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Revision shoulder surgery

Overview

Revision shoulder arthroplasty is typically performed at a mean of 3.9 years following the primary procedure, addressing implants generally designed to last 10 to 15 years [5]. These secondary procedures face a higher risk of failure compared to first-time revisions [1]. While the majority of cases are performed for patients unlikely to have a periprosthetic joint infection (PJI), with less than 10% meeting International Consensus Meeting criteria for definite PJI [6], the surgery remains technically challenging [13]. Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years [2].

Despite generally inferior outcomes compared to primary reverse total shoulder arthroplasty, revision procedures lead to notable improvements in pain, motion, and function [4]. However, complications and reoperations are common [4], with failure rates for baseplate failure specifically exceeding those of primary RSA [9]. Outcomes for revision of failed anatomic arthroplasty are comparable to primary procedures [9], whereas conversion of humeral head replacement to total shoulder arthroplasty presents a complex surgery with frequent unsatisfactory results despite the potential for excellent outcomes in select cases [7]. Proper patient selection and attention to technical details are required to mitigate the currently high complication rate associated with reverse total shoulder arthroplasty [26].

Anatomy & Pathophysiology

Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. While shoulder arthroplasties are generally designed to last 10-15 years [5], revisions are currently being performed at a mean of 3.9 years from the primary procedure [5]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2]. Glenoid failure and instability remain the most common causes of revision shoulder arthroplasty [15], with glenoid component loosening specifically identified as a common cause of failure in this setting [42]. Conversion of humeral head replacement to total shoulder arthroplasty is complex and unsatisfactory results are frequent [7]; for instance, seven of eighteen shoulders treated for glenoid arthrosis with revision total shoulder arthroplasty had an unsatisfactory result due to limited range of motion or the need for a subsequent operation [47].

Osseous Defects: Structural bone grafting on the glenoid side is successful at managing large defects, producing similar or better clinical outcomes compared with patients without bone loss [22]. The use of distal clavicle autograft to address glenoid defects shows promising short-term outcomes with improved shoulder function and stability [24]. Custom glenoid components warrant further long-term study given their short-term superior performance in improving pain and higher ASES and Constant scores [17], while custom-made glenoid components in revision reverse shoulder arthroplasty show promising clinical and radiological short-term outcomes [43]. There is a slight clinical benefit to reimplanting a glenoid component whenever structurally possible [27]. When bone graft is used, the mean depth of glenoid peg penetration in native bone is 9 mm [49].

Kinematics and Reconstruction: The active range of motion of the arm with a reverse prosthesis is better in the primary placed prosthesis, with this difference occurring mainly in the glenohumeral joint [41]. Optimal fixation, design selection, and management of bone deficiencies are critical for functional outcomes in revision shoulder arthroplasty [42]. The PHAROS classification system may be useful to anticipate the complexity of humeral reconstruction in revision total shoulder arthroplasty [14].

Evaluation: A thorough and systematic approach including history, physical examination, and appropriate diagnostic studies is necessary to evaluate failed shoulder arthroplasty because the cause of pain and disability is often multifactorial [20].

Classification

PHAROS: The Proximal Humeral Arthroplasty Revision Osseous inSufficiency (PHAROS) classification system is utilized to anticipate the complexity of humeral reconstruction in revision shoulder arthroplasty [14].

Other Considerations: Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2] and is performed at a mean of 3.9 years from the primary procedure [5]. Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [13]. The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a periprosthetic joint infection (PJI), with less than 10% meeting ICM criteria for definite PJI [6]. Unexpected positive cultures (UPCs) are a prevalent condition in revision shoulder arthroplasty for causes different than infection [36]. Significant differences in skin Cutibacterium subtype distributions exist between shoulders undergoing revision shoulder arthroplasty and those undergoing primary shoulder arthroplasty [38]. A massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures [11]. ASES members represent the largest proportion of high-volume shoulder arthroplasty surgeons in the United States and perform a majority of all primary and revision arthroplasties among this group [35].

Clinical Presentation

Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2], though outcomes remain generally inferior to primary reverse total shoulder arthroplasty despite notable improvements in pain, motion, and function [4]. While shoulder arthroplasties are generally designed to last 10-15 years [5], revisions are currently performed at a mean of 3.9 years from the primary procedure [5]. A massive increase in primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures [11].

