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Shoulder Revision 3rd replacement

austin2020

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Hi, I'm not sure if anyone can help me, I'm interested to find out if anyone's had anything approaching a similar experience and what the outcomes might be down the line.

I'm 36 and in the next few weeks will be having my 3rd shoulder replacement on the same shoulder and 6th operation on it. I've always been relatively fit and active, played quite a lot of sports until the injury that led down this path.

The first replacement failed after 2 years due to complications with primary glenoid dysplasia, which in turn caused a reasonable amount of damage due to metalosis.

The second replacement ended up being a ream and run owing to the damage from the metalosis to the glenoid.

Two years on from that there's been good remodelling and although the shoulder is stable finally I've got restricted ROM with reasonably significant pain. After 4 years on prescription meds I managed to transition off them around christmas with the help of CBD oil but that's now not having the effect it did have.

As I said I'd be interested to hear if anyone's had multiple replacements and any similar issues and how they've got on.

Thanks
 

Jaycey

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@austin2020 Welcome to BoneSmart! You have certainly had a struggle with this shoulder.

Our shoulder forum is growing but according to a search you are the first to have a revision. I hope you will stick with us and let us support you through this journey.
 

Jamie

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Jaycey's right.....we don't have the depth of experience with multiple surgeries on shoulders here on the forum like we do with knees and hips. Having you document your experiences will certainly help others down the road and I hope you do stay with us at least until things get completely resolved for you.

That said, revisions are still basically the same as a primary shoulder surgery and many of the things you may experience will be similar to what those of us with bionic shoulders have gone through. One thing to keep in mind is that the world of shoulder replacements has changed dramatically in the past couple of years and it continues to do so. This is the fastest growing area of joint replacements now. At least, I'm assuming that's the case in the UK as it is here in the States. So hopefully your current surgeon will be able to help you regain some of those lost motions.

Please continue to let us know how you're doing.
 
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austin2020

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Thanks both.

I'm happy to share my experiences if it helps anyone. If it's of any use, by way of background...

Injury history
Four major injuries, primarily as a result of sport.
  • Dislocation as a child which was relocated without complication
  • Double AC separation a year apart as a result of sports injuries in my late teens
  • A never fully diagnosed injury in my late 20s, originally thought to be a slap tear.
Treatments
I've had a range of treatments since this started in 1999/2000. The first and second operations were performed by different surgeons, the last 3 have all been the same surgeon. I had no complaints with the first surgeon or my current who seems to generally be regarded as one of the best in the UK. The second, I believe, shouldn't have performed the operation he did and then when it didn't work essentially washed his hands of me, which led me to seek out my current surgeon.
  • 4 rounds of steroid injections in my late teens
  • 1st surgery - Arthroscopy to clear the ACJ in my late teens
  • 2 rounds of steroid injections in my late twenties
  • 2nd surgery (2013) - Debridement, micro-fracturing, and long-head biceps tenodesis
  • 2 rounds of hyaluronic acid treatments
  • 3rd surgery (2015) - contracture release surgery
  • 4th surgery (2016) - Total Shoulder Replacement
  • Suprascap nerve block
  • 5th surgery (2018) - Revision replacement / hemiarthroplasty (ream and run)
  • Suprascap nerve block
Pain Management
On and off since 2013 and the majority of the time since 2015 I have been relying on prescription pain medication, until Christmas 2019 when that was replaced with CBD products. I was wholly against using CBD, but was convinced to try it. I spent a lot of time speaking to people and researching it. It by no means gives me a pain-free existence, but I'd describe it as having raised my tolerance to a level where I can live with it, until recently anyway.
  • Co-codomol
  • Tramadol
  • Oramorph
  • Suprascap nerve block
  • Over the counter anti-inflammatories
  • FourFive CBD 1000mg oil
Current Symptoms
I have two children under 4 and as a result of lockdown with both myself and my wife working from home with the kids, there's been a significant deterioration, likely owing to working in less than ideal conditions and all the other complications it's presented everyone with.
  • No external rotation past neutral
  • 30-degree elevation
  • 30-degree abduction
  • Strength is pretty good generally
  • Pain
    • Pain at rest 2-4
    • Pain through unloaded movement 4-6
    • Pain through loaded movement 6-7
    • Pain through sleep 4-5
    • Pain resisting gravity (when lowering) 7-9
My situation is slightly complicated by mild spondylolisthesis and avascular necrosis (Keinboch's Disease) in my right arm. The latter has reduced the range and flexibility in my right hand which magnifies ROM related issues. The spondylolisthesis, which is mild and manageable, can leave me very stiff and sore generally a few times a year.
 

Jaycey

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Thanks for the detailed history @austin2020 ! Can you give us your surgery date and which shoulder you are having revised? I'll pop the information in your signature for you.
 

Jamie

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Great details. Thank you!
 
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austin2020

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Booked for the 20th in London, COVID permitting.
 
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austin2020

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Apologies for the radio silence....

I'm now 3 weeks post surgery, was sent home after just the 2 days, unlike previous procedures and so far, so good.

With the exception of a small repair to a tendon, it all went to plan / within the bounds of a normal TSR, which hasn't happened before.

The remodeled glenoid was in significantly better condition than could have been hoped for and the anterior wear if anything has improved the conditions for a successful outcome.

The pain has been far more manageable owing due to the drug regiment of 10-20mg MST & Ibuprofen, compared to previous models. Basic mobilisation / activation exercises at this stage, still a long road, but seems to be good so far.
 

dapplega

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@austin2020 - happy to hear your surgery went well, you are due!
Did they add a poly glenoid in this revision or did they leave the remodeled glenoid from the ream and run? Did they give you any ideas why the ream and run didn't yield the expected results with regards to ROM and pain relief?
I have a vested interested as I'm tentatively scheduled for ream and run next month. :)
 

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