Our Summary

This research paper focuses on the reasons why a specific type of shoulder surgery, called shoulder surface replacement hemiarthroplasty (SRH), might fail and looks at the results of follow-up surgeries. The study involved 25 patients who had unsuccessful SRH surgeries.

The researchers found that the most common reasons for the initial surgeries failing were wearing away of the glenoid (a part of the shoulder bone) and progressive failure of the rotator cuff (a group of muscles and tendons in the shoulder).

The study also looked at the outcomes for patients who had to undergo revision surgery. It was found that the results varied, but those who had their revision surgery done as an anatomic total shoulder arthroplasty (TSA) - a procedure where the whole shoulder joint is replaced- generally had better function in their shoulders afterwards.

The study concludes that revision surgery for failed SRH can be difficult and the results can vary. However, changing the procedure to anatomic TSA seems to offer better functional outcomes for the patients.

FAQs

  1. What were the most common reasons for the failure of the initial shoulder surface replacement hemiarthroplasty (SRH)?
  2. What is the difference between a SRH and an anatomic total shoulder arthroplasty (TSA)?
  3. What were the observed outcomes for patients who had to undergo revision surgery after a failed SRH?

Doctor’s Tip

One tip that a doctor might give a patient considering shoulder replacement surgery is to make sure to follow post-operative rehabilitation and physical therapy programs diligently. This can help improve range of motion, strength, and overall function of the shoulder joint after surgery. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can also help support the healing process and long-term success of the shoulder replacement.

Suitable For

Patients who are typically recommended for shoulder replacement surgery, such as SRH or TSA, are those who have severe shoulder pain and limited range of motion due to conditions such as osteoarthritis, rheumatoid arthritis, or avascular necrosis. These patients may have tried non-surgical treatments such as physical therapy, medications, and injections without success. Additionally, patients with significant rotator cuff tears or fractures may also be candidates for shoulder replacement surgery.

It is important for patients to undergo a thorough evaluation by their orthopedic surgeon to determine if shoulder replacement surgery is the best option for them. The decision to undergo surgery should be based on the severity of the condition, the patient’s overall health and functional goals, and the potential risks and benefits of the procedure.

Overall, shoulder replacement surgery can be a successful treatment option for patients with debilitating shoulder pain and dysfunction. However, as with any surgical procedure, there are potential risks and complications that should be discussed with a healthcare provider before making a decision.

Timeline

  • Before shoulder replacement:
  1. Patient experiences chronic shoulder pain, stiffness, and decreased range of motion
  2. Patient undergoes various non-surgical treatments such as physical therapy, pain medications, and cortisone injections
  3. Imaging tests such as X-rays, MRI, or CT scans are done to assess the extent of damage in the shoulder joint
  4. Orthopedic surgeon recommends shoulder replacement surgery as a last resort option
  • After shoulder replacement:
  1. Patient undergoes shoulder replacement surgery, either SRH or TSA, depending on the extent of damage
  2. Patient goes through a period of post-operative recovery, including physical therapy and pain management
  3. Patient gradually regains shoulder function and range of motion
  4. In some cases, patients may experience complications or failure of the initial surgery, leading to the need for revision surgery
  5. Revision surgery is performed, with the option of changing the procedure to anatomic TSA for better functional outcomes
  6. Patients undergo rehabilitation and physical therapy to regain shoulder function after revision surgery.

What to Ask Your Doctor

Questions a patient should ask their doctor about shoulder replacement include:

  1. What type of shoulder replacement surgery will I be undergoing (e.g., shoulder surface replacement hemiarthroplasty, anatomic total shoulder arthroplasty)?
  2. What are the potential reasons for the surgery to fail, and how common are these complications?
  3. What are the signs and symptoms of a failed shoulder replacement that I should watch out for?
  4. What are the potential options for revision surgery if the initial procedure fails?
  5. What are the expected outcomes and recovery timeline for revision surgery, particularly if it involves converting to an anatomic total shoulder arthroplasty?
  6. What are the risks and potential complications associated with revision surgery for a failed shoulder replacement?
  7. What type of rehabilitation and physical therapy will be necessary following revision surgery?
  8. What is the long-term prognosis for patients who undergo revision surgery for failed shoulder replacement?
  9. Are there any lifestyle modifications or restrictions I should consider following revision surgery to optimize the outcome?
  10. Are there any alternative treatments or therapies that I should consider before undergoing revision surgery for a failed shoulder replacement?

Reference

Authors: Jaiswal A, Malhotra A, Hay S, Kelly CP. Journal: Musculoskelet Surg. 2019 Apr;103(1):69-75. doi: 10.1007/s12306-018-0541-0. Epub 2018 May 9. PMID: 29744735