23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component

Name of the Procedure:

Revision of Total Shoulder Arthroplasty, including Allograft when Performed; Humeral or Glenoid Component

Summary

The revision of total shoulder arthroplasty is a surgical procedure to replace or repair an existing shoulder implant (either the humeral or glenoid component) with the use of donor tissue (allograft) if necessary. This surgery is typically done to address issues related to wear, loosening, or damage of the initial implant.

Purpose

• Medical Condition: Addresses issues such as implant loosening, wear, infection, or improper implant positioning.
• Goals: To alleviate pain, restore function, and improve the range of motion of the shoulder.

Indications

• Persistent pain and discomfort in the shoulder with a previously implanted prosthesis.
• Evidence of implant loosening, shifting or mechanical failure.
• Shoulder joint infection.
• Decreased range of motion and function of the shoulder.
• X-ray or imaging studies showing implant issues.

Preparation

• Pre-procedure Instructions: Patients may be advised to fast for a specific period before the procedure and adjust current medications (especially blood thinners).
• Diagnostic Tests: Blood tests, imaging studies (X-rays or MRIs), and potentially an evaluation by a medical specialist (such as an orthopedic surgeon).

Procedure Description

• Steps Involved:
  1. Anesthesia administration (general or regional).
  2. Making an incision to expose the shoulder joint and the existing implant.
  3. Removal of the old implant components.
  4. Preparation of the bone surfaces and, if needed, insertion of allograft material.
  5. Placement of new implant components (humeral or glenoid).
  6. Verification of the proper function and stability of the new implant.
  7. Closing the incision with sutures or staples.
  8. Application of a sterile dressing.
• Tools & Equipment: Surgical instruments for orthopedic procedures, shoulder prosthetic components, and allograft material.
• Anesthesia: General anesthesia or regional block.

Duration

Approximately 2-4 hours, depending on the complexity of the revision.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic Surgeon
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Common Risks: Infection, blood clots, implant loosening, fracture around the implant, and nerve damage.
• Rare Risks: Persistent pain, anesthetic-related complications, and need for further surgeries.

Benefits

• Relief from pain.
• Improved shoulder function and range of motion.
• Enhanced quality of life. Benefits are typically noticeable within a few months post-procedure.

Recovery

• Post-procedure Care: Pain management with medications, physical therapy, and wound care instructions.
• Expected Recovery Time: Several weeks to months.
• Restrictions: Limited use of the affected shoulder initially, avoiding strenuous activities.
• Follow-up: Regular check-ups to monitor healing and implant function.

Alternatives

• Non-surgical treatments such as physical therapy, medication management, and corticosteroid injections.
• Less invasive surgical options if appropriate.

Pros & Cons of Alternatives:

• Non-surgical: Lower risk but may not effectively address severe issues.
• Less Invasive Surgery: May provide relief but might not be as effective for extensive problems.

Patient Experience

During the procedure, the patient will be under anesthesia and won't feel anything. Post-surgery experiences include pain, swelling, and restricted shoulder movement, which are managed with pain relief measures and physical therapy. Pain usually decreases significantly over the first few weeks.