Learning objectives
Preoperative imaging: Radiographs,
CT,
MRI and their specific indications
Consider basic surgical considerations
Review various shoulder implants including non-arthroplasty metal work
Highlight the imaging findings of various complications related to shoulder arthroplasty
Background
INTRODUCTION
Shoulder arthroplasty dates back to 1893,
when Jules-Émile Péan,
a French surgeon implanted a platinum and rubber prosthesis to
replace a shoulder joint that had been destroyed by tuberculosis.
In 1951,
Charles Neer developed and pioneered a prosthesis Fig. 1 for the managment of proximal humeral fractures with the indications subsequently expanding to include the management of arthritis Fig. 2.
INDICATION & IMPLANTS
Degenerative oesteoarthritis (OA) of the shoulder is less common than in weight beaering joints.
As well as OA,
there are numerous...
Imaging findings OR Procedure Details
PREOPERATIVE IMAGING & CONSIDERATIONS
Glenohumeral OA leads to posterior glenoid erosion,
flattening of humeral head.
Rotator cuff tears are uncommon.
Not recognising posterior wear can lead to glenoid component in retroversion and risk posterior instability.
CT often useful in preoperative planning and in particular to assess for glenoid version and bone stock.
Major wear of the glenoid may require additional bone graft from the humeral head.
Before CT,
the glenoid version was measured on axillary radiographs.
However,
radiographs have been shown ineffective in assessing the...
Conclusion
Numerous types of arthroplasty with a variety of indications.
Preoperative imaging can be valuable in assessing the bone morphology of the glenoid (version and bone stock),
and rotator cuff integrity.
RTSA is a powerful tool in the treatment of patients with previously unreconstructible shoulder problems and/or failed arthroplasty.
Fracture fixation largely consists of plates (PHILOS) and intramedullary nails.
Various other types of metalwork - bone anchors and screws.
Numerous complications can arise.
Nuclear medicine studies can be a useful tool.
This understanding will facilitate radiologist-orthopaedist...
References
1.
Lugli T: Artificial shoulder joint by Péan (1893): The facts of an exceptional intervention and the prosthetic method.
Clin Orthop Relat Res 1978;133:215-218.
2.
Neer CS II: Articular replacement for the humeral head.
J Bone Joint Surg Am 1955;37:215-228.
3.
Moeckel BH,
Dines DM,
Warren RF,
Altchek DW: Modular hemiarthroplasty for fractures of the proximal part of the humerus.
J Bone Joint Surg Am 1992;74: 884-889.
4.
Radnay CS,
Setter KJ,
Chambers L,
Levine WN,
Bigliani LU,
Ahmad CS: Total shoulder replacement compared with...
Personal Information
Lead author
Dr Neeraj Purohit MB ChB,
MRCS,
MSc,
FRCR
University Hospital Southampton,
UK
[email protected]
@mskradiologist