Reverse Shoulder Arthroplasty: How to Manage Failure

  • Srinath Kamineni


Since its introduction as a treatment for the unreconstructable rotator cuff tear and cuff tear arthropathy, the reverse shoulder arthroplasty (RSA) has become a mainstay of treating these pathologies. With increasing success has followed increasing usage, expansion of indications, and the inevitable increase in complications and revision surgeries. A recent systematic literature review reported an overall complication rate of 20% and that 13% of RSA operations either needed surgical revision of the implants or reoperations. Failure of RSA can be due to a surgeon-related technical error, an implant design-related failure, or a general failure related to any arthroplasty. Indeed, many of these factors coexist when an operation fails. The vast majority of complications can be grouped into some major categories, such as instability, infections, component loosening, component disassembling, fractures, and scapular notching.


Reverse shoulder arthroplasty Instability Infection Loosening Scapular notching 


  1. 1.
    Kessel L, Bayley I. Prosthetic replacement of shoulder joint: preliminary communication. J R Soc Med. 1979;72(10):748–52.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16(1):65–8.PubMedGoogle Scholar
  3. 3.
    Zumstein MA, et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20(1):146–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Wall BT, Mottier F, Walch G. Complications and revision of the reverse pros-thesis: a multicenter study of 457 cases. Reverse shoulder arthroplasty. Montpellier: Sauramps Médical; 2006.Google Scholar
  5. 5.
    Boileau P, Rumian AP, Zumstein MA. Reversed shoulder arthroplasty with modified L’Episcopo for combined loss of active elevation and external rotation. J Shoulder Elb Surg. 2010;19(2 Suppl):20–30.CrossRefGoogle Scholar
  6. 6.
    Boileau P, et al. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elb Surg. 2013;22(10):1359–70.CrossRefGoogle Scholar
  7. 7.
    Teusink MJ, et al. Results of closed management of acute dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(4):621–7.CrossRefGoogle Scholar
  8. 8.
    Boileau P, et al. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg. 2006;15(5):527–40.CrossRefGoogle Scholar
  9. 9.
    Chacon A, et al. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am. 2009;91(1):119–27.CrossRefPubMedGoogle Scholar
  10. 10.
    Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S33–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Morris BJ, et al. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(2):161–6.CrossRefGoogle Scholar
  12. 12.
    Jacquot A, et al. Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients. J Shoulder Elb Surg. 2015;24(11):1713–22.CrossRefGoogle Scholar
  13. 13.
    Braman JP, et al. The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections. J Shoulder Elb Surg. 2006;15(5):549–53.CrossRefGoogle Scholar
  14. 14.
    Zavala JA, et al. Management of deep infection after reverse total shoulder arthroplasty: a case series. J Shoulder Elbow Surg. 2011;21(10):1310–5.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ghijselings S, Stuyck J, Debeer P. Surgical treatment algorithm for infected shoulder arthroplasty: a retrospective analysis of 17 cases. Acta Orthop Belg. 2013;79(6):626–35.Google Scholar
  16. 16.
    Beekman PD, et al. One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg Br. 2010;92(6):817–22.CrossRefGoogle Scholar
  17. 17.
    Verhelst L, et al. Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome? J Shoulder Elb Surg. 2011;20(8):1224–33.CrossRefGoogle Scholar
  18. 18.
    Jawa A, et al. Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) use for the treatment of infection after shoulder arthroplasty. J Bone Joint Surg Am. 2011;93(21):2001–9.CrossRefGoogle Scholar
  19. 19.
    Sahota S, Sperling JW, Cofield RH. Humeral windows and longitudinal splits for component removal in revision shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(10):1485–91.CrossRefGoogle Scholar
  20. 20.
    Gerber C, et al. Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. J Bone Joint Surg Am. 2007;89(5):940–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Favre P, et al. Latissimus dorsi transfer to restore external rotation with reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2008;17(4):650–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Puskas GJ, et al. Secondary latissimus dorsi transfer after failed reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(12):e337–44.CrossRefGoogle Scholar
  23. 23.
    Elwell J, Choi J, Willing R. Quantifying the competing relationship between adduction range of motion and baseplate micromotion with lateralization of reverse total shoulder arthroplasty. J Biomech. 2017;52:24–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Gutierrez S, et al. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg. 2007;16(3 Suppl):S9–S12.CrossRefPubMedGoogle Scholar
  25. 25.
    Garberina MJ, Williams GR Jr. Polyethylene dissociation after reverse total shoulder arthroplasty: the use of diagnostic arthroscopy. J Shoulder Elbow Surg. 2008;17(1):e16–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Cusick MC, et al. Glenosphere dissociation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(7):1061–8.CrossRefGoogle Scholar
  27. 27.
    Otto RJ, et al. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elb Surg. 2013;22(11):1514–21.CrossRefGoogle Scholar
  28. 28.
    Hattrup SJ. The influence of postoperative acromial and scapular spine fractures on the results of reverse shoulder arthroplasty. Orthopedics. 2010;33(5):302.Google Scholar
  29. 29.
    Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res. 2011;469(9):2544–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Wahlquist TC, Hunt AF, Braman JP. Acromial base fractures after reverse total shoulder arthroplasty: report of five cases. J Shoulder Elbow Surg. 2011;20(7):1178–83.CrossRefPubMedGoogle Scholar
  31. 31.
    Mollon B, et al. Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elb Surg. 2017;26(7):1253–61.CrossRefGoogle Scholar
  32. 32.
    Katz D, et al. Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up. Int Orthop. 2016;40(1):99–108.CrossRefPubMedGoogle Scholar
  33. 33.
    Li X, et al. Inferior glenosphere placement reduces scapular notching in reverse total shoulder arthroplasty. Orthopedics. 2015;38(2):e88–93.CrossRefPubMedGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Srinath Kamineni
    • 1
  1. 1.University of Kentucky, Shoulder Elbow Research Centre, Orthopaedics and Sports MedicineLexingtonUSA

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