The evaluation of the failed shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• The rising incidence of shoulder arthroplasty presents challenges in managing failed procedures.
• Patients often experience pain, limited range of motion, or instability following shoulder arthroplasty.

Purpose of the Study:

• To outline a systematic approach for evaluating failed shoulder arthroplasty.
• To identify common causes of pain, dysfunction, and instability after shoulder replacement.

Main Methods:

• Comprehensive patient history and physical examination.
• Utilizing various diagnostic studies including imaging (radiography, CT, ultrasound), laboratory tests, joint aspiration, and electrodiagnostic studies.
• Systematic review of potential etiologies for early and late implant failure.

Main Results:

• Early pain causes include surgical errors, infection, nerve injury, and complex regional pain syndrome.
• Late pain causes involve chronic infection, component wear, loosening, glenoid erosion, rotator cuff issues, and fracture.
• Poor range of motion stems from rehabilitation deficits, implant problems, and heterotopic ossification.
• Instability is primarily linked to rotator cuff deficiency and implant factors.

Conclusions:

• Diagnosing the cause of failed shoulder arthroplasty requires a thorough, multi-faceted evaluation.
• Etiologies are often multifactorial, necessitating a systematic diagnostic pathway.
• Effective management hinges on accurate identification of the underlying cause(s) of failure.