This is a 20-year, two-center review of 542 failed shoulder arthroplasties requiring revision. It maps the epidemiology, causes of failure, and implant selection for revising hemiarthroplasty, anatomic total shoulder, and reverse arthroplasty.
When you face a failed shoulder arthroplasty, assume the failure is multifactorial until proven otherwise. The central lesson: glenoid failure and instability drive revision across all implant types, and coexisting low-grade infection, soft-tissue insufficiency, and bone loss are routinely missed at the first revision.
That miss is why 21% of these patients need multiple operations, with infection climbing from 12% to 25% once you are on a second revision. Decision rule: if there is cuff insufficiency, instability, or bone loss, converting to anatomic TSA fails in over 70% of cases. Default to RSA, which addresses both bony and soft-tissue deficits and was the final implant in 48%.
Also remember this is a Level IV case series from two high-volume French centers, so the numbers reflect referral-center complexity and may not generalize to routine practice. The practical takeaway is workup before revision: rule out indolent infection and characterize bone and soft tissue before choosing an implant.
This is a 20-year, two-center review of 542 failed shoulder arthroplasties requiring revision. It maps the epidemiology, causes of failure, and implant selection for revising hemiarthroplasty, anatomic total shoulder, and reverse arthroplasty.
When you face a failed shoulder arthroplasty, assume the failure is multifactorial until proven otherwise. The central lesson: glenoid failure and instability drive revision across all implant types, and coexisting low-grade infection, soft-tissue insufficiency, and bone loss are routinely missed at the first revision.
That miss is why 21% of these patients need multiple operations, with infection climbing from 12% to 25% once you are on a second revision. Decision rule: if there is cuff insufficiency, instability, or bone loss, converting to anatomic TSA fails in over 70% of cases. Default to RSA, which addresses both bony and soft-tissue deficits and was the final implant in 48%.
Also remember this is a Level IV case series from two high-volume French centers, so the numbers reflect referral-center complexity and may not generalize to routine practice. The practical takeaway is workup before revision: rule out indolent infection and characterize bone and soft tissue before choosing an implant.