Total shoulder arthroplasty (TSA) is a highly successful procedure for treating arthritis and restoring function in the shoulder. However, like any joint replacement, it is not permanent. Over time, some patients may require a revision procedure—a surgery performed to repair or replace components of the original prosthesis.
Revision TSA is more complex than primary surgery, requiring careful planning, specialized implants, and experienced surgical expertise.
What Is a TSA Revision?
A revision total shoulder arthroplasty is a secondary operation performed when the original TSA fails or no longer provides adequate function. Revision may involve:
- Component exchange: Replacing one part of the implant, such as the glenoid or humeral component.
- Full revision: Replacing both the humeral head and glenoid components.
- Conversion procedures: Changing from an anatomic TSA to a reverse TSA if the rotator cuff is no longer functional.
Reasons for TSA Revision
Mechanical Issues
- Implant loosening due to wear, poor bone support, or mechanical stress.
- Component failure, such as fractures of the prosthetic material.
Biological Factors
- Rotator cuff failure leading to instability or superior migration.
- Bone loss or osteolysis around implants caused by wear particles.
Infection
- Periprosthetic joint infection is one of the most serious complications, sometimes requiring staged revision procedures.
Instability or Malposition
- Implants placed in improper alignment may lead to recurrent dislocations, pain, and reduced function.
Types of TSA Revisions
- Isolated Humeral Revision
- Replacement of the humeral stem and head when glenoid fixation is intact.
- Isolated Glenoid Revision
- Performed when the glenoid component loosens or wears out.
- Combined Revision
- Both humeral and glenoid components are replaced.
- Conversion to Reverse TSA
- Chosen when the rotator cuff has failed and anatomic TSA is no longer functional.
Patient Journey in Revision TSA
- Evaluation: Imaging (X-ray, CT, sometimes MRI) helps identify component failure, bone loss, or infection.
- Surgical Planning: Specialized implants, custom augments, or bone grafting may be required.
- Recovery: Rehabilitation is often longer than after primary TSA, with initial immobilization followed by structured therapy.
- Outcomes: While revision success rates are lower than primary TSA, most patients experience significant pain relief and functional gains.
Summary Table
| Revision Type | Indication | Key Consideration |
| Isolated Humeral Revision | Humeral loosening or failure | Stem extraction may require advanced tools |
| Isolated Glenoid Revision | Glenoid wear/loosening | Bone grafting often necessary |
| Combined Revision | Both components failing | More complex, longer recovery |
| Conversion to Reverse TSA | Cuff failure, instability | Provides stability via deltoid mechanics |
Frequently Asked Questions
1. How long does a total shoulder replacement last before revision is needed?
On average, 10–15 years, though it varies by patient age, activity, and implant type.
2. Is revision surgery riskier than the first replacement?
Yes, revision carries higher complication risks due to scar tissue, bone loss, and infection risks.
3. Can all failed TSAs be revised?
Most can, but severe bone loss or infection may limit options and require staged approaches.
4. Will revision surgery restore full function?
It often improves pain and function, but outcomes are typically less predictable than primary surgery.
5. How long is recovery after revision TSA?
Typically 6–12 months, depending on complexity and the patient’s overall health.
