JSES - 2026-06-01 - Journal Article
Trends in 1030 revision shoulder arthroplasty cases: changing rates, indications, and treatments.
Kolakowski L, Stadecker M, Kucharik M, Layuno-Matos JG, Jones CA, Hunt A, Plummer OR, Christmas KN, Simon P, Frankle MA
Topics
Key Takeaway
Over 20 years, rTSA failures now equal hemiarthroplasty failures as a revision indication (358 each), with rTSA carrying the highest re-revision rate at 21% driven by instability, baseplate failure, and infection.
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Summary
This single-surgeon retrospective database study characterized 1,030 revision shoulder arthroplasties over 20 years to define shifting indications, revision targets, and outcomes by implant type. Revisions of failed HA declined while failed aTSA and rTSA revisions rose; 85% of all revisions were converted to rTSA. ASES score improvement was greatest for aTSA revised for glenoid loosening or cuff failure and rTSA revised for baseplate failure; humeral loosening, infection, and instability carried the highest re-revision rates (overall 15%, rTSA 21%).
Key Limitation
Single-surgeon series from a high-volume revision specialist introduces significant referral bias, making complication and re-revision rates non-representative of community practice.
Original Abstract
BACKGROUND
Introduction of reverse total shoulder arthroplasty (rTSA) has contributed to a large increase in primary rTSA volume. The impact of rTSA on revision TSA has not been well described. This study aims to describe the change of 1) the volume of revision and re-revision TSA, 2) the indications for revision TSA, and 3) patient reported outcomes related to revision indication.
METHODS
This is a retrospective review of a prospectively collected single surgeon database from 2002 to 2022. Patients undergoing revision TSA were identified using CPT codes 23472 and 23332 (before 2014) and 23474 (2014 and later). The primary outcome was the change in the rate of revision surgery year-over-year. Secondary outcomes include type of revision preformed, revision indication, re-revision rate, and patient reported outcomes.
RESULTS
Eight hundred fifty-nine patients underwent 1,030 revision surgeries, averaging 52 revisions per year (range 14-66). This reflects 20% of the surgeon's overall shoulder arthroplasty volume. Average time to revision was 41 months (range 0-229). Three hundred fifty-eight failed hemiarthroplasties (HA), 312 failed anatomic total shoulder arthroplasties (aTSAs), 358 failed reverse shoulder arthroplasties (rTSAs) and 2 failed resection arthroplasties were revised. Revisions of failed HA decreased; revisions of both failed aTSA and rTSA increased. Most patients were revised to rTSA (85%); revisions to hemiarthroplasty (8%), aTSA (6%), and resection arthroplasty (<1%) were less common. The most common revision indication by implant type was HA failed because of rotator cuff failure (45%) and glenoid wear (34%); aTSA failed because of glenoid loosening (41%) and rotator cuff failure (33%); rTSA failed because of instability (32%), baseplate failure (27%), and infection (22%). The mean American Shoulder and Elbow Surgeons score improvement from pre-to-postoperative was highest in revisions for aTSA with glenoid loosening and rotator cuff failure, HA with osteoarthritis progression, and rTSA with baseplate failure. A total of 131 patients required multiple revisions, an overall 15% re-revision rate. The re-revision rate by implant was 15% HA, 13% aTSA, and 21% rTSA. Humeral loosening, infection, and instability had the highest rates of re-revision.
DISCUSSION
There is an increasing burden of revision TSA; aTSA and rTSA failures are rising. Patients revised for both glenoid loosening and rotator cuff failure (aTSA), baseplate failure (rTSA), and osteoarthritis progression (HA) had the largest clinical benefit by American Shoulder and Elbow Surgeons score improvement. Revisions performed for humeral loosening, infection, and instability had the highest rate of multiple revisions. These failures pose unique challenges and are opportunities for innovation.