This retrospective case series reviews 37 reverse shoulder arthroplasty revisions performed at a single center over 12 years. It identifies why RSAs fail, how each failure mode is treated, and whether the prosthesis can be retained. The authors propose a preoperative workup and an instability treatment algorithm.
When an RSA dislocates, do not just reduce it and hope. This paper shows closed reduction fails in two-thirds of cases because the real problem is usually mechanical: a shortened, over-medialized humerus that cannot tension the deltoid.
The practical decision rule is a length-and-medialization threshold. If humeral shortening is under 15 mm and medialization is under 15 mm, a metallic spacer plus thicker polyethylene may suffice. Above those thresholds, exchange the stem for a longer, prouder implant and lateralize the glenosphere.
For humeral loosening or derotation, recognize that bone loss over 30 mm generates rotational forces that unscrew modular stems. A monoblock stem with proximal allograft addresses this. Before any RSA revision, order full-length scaled radiographs of both humeri and an infection workup (CRP, aspiration, biopsy). Prior surgery raises infection risk, and P. acnes is the organism to expect.
This retrospective case series reviews 37 reverse shoulder arthroplasty revisions performed at a single center over 12 years. It identifies why RSAs fail, how each failure mode is treated, and whether the prosthesis can be retained. The authors propose a preoperative workup and an instability treatment algorithm.
When an RSA dislocates, do not just reduce it and hope. This paper shows closed reduction fails in two-thirds of cases because the real problem is usually mechanical: a shortened, over-medialized humerus that cannot tension the deltoid.
The practical decision rule is a length-and-medialization threshold. If humeral shortening is under 15 mm and medialization is under 15 mm, a metallic spacer plus thicker polyethylene may suffice. Above those thresholds, exchange the stem for a longer, prouder implant and lateralize the glenosphere.
For humeral loosening or derotation, recognize that bone loss over 30 mm generates rotational forces that unscrew modular stems. A monoblock stem with proximal allograft addresses this. Before any RSA revision, order full-length scaled radiographs of both humeri and an infection workup (CRP, aspiration, biopsy). Prior surgery raises infection risk, and P. acnes is the organism to expect.