title: The evaluation of the failed shoulder arthroplasty.
abstract: As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial.
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
authors.forename: Brett P
authors.initials: BP
authors.lastname: Wiater
authors.affiliation: MidAmerica Hand to Shoulder Clinic, Palos Hills, IL, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Moravek
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester Hills, MI, USA. Electronic address: mwiater@beaumont.edu.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wiater
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000628:therapy; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000601:surgery*; D017211:Treatment Failure
keywords: Shoulder arthroplasty; diagnosis; failed shoulder replacement; unsatisfactory outcome