Revision Shoulder Arthroplasty

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Revision Shoulder Arthroplasty to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of a revision surgery is to salvage a shoulder replacement that has failed due to infection, instability, component loosening, or fracture. These are complex, "high-stakes" procedures that require extensive preoperative planning and a highly specialized skillset. While the primary goal is always to relieve pain and restore stability, it is important to understand that functional outcomes may be diminished compared to a primary replacement. Success relies heavily on having a dedicated shoulder surgeon with a comprehensive plan to address bone loss, soft tissue deficiency, and bacterial colonization.

The Workup

Before any revision surgery, Dr. Wall performs a rigorous diagnostic evaluation to identify why the previous implant failed. This is critical to preventing the new implant from failing for the same reason.

  • Infection Screening: Every failed shoulder is considered infected until proven otherwise. This workup includes blood tests and often an aspiration (fluid sample) from the joint.

  • Arthroscopic Biopsy: In some cases, Dr. Wall may perform a minimally invasive arthroscopic biopsy to obtain tissue samples for culture and to visually inspect the implants and bone stock before committing to the final revision surgery.

  • Advanced Imaging: CT scans with metal-artifact reduction are used to map out bone loss and plan for complex reconstruction.

The Procedure

Revision surgery is never "one size fits all." Depending on the cause of failure, Dr. Wall may utilize one of several advanced techniques. The final product in most revision cases is often some form of a reverse shoulder arthroplasty.

  • Infection Management (One vs. Two-Stage):

    • One-Stage Exchange: For specific, low-virulence infections with healthy soft tissues, the old implant may be removed and a new one inserted in the same surgery.

    • Two-Stage Exchange: For chronic or aggressive infections, the implants are removed, and an antibiotic-loaded cement spacer is placed. Patients can function fairly well with this, but usually not perfectly. A new, permanent prosthesis is implanted only after the infection is fully eradicated (typically 6–12 weeks later, during most of which the patient is on IV antibiotics).

  • Bone Loss Reconstruction:

    • Allograft Prosthetic Composites (APC): If the upper humerus is destroyed, Dr. Wall may use a donor bone (allograft) combined with a metal prosthesis to reconstruct the entire upper arm.

    • Glenoid Reconstruction: Severe socket bone loss may be treated with structural bone grafts or custom-printed metal augments to create a stable platform for the new joint.

  • Soft Tissue Balancing: If the rotator cuff is absent or the shoulder is unstable, tendon transfers (such as the lower trapezius or latissimus dorsi) may be performed simultaneously to restore external rotation and prevent dislocation.

Post-Op Protocol

  • Immobilization (Phase 1: 0–6 weeks): Strict protection is required. You must wear a sling at all times, except for hygiene. No shoulder motion is permitted to allow for bone graft incorporation and soft tissue healing. You may perform elbow, wrist, and hand motion as tolerated.

  • Start Formal PT: Professional physical therapy begins at Post-Op Week 6.

  • Phase 2 (6–12 weeks): The sling is discontinued. Therapy focuses on progressive passive, active-assisted, and eventually active motion as tolerated. No lifting, pushing, pulling, or weightbearing is allowed.

  • Phase 3 (12–16 weeks): Progressive stretching and strengthening begin, starting with resistance bands.

  • Phase 4 (16 weeks+): Ongoing stretching and strengthening as tolerated, progressing to weights.

When to Seek Care

You should schedule a consultation if:

  • You have a shoulder replacement that was doing well but has now become painful or stiff.

  • You experience instability, feeling like your shoulder replacement is "sliding" or dislocating.

  • You have developed a draining wound or sinus tract around your old incision.