Keywords:
Arthritides, Complications, SPECT-CT, Plain radiographic studies, CT, Musculoskeletal joint, Infection
Authors:
N. Purohit1, I. Katsimilis1, R. Ray1, N. J. Menon2, V. T. Skiadas1, M. Sampson3; 1Southampton/UK, 2Leeds, We/UK, 3Southampton /UK
DOI:
10.1594/essr2015/P-0120
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 other indications for shoulder arthroplasty:
- Arthritides (degenerative,
inflammatory,
post-traumatic)
- Severe proximal humeral fractures
- Shoulder girdle tumours
- Osteonecrosis
- Rotator cuff deficiency
- Revision arthroplasty
- Hemiarthroplasty,
total shoulder arthroplasty (TSA),
and reverse total shoulder arthroplasty (RTSA) are the three main types of shoulder joint reconstruction requiring prostheses.
- Growing increase in the number of shoulder arthroplasty being performed in the past decade.
- The British National Joint Registry of 2013 registered a total of 2225 shoulder replacement; 1968 primary and 257 revisions.
-
Of the primary procedures,
29% were total replacements,
16% hemiarthoplasty,
5% resurfacing arthroplasty,
15% resurfacing hemiarthroplasty and 35% reverse prostheses.
![](https://epos.myesr.org/posterimage/esr/essr2015/130930/media/633734?maxheight=300&maxwidth=300)
Fig. 3: Data from the National Joint Registry 2013 for Primary shoulder arthroplasty
OTHER IMPLANTS
- Other implants that are commonly encountered about the shoulder include devices used in fracture fixation and repair of rotator cuff tendons.
- These include humeral plates,
nails and metallic bone anchors for tendon repair.
COMPLICATIONS
-
Shoulder arthroplasty can suffer the same fate as hip and knee replacements.
-
Infection,
aseptic loosening and periprosthetic fracture are all complications that can arise around a shoulder prosthesis,
with the early signs often being subtle.
- In cases of fracture fixation,
non-union can be demonstrated on imaging with the patient often necessitating revision surgery.
Familiarisation with normal imaging findings in these cases will enable the radiologist to diagnose complications early on and to expedite the patients management.