JSES - 2026-04-24 - Journal Article
Revision Reverse Shoulder Arthroplasty After Failed Shoulder Arthroplasty: Long-Term Survivorship and Risk Factors for Failure.
Patel R, Kucharik M, Schmidt CM, Kolakowski L, Christmas KN, Simon P, Frankle MA
Topics
Key Takeaway
Revision rTSA for failed primary rTSA achieves only 59.5% survivorship at 10 years, significantly worse than revision for failed aTSA (82.1%) or failed HA (74.2%), with fewer than half of all revision rTSA patients achieving PASS at one year.
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Summary
This study examined survivorship and PROs after revision rTSA stratified by index failed implant type (HA, aTSA, rTSA) in 320 patients from a single-surgeon database spanning 2002–2022. Overall 10-year survivorship was 71.4%, but revision from failed rTSA was significantly inferior at 59.5% versus 82.1% (failed aTSA) and 74.2% (failed HA) (p<0.001). Only 48.8% of the overall cohort achieved PASS at one year (mean ASES 61.3), with failed rTSA subgroup performing worst (ASES 53.3); of 58 secondary revisions, humeral loosening carried the highest hazard for tertiary failure.
Key Limitation
Single-surgeon series with mean follow-up of only 50 months and high standard deviation (±45.7 months) limits the precision of 10-year Kaplan-Meier estimates, particularly for the failed rTSA subgroup.
Original Abstract
BACKGROUND
Reverse shoulder arthroplasty (rTSA) is increasingly used as a revision option, but long-term survivorship and patient-reported outcomes (PROs) after revision rTSA remain poorly defined. We hypothesized that revision rTSA for failed reverse shoulder arthroplasty (failed rTSA) would have inferior survivorship and patient reported outcomes when compared to revision rTSA for failed anatomic total shoulder arthroplasty (failed aTSA) or failed hemiarthroplasty (failed HA). Moreover, we hypothesized that that shoulders undergoing secondary revision would have a higher risk of failure when compared to those undergoing first-time revision surgery.
METHODS
This study is a retrospective review of a prospectively collected, single-surgeon institutional database from 2002-2022. Patients undergoing first-time revision rTSA for aseptic mechanical failure of a prior arthroplasty were included if they had ≥12 months of follow-up or required subsequent revision within 12 months. Survivorship was assessed using Kaplan-Meier analysis. PROs (ASES scores and satisfaction) were collected at one year, with subgroup analysis by index failed arthroplasty type: failed HA, failed aTSA, and failed rTSA. Modes of failure after secondary revision were also examined. Statistical significance was set at P<0.05.
RESULTS
Of 464 first-time revision rTSA for mechanical failure from 2002-2022, 320 revision rTSAs had appropriate follow-up and met inclusion criteria, with mean follow-up of 50.3 ± 45.7 months. Mean age was 67.4 ± 10.0 years; 54.1% were female. Overall survivorship of revision rTSA was 86.4% at 2 years, and 71.4% at 10 years. In terms of survivorship stratified by index arthroplasty, the survivorship of failed HA, failed aTSA, and failed rTSA was the following: failed HA: 2-year 93.4% and 10-year 74.2%; failed aTSA: 2-year 88.6% and 10-year 82.1%; failed rTSA: 2-year 74.6% and 10-year 59.5%. Overall survivorship was inferior in shoulders revised from failed rTSA compared with failed HA or failed aTSA (P<0.001). At one year, the overall cohort reported mean ASES of 61.3 ± 25.0, with 48.8% achieving patient acceptable symptom state (PASS). Shoulders revised from failed rTSA had lower ASES scores (53.3 ± 26.2) than those revised from failed HA (63.3 ± 23.1) or failed aTSA (64.3 ± 25.0) (p=0.008). Of the 320 revision rTSAs, 58 (18.1%) required secondary revision; mechanisms of failure included instability (5.0%), humeral loosening (4.1%), infection (4.1%), glenoid failure (3.4%), and periprosthetic fracture (1.6%). Of these, 17 (29.3%) underwent tertiary revision. Secondary revisions due to humeral loosening showed the highest hazard for tertiary failure.
CONCLUSION
Revision rTSA for mechanical failure demonstrates modest long-term durability and functional improvement, with over 70% survivorship at 10 years. However, less than half of patients achieved acceptable symptom states at short term follow-up. Specifically, revision from failed rTSA yields inferior survivorship and patient-reported outcomes when compared to failed aTSA or failed HA. Secondary revision procedures carried greater risk of failure, with humeral loosening remaining particularly difficult to manage. These findings highlight the need for careful patient counseling and ongoing investigation into strategies to improve survivorship after revision rTSA.