Glenoid failure and instability are the most common causes of revision shoulder arthroplasty [15]. Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, though unsatisfactory results are frequent [7]. Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair [10]. Custom glenoid components warrant further long-term study given their short-term superior performance in improving pain and higher ASES and Constant scores [17].

Determining the presence of infection in revision shoulder arthroplasty can be difficult, requiring a standardized approach to determine the best course of treatment [18]. Specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty [19]. A thorough and systematic approach including history, physical examination, and appropriate diagnostic studies is necessary to evaluate failed shoulder arthroplasty as the cause of pain and disability is often multifactorial [20]. The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a periprosthetic joint infection (PJI) [6], with less than 10% of revision shoulder arthroplasty patients meeting ICM criteria for definite PJI [6].

More than a quarter of patients requiring revision surgery after shoulder stabilization procedures have a subclinical shoulder infection [21]. Males are at a higher risk of developing an infection than females in the context of revision surgery after shoulder stabilization procedures [21]. Complications associated with antibiotic administration after revision shoulder arthroplasty are not infrequent and are more common in patients whose initial protocol is IV antibiotics [23]. Intraoperative humeral fractures occur in approximately 16% of shoulders undergoing revision surgery [32], with intraoperative humeral fractures during revision reverse shoulder arthroplasty being most common in female patients, those with instability, and those with prior hemiarthroplasty [32]. A positive intraoperative culture result during revision shoulder arthroplasty without other signs of infection has a low risk for recurrence of clinical infection [33], yet cultures taken at revision surgery for failed shoulder arthroplasty are often positive [34].

Investigations

Plain radiography: Revision shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [13]. Glenoid failure and instability are the most common causes of revision shoulder arthroplasty [15]. Revision procedures lead to notable improvements in pain, motion, and function despite generally inferior outcomes compared to primary reverse total shoulder arthroplasty and common complications [4]. Revisions are being performed at a mean of 3.9 years from the primary procedure [5]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2]. Complications and reoperation rates for revision reverse shoulder arthroplasty are higher than those for primary RSA, though outcomes are comparable for revision of failed anatomic shoulder arthroplasty [9]. Revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcomes [12]. Bone grafting large glenoid defects during revision shoulder arthroplasty can improve clinical outcome scores, but substantial resorption of the graft material remains a concern [53]. Neither clinical nor radiographic follow-up show long-stem humeral components to be at high risk for loosening in revision shoulder arthroplasty [51]. There is a slight clinical benefit to reimplanting a glenoid component whenever structurally possible [27].

CT: The PHAROS classification system may be useful to anticipate the complexity of humeral reconstruction in revision total shoulder arthroplasty [14].

Bone scan: Specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty [19].

Aspiration: Determining the presence of infection in revision shoulder arthroplasty can be difficult, and a standardized approach is needed to determine the best course of treatment [18]. Less than 10% of revision shoulder arthroplasties meet ICM criteria for definite periprosthetic joint infection (PJI) [6].

Other Considerations: Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Detailed analysis of intraoperative and postoperative complications and shoulder function at the time of revision offers new information in addition to results from other registries [3]. A massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures [11]. Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair [10]. Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulabral repair [16].

Treatment

Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Generally, shoulder arthroplasties are designed to last 10-15 years [5], yet revisions are being performed at a mean 3.9 years from the primary procedure [5]. Although outcomes are generally inferior to primary reverse total shoulder arthroplasty, revision procedures lead to notable improvements in pain, motion, and function [4]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2] and significant long-term clinical improvements [2]. However, complications and revision surgeries are common in revision reverse shoulder arthroplasty [4], and complications and reoperation rates for revision reverse shoulder arthroplasty for baseplate failure are higher than those for primary RSA [9].

Indications: The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a periprosthetic joint infection (PJI) [6], with less than 10% of revision shoulder arthroplasties meeting ICM criteria for definite PJI [6]. Nearly one-quarter of revision shoulder arthroplasties had unexpected positive cultures [46], though patients without unexpected positive cultures had a nonsignificantly higher risk of reoperation compared with those with unexpected positive cultures [46]. More than a quarter of patients requiring revision surgery after shoulder stabilization procedures have a subclinical shoulder infection [21], and males are at a higher risk of developing an infection than females in revision surgery after shoulder stabilization procedures [21].

