23474 Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component

Name of the Procedure:

Revision of Total Shoulder Arthroplasty with Allograft; Humeral and Glenoid Component

Summary

Revision of total shoulder arthroplasty is a surgical procedure to replace or repair a previously implanted shoulder prosthesis. This procedure addresses issues with both the humeral and glenoid components and may involve the use of allografts (donor tissue) to enhance the reconstruction.

Purpose

The procedure aims to address complications from a prior shoulder arthroplasty, such as loosening or wear of the prosthesis, infection, or bone loss. The goal is to restore shoulder function, reduce pain, and improve the patient's quality of life.

Indications

• Persistent shoulder pain that does not respond to conservative treatments.
• Instability or dislocation of the shoulder prosthesis.
• Loosening or wearing out of the implant components.
• Infection of the shoulder joint.
• Significant bone loss around the shoulder prosthesis.

Preparation

• Patients may be instructed to fast for a specified period before surgery.
• Certain medications, particularly blood thinners, may need to be adjusted or stopped.
• Pre-operative imaging studies like X-rays, CT scans, or MRIs will be performed.
• Blood tests and a thorough medical evaluation are required to assess overall health.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the previous surgical site to access the shoulder joint.
3. The surgeon carefully removes the old prosthetic components.
4. Bone defects are addressed using allografts.
5. New humeral and glenoid components are implanted.
6. The shoulder joint is tested for proper function and stability.
7. The incision is closed with sutures, and a sterile dressing is applied.

Specialized tools such as bone saws, reamers, and fixation devices are used. Imaging guidance and computer navigation may also be employed to ensure precise placement of the new components.

Duration

The procedure typically takes 2 to 4 hours, but this can vary depending on the complexity of the case.

Setting

The surgery is performed in a hospital operating room equipped for orthopedic procedures.

Personnel

• Orthopedic surgeon specialized in shoulder procedures.
• Surgical assistants and nurses.
• Anesthesiologist and anesthesia team.
• Radiology technician (if imaging guidance is utilized).

Risks and Complications

• Infection.
• Blood clots.
• Nerve or blood vessel damage.
• Prosthesis loosening or failure.
• Allergic reaction to anesthesia.
• Fracture of the surrounding bone.

Benefits

• Reduction or elimination of shoulder pain.
• Improved shoulder function and range of motion.
• Enhanced quality of life.
• Reduced risk of future complications related to the old prosthesis.

Recovery

• Initial recovery in the hospital for monitoring.
• Pain management with medications.
• Physical therapy usually starts within a few days post-surgery.
• Avoiding heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor progress.

Alternatives

• Non-surgical management with physical therapy, medications, and injections.
• Hemiarthroplasty (partial shoulder replacement).
• Arthroscopic debridement.

While these alternatives may offer temporary relief, they might not be as effective in addressing severe complications as a revision total shoulder arthroplasty.

Patient Experience

• Patients will be under general anesthesia during the procedure and therefore will not experience any sensations during surgery.
• Post-operative pain is managed with medications.
• Swelling, stiffness, and discomfort are common initially, but these symptoms typically improve over time with therapy and care.
• Adherence to post-operative instructions is crucial for a successful recovery and outcome.