart attack — a heart attack can sometimes cause death.
• Stroke — a stroke can sometimes cause death.

Specific complications of this operation

• Damage to nerves around your shoulder, leading to weakness, numbness or pain in your shoulder or arm. This usually gets better but may be permanent.
• Infection, which can result in loosening and failure of your shoulder replacement.
• Loosening without infection. You may need another operation to do your shoulder replacement again.
• Rotator-cuff tears.
• Dislocation of your shoulder replacement.
• Stiff shoulder — you should get more movement than you had before the operation but sometimes movement does not improve. It will never feel quite the same as a normal shoulder.
• Failure of the revision total shoulder replacement. You may need another operation.
• Difficulty passing urine. If it gets worse (bladder retention) you may need to go home with a urinary catheter and come back to hospital to have it removed around 2 weeks later.

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 2 to 3 days.

You will need to keep your arm in a sling to keep the tension away from your shoulder joint.

It often takes longer to recover from a revision shoulder replacement than your first shoulder replacement.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery and most revision total shoulder replacements work well.

A revision total shoulder replacement can fail with time if it wears out or the original problem comes back.

Summary

If your original shoulder replacement fails, you can usually have another operation to do your shoulder replacement again. If this revision operation is successful, you should be able to continue many of your normal activities.

IMPORTANT INFORMATION

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