Current Concepts of Shoulder Arthroplasty for Radiologists: Part 1-Epidemiology, History, Preoperative Imaging, and Hemiarthroplasty

Department of Radiology, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033.
American Journal of Roentgenology (Impact Factor: 2.73). 10/2012; 199(4):757-67. DOI: 10.2214/AJR.12.8854
Source: PubMed


The purpose of this article is to provide a review of indications for shoulder arthroplasty, describe preoperative imaging assessment, present new and modified designs of shoulder arthroplasty, illustrate normal and abnormal postoperative imaging findings, and review key radiographic measurements.

Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing shoulder prostheses.

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    ABSTRACT: This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.
    Acta Orthopaedica 06/2014; 85(355):1-23. DOI:10.3109/17453674.2014.922007 · 2.77 Impact Factor
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    ABSTRACT: Background Magnetic resonance (MR) imaging evaluation of the painful failed shoulder arthroplasty is a useful imaging modality due to advancements in metal artifact reduction techniques, which allow assessment of the integrity of the supporting soft-tissue envelope and the implant. Questions/Purposes The focus of this pictorial review is to illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process. Methods A PubMed (MEDLINE) search focusing on the complications and imaging assessment of shoulder arthroplasty was performed. Articles were selected for review based on their pertinence to the aforementioned topics. Results We discuss the ability of MR imaging to identify why a patient’s arthroplasty may have failed. Specific causes including component loosening and implant failure, rotator cuff and deltoid integrity, infection, subtle fractures, and nerve pathology are reviewed, with illustrative sample images. Conclusion MRI is a valuable tool in the assessment for pathology in the shoulder following arthroplasty.
    HSS Journal 10/2014; 10(3):213-24. DOI:10.1007/s11420-014-9399-3
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    ABSTRACT: While the definition of “stiffness” after shoulder arthroplasty remains controversial, loss of range of motion in the post-arthroplasty setting can be a disabling functional complication. Cause of limitations in range of motion after shoulder arthroplasty can be attributed to four potential etiologies: failure to address preoperative indications, implant complications, surgical technical errors, and finally soft tissue management and soft tissue results. Preoperative diagnostic error, implant failures, and intraoperative technical errors are often managed with revision surgery however there appears to be a role for contracture releases in the treatment of shoulder stiffness.
    Seminars in Arthroplasty 02/2015; 25(4). DOI:10.1053/j.sart.2015.02.010

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