When should a revision shoulder arthroplasty be considered?
A revision shoulder arthroplasty is a decision that should be carefully considered. Dr. Provencher will obtain a comprehensive medical history and perform a thorough physical examination. Diagnostic imaging, such as x-rays and magnetic resonance imaging (MRI), may be requested to accurately identify any damage to the structures of the shoulder joint. Additional imaging, such as an MR arthrogram, may also be needed to rule out a compromised blood flow of the shoulder joint. The electromyographic nerve test (EMG) may also be needed to assess the quality of nerve around the shoulder joint.
The following are some important factors that Dr. Provencher will take into account when considering a revision shoulder arthroplasty:
Infection following a shoulder replacement is a significant concern when considering a revision shoulder arthroplasty. If an infection is suspected, Dr. Provencher will order laboratory studies, including a shoulder biopsy, to confirm an infection is present. Antibiotics are generally the primary treatment course if an infection is confirmed. Removal of the prosthetic implant is common when the infection lies deep in the shoulder alongside the shoulder prosthesis. Depending on the extent of infection, patients may require several surgical procedures to completely eliminate the infection. On occasion, a temporary shoulder joint spacer may be implemented while the infection is undergoing treatment.
There are several reasons that may cause shoulder joint instability: loosening and/or poor alignment of the shoulder prosthesis, damage to the soft tissues, a shoulder fracture, or anatomical deformities. If the shoulder joint is determined to be unstable during the physical examination by Dr. Provencher, additional joint testing and imaging will be performed to identify the specific cause and determine the appropriate treatment plan.
In the event of the prosthetic implant loosening or dislocating, Dr. Provencher will evaluate the patient’s age, rotator cuff condition, and bone availability to determine the type of revision procedure that will provide the best outcome.
Shoulder Prosthesis Condition.
If the shoulder prosthesis has deteriorated resulting in shoulder pain and loosening of the implant, Dr. Provencher will assess the condition of the prosthetic implant to identify the best mechanical solution for treating these symptoms.
Rotator Cuff Condition.
A revision shoulder arthroplasty is typically the recommended treatment in patients with damaged or torn rotator cuffs. Instability of the shoulder often develops when damage to the rotator cuff is left untreated thereby resulting in the need for a revision shoulder arthroplasty.