Revision total shoulder arthroplasty can be technically challenging. Results are inferior to those of primary arthroplasty, particularly when the indications for revision are related to soft-tissue problems. Patient selection is important. In the stiff arthroplasty, the surgeon must address rotator cuff and capsular contractures as well as exuberant soft-tissue adhesions. Unstable arthroplasty can be the result of asymmetric soft-tissue balancing or deficiencies (eg, subscapularis deficiency) that can lead to loss of the rotator cuff force couples and, subsequently, to instability on attempted glenohumeral motion. Infection must be considered in the workup of the failed total shoulder. In this era of ever-increasing use of shoulder arthroplasty, surgeons will be presented with growing numbers of patients who require revision surgery. An organized approach is needed to diagnose and manage the stiff or unstable total shoulder arthroplasty.



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