Re-revision following revision of a failed primary reverse total shoulder arthroplasty: an analysis of the National Joint Registry and Hospital Episode Statistics for England

Background

Reverse total shoulder arthroplasty (rTSA) is the most common type of shoulder replacement in the UK and its use continues to rise. There is minimal data in the literature looking at re-revision following revision of a failed rTSA. This study utilizes the National Joint Registry and Hospital Episode Statistics for England to calculate the incidence and risk factors for re-revision of a failed primary rTSA.

Methods

Patients were included if they had a revision procedure between April 1, 2012, and March 31, 2022. This National Joint Registry database was linked to Hospital Episode Statistics and Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4.9 codes were used to identify a further revision procedure. The primary outcome was implant survival, the Kaplan-Meir method was used for analysis. Secondary outcomes were risk factors that predispose a patient to a further revision procedure. A multivariable regression analysis was performed to assess for independent risk factors for re-revision.

Results

There were 685 patients who underwent a revision of a primary rTSA done by 244 consultant surgeons with a median caseload of 4 patients (interquartile range 2-7) over a 10-year period. At 1 year, the incidence of re-revision was 15.91%; at 3 years, it was 21.41%; and at 5 years, it was 23.18%. A 1-year decrease in age resulted in a 4% increased risk of re-revision (hazard ratio 0.96 [95% confidence interval 0.94-0.98]), and if the primary revision was due to instability/dislocation, there was a 2-fold increased risk of re-revision compared to if the primary revision was done for any other indication (hazard ratio 2.47 [95% confidence interval 1.59-3.82]).

Conclusion

Re-revision rates following revision rTSA are high with independent risk factors being younger age and instability as primary revision diagnosis. Given the risk profile and low volume of revision cases performed by surgeons, centralizing revision rTSA surgeries to high-volume centers may warrant further exploration to improve outcomes.