Surgical Approach / Technique: Revision total shoulder arthroplasty is technically challenging [13] and has inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication [13]. Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results [7], yet unsatisfactory results are frequent in conversion of humeral head replacement to total shoulder arthroplasty [7]. The surgery for conversion of humeral head replacement to total shoulder arthroplasty is complex [7]. Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary humeral head replacement [31] and can be performed with or without the need to change the humeral component [31]. Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair [10], and arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulabral repair [16].

Implant Selection: Revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcome [12], and glenoid component reinsertion should be attempted whenever possible in revision shoulder arthroplasty with glenoid bone grafting [12]. Structural bone grafting on the glenoid side is successful at managing large defects in revision shoulder arthroplasty [22] and produces similar or better clinical outcomes compared with patients without bone loss [22]. Custom glenoid components warrant further long-term study given their short-term superior performance in improving pain and higher ASES and Constant scores [17]. The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty [28], though there is a high percentage of patients with humeral loosening when using long-stem humeral components in revision reverse shoulder arthroplasty [28].

Adjuncts: Proper patient selection and attention to technical details are needed to reduce the currently high complication rate associated with reverse total shoulder arthroplasty [26]. Clinical outcomes after single-stage revision for Propionibacterium culture-positive shoulders were at least as good as the outcomes in revision procedures for control shoulders [30]. Outcomes for revision of failed anatomic shoulder arthroplasty are comparable to primary RSA [9].

Complications

Revision Failure: Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2], with over 80% of revision replacements lasting 5 years and over 70% lasting 10 years [29].

General Outcomes: Revision procedures generally lead to notable improvements in pain, motion, and function despite outcomes being inferior to primary reverse total shoulder arthroplasty and common complications and revision surgeries [4]. Complications and reoperation rates for revision reverse shoulder arthroplasty are higher than those for primary RSA, though outcomes are comparable for revision of failed anatomic shoulder arthroplasty [9]. Revision reverse total shoulder arthroplasty for failed hemiarthroplasty has high overall complication and reintervention rates, specifically for hardware loosening and revision rates [37].

Infection (PJI): Complications associated with antibiotic administration after revision shoulder arthroplasty are not infrequent and are more common in patients whose initial protocol is IV antibiotics [23].

Other Considerations: The open Latarjet procedure shows good safety with low risk of major complications in treating anterior shoulder instability in a primary and revision surgical setting when performed by an experienced shoulder surgeon [40].

Recovery

Light activity (weeks): Evidence does not specify a precise week range for light activity or driving in the provided literature. While revision shoulder arthroplasties are designed to last 10-15 years [5], revisions are currently performed at a mean of 3.9 years from the primary procedure [5]. The annual incidence of revision total shoulder arthroplasty increased 5.6-fold from 2015 to 2024, with a notable acceleration in recent years [25].

Full activity (months): The literature does not define a specific month range for full activity or return to manual work. However, revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements [2], and although outcomes are generally inferior to primary reverse total shoulder arthroplasty, revision procedures lead to notable improvements in pain, motion, and function [4]. Over 80% of revision replacements last 5 years, and over 70% last 10 years [29].

Complete recovery / outcome plateau (months): Specific timelines for functional plateau are not detailed in the source bullets. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2]. Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery [1]. Complications and revision surgeries are common in revision shoulder arthroplasty [4].

Rehabilitation protocol: The provided evidence does not contain specific details regarding PT phasing, immobilisation duration, or sling removal timing. However, the surgery for conversion of humeral head replacement to total shoulder arthroplasty is complex [7], and unsatisfactory results are frequent in this conversion [7]. Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results [7]. Glenoid component reinsertion should be attempted whenever possible in revision shoulder arthroplasty with glenoid bone grafting [12]. Revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcomes [12]. Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulabral repair [16].

