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Revision and Complex Shoulder Arthroplasty

Edited by Robert H. Cofield and John W. Sperling pp 305 Philadelphia: Lippincott, Williams & Wilkins, 2010 ISBN: 978-0-7817-7747-6

All shoulder surgeons need help when "revising" a shoulder arthroplasty. It can present enormous challenges both diagnostically and surgically. The editors, Cofield and Sperling from the Mayo Clinic, have reported else where their experiences over the years with both primary and revision shoulder arthroplasty. For the compilation of this book they have invited other well known centres to contribute; 75% of them are in the United States. This is a multi-author book with a variety of styles, but this really does not matter because very few people will read the book from end to end, but rather dip into it as a reference when help is required with a difficult case.

It is essentially divided into three sections, the first defines what constitutes the unsatisfactory shoulder, how outcomes are measured and data collected. Particular reference is made to the Mayo Clinic registry which supplies a large part of the reference for the book. Sections are given over to clinical evaluation and time rightly spent on the diagnosis of low grade infection, which is becoming more recognised as a cause of failure in shoulder arthroplasty. The second section, which is probably why most people would buy this book, is devoted to specific surgical techniques dealing with revision of different types of prosthesis and the results which can be expected. The third part of the book is a collection of issues related to complex arthroplasty including the treatment of peri-prosthetic fractures, hemi-arthroplasty versus total replacement and arthroplasty for specific indications, for example cuff tear arthropathy, old trauma, nonunion, locked dislocation, and the problem of prosthetic instability. There are excellent review chapters on the place of arthroplasty in the treatment of associated neuromuscular disorders, (Parkinsonism, cerebral palsy), and developmental dysplasia, all of which are extremely challenging for the shoulder surgeon and about which very little has been written. Mention is made of shoulder replacement in the paraplegic, but disappointingly no specific mention of shoulder replacement for the upper-limb amputee who has particular problems. It is interesting, when reading the references quoted for this section, how old some of them are in the nonsurgical literature and how few references there are in modern rehabilitation journals concerning these matters. 

Sadly there is no reference to the use of surface replacement arthroplasty in the avoidance of most of these complications. In a large number of the cases quoted in this book, the major reconstruction and salvage surgery might have been avoided by the timely use of less interventional surgery in the first place; for example, the problems of stress fracture around prosthetic stems could be eliminated by using surface replacement for the glenohumeral joint. There is no reference to the use of arthrodesis of the shoulder which still has a place and can function far better than the very poor results of some major salvage procedures. 

Throughout the world there is a huge increase in the use, and sadly abuse, of the reverse geometry shoulder replacement. The original indications for this type of shoulder replacement have been extended widely and often inappropriately. Every paper written on the subject highlights the high complication rate of reverse geometry which increases dramatically when it is used as a salvage procedure. Most papers suggest, and it is clearly reiterated in this book, that the indications for the reverse prosthesis need to be better defined. However I think we have more than enough information on this already; and we need no further refinement but to read the current literature. The use of this prosthesis has greatly increased the requirement for major salvage surgery; hence the need for this book.

Because the number of shoulders replaced is small compared with the hip and knee, the shoulder world has been slow to take the lessons already learned by the greater numbers of failing hip and knee arthroplasties. It should not be necessary to reinvent the wheel, nor wait for the same to happen in the shoulder. The problems of bone infection are universal. Most people will be buying this book to help them out of a sticky situation when they have a problem with a failed arthroplasty, and for the most part this book certainly provides them with what they need.

S. A. Copeland

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