Can Hardware/Arthroplastic Shoulder Be Put Back Via Closed Reduction?
Yes, closed reduction should be attempted first for dislocated shoulder arthroplasty components, as it successfully avoids revision surgery in approximately 29-62% of cases, though success rates vary significantly based on timing and patient factors. 1, 2
Initial Management Approach
When a shoulder arthroplasty dislocates, attempt closed reduction immediately as the first-line intervention. This can often be performed in the office setting without requiring operative intervention 2.
Success Rates and Expectations
- Early dislocations (within 90 days): Closed reduction maintains stability in approximately 44-62% of cases 2, 3
- Overall success: Closed reduction avoids revision surgery in 29% of all dislocation cases 1
- Recurrence risk: Approximately 38-56% will require subsequent intervention after initial closed reduction 2, 3
Key Clinical Factors Affecting Success
High-Risk Features for Failure (Consider Early Surgical Referral):
- Body mass index >30 kg/m² (82% of early dislocations) 3
- Male gender (82% of cases) 3
- Subscapularis deficiency (64% of cases) 3
- Previous shoulder surgery (64-80% of cases, especially prior arthroplasty) 2, 3
- Reverse total shoulder arthroplasty (rTSA) configuration 1
Timing Considerations:
- Average time to first dislocation: 200 days, with 62% occurring within first 90 days 2
- Mean time for early dislocations: 3.4 weeks postoperatively 3
Post-Reduction Protocol
After successful closed reduction:
- Immobilize temporarily in standard sling or, for high-risk patients (BMI >30, male, subscapularis deficiency, previous surgery), use abduction orthosis 3
- Monitor closely for recurrent instability during rehabilitation
- Obtain radiographs to confirm reduction and assess component position 4
When Closed Reduction Fails
If closed reduction fails or instability recurs:
- First revision surgery: 78% achieve stability 1
- Second revision (if first fails): Only 52% achieve stability 1
- Most common successful revision strategy: Complete revision or combined humeral spacer + glenosphere revision (82% success rate) 1
- Humeral spacer exchange alone: 60% success rate 1
Critical Pitfalls to Avoid
Do not abandon closed reduction prematurely: Even though outcomes after revision surgery are not significantly different from closed treatment (ASES scores 68.0 vs 62.7, p=0.64), closed reduction avoids operative risks 2
Do not delay tertiary referral: In medically frail patients or after failed initial closed reduction, prompt referral to specialized shoulder centers is essential 5
Recognize chronic locked dislocations: While case reports suggest closed reduction may succeed beyond 3 weeks for native shoulder dislocations 6, this evidence does not apply to prosthetic dislocations, which have different biomechanical considerations
Multiple revision attempts have diminishing returns: After second revision, success drops to 52%, and ultimate outcomes show only 78% maintain stable implants, with 11% remaining unstable, 6% requiring resection arthroplasty, and 5% converted to hemiarthroplasty 1
Functional Outcomes
Patients successfully managed with closed reduction demonstrate:
- Significant improvement in Visual Analog Scale pain scores (p=0.014) 3
- Significant improvement in ASES scores (p=0.018) 3
- Trend toward improvement in Simple Shoulder Test scores (p=0.073) 3
The bottom line: Always attempt closed reduction first, but set realistic expectations with patients who have multiple risk factors, as they may ultimately require revision surgery despite initial successful reduction.