Functional milestones: Validated PROM trajectories are not explicitly quantified in the provided text. However, promising short-term outcomes with improved shoulder function and stability have been described using distal clavicle autograft for addressing glenoid defects in revision total shoulder arthroplasty [24]. Further follow-up and additional cases are needed to confirm long-term efficacy of distal clavicle autograft for addressing glenoid defects in revision total shoulder arthroplasty [24]. Outcomes for revision reverse shoulder arthroplasty for baseplate failure are comparable to those for revision of failed anatomic shoulder arthroplasty [9]. Complications and reoperation rates for revision reverse shoulder arthroplasty for baseplate failure are higher than those for primary RSA [9].

Other Considerations: There is a high incidence of humeral component malposition in cases requiring revision arthroplasty [52]. The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty [28], yet there is a high percentage of patients with humeral loosening when using cemented long stems in revision reverse shoulder arthroplasty [28]. In the setting of revision shoulder arthroplasty, timing of antibiotic administration did not significantly influence culture yield [48]. The current RVU model does not adequately factor surgical time for revision shoulder arthroplasty [50], translating to a notable yearly reimbursement difference that favors primary shoulder arthroplasty [50].

Key Evidence

  • [L3] Shoulders undergoing secondary revision face a higher risk of failure compared to those undergoing first-time revision surgery. (10.1016/j.jse.2026.04.028)
  • [L3] Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years. (10.1302/0301-620x.107b11.bjj-2025-0436.r1)
  • [L3] Especially, the detailed analysis of intraoperative and postoperative complications and the shoulder function at the time of revision offers new information in addition to the results of other registries. (10.1016/j.jseint.2020.12.003)
  • [L5] Although the outcomes are generally inferior to primary reverse total shoulder arthroplasty and complications and revision surgeries are common, revision procedures still lead to notable improvements in pain, motion, and function. (10.5435/jaaos-d-17-00535)
  • [L4] Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure. (10.1016/j.jse.2019.12.015)
  • [L3] The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a PJI, with less than 10% meeting ICM criteria for definite PJI. (10.1016/j.jse.2025.01.040)
  • [L4] Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but the surgery is complex and unsatisfactory results are frequent. (10.1016/j.jse.2008.09.006)
  • [L4] Complications and reoperation rates were higher than those for primary RSA but outcomes were comparable for revision of failed anatomic shoulder arthroplasty. (10.1016/j.jse.2023.06.039)
  • [L4] Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. (10.1016/j.jse.2014.11.034)
  • [L3] A massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. (10.3390/jcm10215123)
  • [L4] Revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcome and glenoid component reinsertion should be attempted whenever possible. (10.1007/s11999-007-0108-0)
  • [L5] Revision total shoulder arthroplasty is technically challenging with inferior results compared to primary arthroplasty, particularly when soft-tissue problems are the indication. (10.5435/jaaos-21-01-23)
  • [L3] This classification system may be useful to anticipate the complexity of humeral reconstruction. (10.1097/corr.0000000000000590)
  • [L4] Glenoid failure and instability are the most common causes of revision. (10.1016/j.jse.2019.07.034)
  • [L3] Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulabral repair. (10.1177/2325967115s00012)
  • [L4] The findings suggest that given the short-term superior performance in improving pain and higher ASES and Constant scores, custom glenoid components warrant further long-term study. (10.1016/j.jse.2026.02.025)
  • [L5] Determining the presence of infection in revision shoulder arthroplasty can be difficult, and a standardized approach is needed to determine the best course of treatment in this particular clinical setting. (10.1016/j.jse.2014.10.005)
  • [L4] Specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty. (10.1016/j.jseint.2025.02.005)
  • [L5] A thorough and systematic approach including history, physical examination, and appropriate diagnostic studies is necessary to evaluate failed shoulder arthroplasty, as the cause of pain and disability is often multifactorial. (10.1016/j.jse.2013.12.003)
  • [L4] More than a quarter of patients requiring revision surgery after shoulder stabilization procedures have a subclinical shoulder infection, with males being at a higher risk of developing an infection than females. (10.1016/j.jse.2023.07.025)
  • [L4] Structural bone grafting on the glenoid side is successful at managing large defects, producing similar or better clinical outcomes compared with patients without bone loss. (10.1016/j.jse.2011.11.021)
  • [L4] Complications associated with antibiotic administration after revision shoulder arthroplasty are not infrequent and are more common in patients whose initial protocol is IV antibiotics. (10.2106/jbjs.19.00846)
