Re-revision rate after anatomic-to-anatomic revision of total shoulder arthroplasty: a descriptive study of the Dutch national registry

Background: Anatomical total shoulder arthroplasty (aTSA) is typically reserved for end-stage glenohumeral arthritis with an intact rotator cuff and adequate glenoid bone stock. With the exponential increase in total shoulder arthroplasty surgeries, complications and the need for re-revision surgery have also increased. Typically, aTSA is revised to a reversed prosthesis, but in some cases the anatomic configuration is maintained. Revision surgery is associated with a higher risk of complications and re-revisions than primary surgery. However, the literature on re-revision surgery after aTSA is sparse. Methods: An observational cohort study was conducted using data from the Dutch National Registry. We report re-revision rates and reasons and analyze the implant survival of revised aTSA (anatomic-to-anatomic revision). Due to the small sample size, this study is strictly descriptive and is not suitable for identifying risk factors or predicting survival. Results: Overall, 5,547 primary aTSAs were registered between 2014 and 2023, and the 58 patients who underwent revision surgery with the implant remaining in an anatomic configuration were included in this study. Re-revision surgery was performed in 10 patients (17%). The most common indications for re-revision surgery were glenoid component loosening (n=4) and rotator cuff rupture (n=4). Implant survival at 3 years after the first revision was 80%. All re-revisions occurred within 3 years after revision surgery. Conclusions: We report a 3-year implant survival of 80% after an anatomic-to-anatomic revision of aTSA. Failure causes and the number of re-revision surgeries in aTSA indicate a high risk of early failure and provide a warning for surgeons considering the retention of an anatomic configuration. Level of evidence: IV.