Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

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Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/1758573220917653 ◽

2020 ◽

pp. 175857322091765

Author(s):

Betty Zhang ◽

Gavinn Niroopan ◽

Chetan Gohal ◽

Bashar Alolabi ◽

Timothy Leroux ◽

...

Keyword(s):

Bone Loss ◽

Shoulder Arthroplasty ◽

Bone Grafting ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Level Of Evidence ◽

Total Shoulder Arthroplasties ◽

Component Loosening ◽

Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

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Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

Shoulder & Elbow ◽

10.1177/1758573220921150 ◽

2020 ◽

pp. 175857322092115

Author(s):

Bradley S Schoch ◽

Joseph J King ◽

Joseph Zuckerman ◽

Thomas W Wright ◽

Chris Roche ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Patient Reported Outcomes ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reoperation Rate ◽

Patient Reported ◽

Total Shoulder Arthroplasties ◽

Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

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Accuracy of Humeral Implant Positioning Using a Canal-Sparing Total Shoulder Arthroplasty System

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219844837 ◽

2019 ◽

Vol 3 ◽

pp. 247154921984483

Author(s):

Eric S Baranek ◽

David P Trofa ◽

William N Levine ◽

Steven S Goldberg

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Glenohumeral Joint ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Humeral Head Prosthesis ◽

The Difference ◽

Clinically Significant ◽

Shoulder Arthroplasties ◽

Improved Accuracy

Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.

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TOTAL SHOULDER ARTHROPLASTY, AN OVERVIEW, INDICATINS AND PROSTHETIC OPTIONS

Wiadomości Lekarskie ◽

10.36740/wlek202009112 ◽

2020 ◽

Vol 73 (9) ◽

pp. 1870-1873

Author(s):

Mateusz Wicha ◽

Agnieszka Tomczyk-Warunek ◽

Jaromir Jarecki ◽

Anna Dubiel

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Long Term Result ◽

Glenohumeral Osteoarthritis ◽

Hip Arthroplasties ◽

Reverse Total Shoulder

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indications for this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

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Imaging of shoulder arthroplasties and their complications: a pictorial review

Insights into Imaging ◽

10.1186/s13244-019-0788-5 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Damien Combes ◽

Romain Lancigu ◽

Patrick Desbordes de Cepoy ◽

Filippo Caporilli-Razza ◽

Laurent Hubert ◽

...

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Shoulder Joint ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Humeral Component ◽

Number Of Patients ◽

Component Loosening ◽

Shoulder Arthroplasties

Abstract Currently, an increasing number of patients benefit from shoulder prosthesis implantation. Radiologists are therefore more often confronted with imaging examinations involving shoulder arthroplasty, whether during a dedicated examination or incidentally. Standard radiography is the first-line imaging modality in the follow-up of these implants, before the possible use of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging), ultrasound, or nuclear medicine examinations. Shoulder arthroplasties are divided into three categories: reverse shoulder arthroplasty, total shoulder arthroplasty, and partial shoulder joint replacement (including humeral hemiarthroplasty and humeral head resurfacing arthroplasty). Each of these prostheses can present complications, either shared by all types of arthroplasty or specific to each. Infection, periprosthetic fractures, humeral component loosening, heterotopic ossification, implant failure, and nerve injury can affect all types of prostheses. Instability, scapular notching, and acromial fractures can be identified after reverse shoulder arthroplasty implantation. Glenoid component loosening and rotator cuff tear are specific complications of total shoulder arthroplasty. Progressive wear of the native glenoid is the only specific complication observed in partial shoulder joint replacement. Knowledge of different types of shoulder prostheses and their complications’ radiological signs is crucial for the radiologist to initiate prompt and adequate management.

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Multimodality imaging in shoulder arthroplasties Part 2: Immediate pre- and intra-operative imaging and imaging of early and late complications – A pictorial review

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_32_2021 ◽

2021 ◽

Vol 0 ◽

pp. 1-6

Author(s):

Matthew Sarvesvaran ◽

Suresh Srinivasan ◽

Rahatdeep Singh Brar ◽

Raj Bhatt ◽

Harun Gupta ◽

...

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Multimodality Imaging ◽

Surgical Techniques ◽

Nuclear Imaging ◽

Late Complications ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Pictorial Review ◽

Shoulder Arthroplasties

Shoulder arthroplasty imaging requires a thorough understanding of surgical techniques, biomechanics involved during and after the joint replacement surgery and complications unique to shoulder arthroplasties. One may believe that imaging of complications requires excessive complex imaging modalities such as MRI or nuclear imaging. However, contrary to such beliefs, one can diagnose such complications mostly on radiographs. We will describe advances in immediate pre-operative imaging and utility of imaging to diagnose shoulder arthroplasty- related complications in part 2 of our two-part pictorial review series.

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