  • [L4] The study describes promising short-term outcomes with improved shoulder function and stability using this technique, though further follow-up and additional cases are needed to confirm long-term efficacy. (10.1016/j.xrrt.2024.10.006)
  • [L3] The study demonstrated a 5.6-fold increase in the annual incidence of revision total shoulder arthroplasty from 2015 to 2024, with a notable acceleration in recent years. (10.1016/j.jse.2026.01.017)
  • [L3] Proper patient selection and attention to technical details are needed to reduce the currently high complication rate associated with reverse total shoulder arthroplasty. (10.5435/jaaos-d-21-01090)
  • [L3] There is a slight clinical benefit to reimplanting a glenoid component whenever structurally possible. (10.1016/j.jse.2007.09.003)
  • [L4] The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty, although the high percentage of patients with humeral loosening is concerning. (10.1016/j.jse.2016.05.015)
  • [L1] Over 80% of revision replacements last 5 years and over 70% last 10 years. (10.1177/24715492221095991)
  • [L3] Clinical outcomes after single-stage revision for Propionibacterium culture-positive shoulders were at least as good as the outcomes in revision procedures for control shoulders. (10.2106/jbjs.16.00149)
  • [L4] Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary humeral head replacement, with or without the need to change the humeral component. (10.1016/j.jse.2011.01.024)
  • [L3] Intraoperative humeral fractures occur in approximately 16% of shoulders undergoing revision surgery and are most common in female patients, those with instability, and those with prior hemiarthroplasty. (10.1007/s11999-015-4448-x)
  • [L4] We found that a positive intraoperative culture result during revision shoulder arthroplasty without other signs of infection has a low risk for recurrence of clinical infection. (10.1016/j.jse.2011.08.052)
  • [L4] Cultures taken at revision surgery for failed shoulder arthroplasty are often positive, and our findings document the importance of these positive cultures. (10.1007/s11999-009-0875-x)
  • [L3] ASES members represent the largest proportion of high-volume shoulder arthroplasty surgeons in the United States and perform a majority of all primary and revision arthroplasties among this group. (10.1016/j.jses.2017.07.002)
  • [L4] UPCs are a prevalent condition in revision shoulder arthroplasty for causes different than infection. (10.1016/j.jse.2012.07.017)
  • [L2] This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates. (10.1177/17585732211019390)
  • [L3] Significant differences in the skin Cutibacterium subtype distributions were found between shoulders undergoing revision shoulder arthroplasty and those undergoing primary shoulder arthroplasty. (10.1016/j.jse.2020.02.007)
  • [L4] When performed by an experienced shoulder surgeon, the open Latarjet procedure shows good safety with low risk of major complications in treating anterior shoulder instability in a primary and revision surgical setting. (10.1002/arj.70066)
  • [L3] The active ROM of the arm with a reverse prosthesis is better in the primary placed prosthesis, and this difference takes place mainly in the glenohumeral joint. (10.1016/j.jse.2010.08.022)
  • [L5] This article reviews principles of glenoid component design and strategies for managing glenoid bone loss in revision shoulder arthroplasty, emphasizing that component loosening is a common cause of failure and that optimal fixation, design selection, and management of bone deficiencies are critical for functional outcomes. (10.1016/j.jse.2011.03.016)
  • [L4] This trial showed promising clinical and radiological short-term outcomes for custom-made glenoid components in revision rTSA. (10.3390/jcm11030551)
  • [L3] Nearly one-quarter of revision shoulder arthroplasties had unexpected positive cultures, but patients without these cultures had a nonsignificantly higher risk of reoperation compared with those with unexpected positive cultures. (10.1016/j.jse.2016.10.023)
  • [L4] However, seven of the eighteen shoulders that had this procedure had an unsatisfactory result due to a limited range of motion or the need for a subsequent operation. (10.2106/00004623-199806000-00010)
  • [L3] In the setting of revision shoulder arthroplasty, timing of antibiotic administration did not significantly influence culture yield. (10.1016/j.jse.2023.05.005)
  • [L4] The mean depth of glenoid peg in native bone was 9 mm. (10.1177/1758573220987557)
  • [L3] The current RVU model does not adequately factor surgical time for revision shoulder arthroplasty and translates to a notable yearly reimbursement difference that favors primary shoulder arthroplasty. (10.5435/jaaos-d-21-00466)
  • [L4] Neither clinical nor radiographic follow-up show these components to be at high risk for loosening. (10.1016/j.jse.2012.10.034)
  • [L4] The study highlights the previously underappreciated high incidence of humeral component malposition in cases requiring revision arthroplasty. (10.1016/j.jse.2024.11.015)
  • [L3] Bone grafting large glenoid defects during revision shoulder arthroplasty can improve clinical outcome scores, but the substantial resorption of the graft material remains a concern. (10.1007/s11999-007-0065-7)

See Also

References

[1] Revision Reverse Shoulder Arthroplasty After Failed Shoulder Arthroplasty: Long-Term Survivorship and Risk Factors for Failure. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.028

[2] Long-term results and implant survival of revision reverse shoulder arthroplasty after a mean follow-up of ten years. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b11.bjj-2025-0436.r1

[3] Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018. JSES International. 2021. DOI: 10.1016/j.jseint.2020.12.003

[4] Revision Reverse Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00535

[5] Revision shoulder arthroplasty: a systematic review and comparison of North American vs. European outcomes and complications. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.015

[6] Assessment of periprosthetic joint infection in revision shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.040

[7] Revision total shoulder arthroplasty for painful humeral head replacement with glenoid arthrosis. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.09.006

[9] Revision reverse shoulder arthroplasty for the management of baseplate failure: an analysis of 676 revision reverse shoulder arthroplasty procedures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.039

[10] Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.11.034

[11] Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures. Journal of Clinical Medicine. 2021. DOI: 10.3390/jcm10215123

[12] Glenoid Reconstruction in Revision Shoulder Arthroplasty. Clinical Orthopaedics & Related Research. 2008. DOI: 10.1007/s11999-007-0108-0

[13] Soft-tissue Management in Revision Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-21-01-23

[14] Humeral Bone Loss in Revision Total Shoulder Arthroplasty: the Proximal Humeral Arthroplasty Revision Osseous inSufficiency (PHAROS) Classification System. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000590

[15] Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.07.034

[16] Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00012

[17] Current treatment options for severe glenoid bone loss in revision shoulder arthroplasty: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.025

[18] Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.005

[19] Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.02.005

[20] The evaluation of the failed shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.12.003

[21] The incidence of subclinical infection in patients undergoing revision shoulder stabilization surgery: a retrospective chart review. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.07.025

[22] Clinical results of revision shoulder arthroplasty using the reverse prosthesis. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.021

[23] The Use and Adverse Effects of Oral and Intravenous Antibiotic Administration for Suspected Infection After Revision Shoulder Arthroplasty. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.19.00846

[24] Addressing glenoid defects with distal clavicle autograft in revision total shoulder arthroplasty. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.10.006

[25] The rising incidence and future trends of revision total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.017

[26] Risk of Revision Shoulder Arthroplasty After Anatomic and Reverse Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-01090

[27] Revision shoulder arthroplasty for glenoid component loosening. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.09.003

[28] Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.05.015

[29] Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis. Journal of Shoulder and Elbow Arthroplasty. 2022. DOI: 10.1177/24715492221095991

[30] Single-Stage Revision Is Effective for Failed Shoulder Arthroplasty with Positive Cultures for Propionibacterium. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.16.00149

[31] Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: the posttraumatic shoulder. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.01.024

[32] What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?. Clinical Orthopaedics and Related Research®. 2015. DOI: 10.1007/s11999-015-4448-x

[33] Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.08.052

[34] Positive Culture Rate in Revision Shoulder Arthroplasty. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-009-0875-x

[35] American Shoulder and Elbow Surgeons membership and its association with primary and revision shoulder arthroplasty volume. JSES Open Access. 2017. DOI: 10.1016/j.jses.2017.07.002

[36] Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.07.017

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[38] Cutibacterium subtype distribution on the skin of primary and revision shoulder arthroplasty patients. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.007

[40] Open Latarjet Yields a Low 90‐Day Complication Rate in Primary and Revision Shoulder Stabilization. Arthroscopy. 2026. DOI: 10.1002/arj.70066

[41] Kinematic and clinical evaluation of shoulder function after primary and revision reverse shoulder prostheses. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.08.022

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