ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty.
There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over the past two decades. Imaging can play an important role in diagnosing the complications that can occur in the setting of these shoulder arthroplasties. This review is divided into two parts. The first part provides a general discussion of various imaging modalities, comprising radiography, CT, MRI, ultrasound, and nuclear medicine, and their role in providing useful, treatment-guiding information. The second part focuses on the most appropriate imaging algorithms for shoulder arthroplasty complications such as aseptic loosening, infection, fracture, rotator cuff tendon tear, and nerve injury. The evidence-based ACR Appropriateness Criteria guidelines offered in this report were reached via an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) for rating the appropriateness of imaging and treatment procedures for specific clinical scenarios. Further analysis and review of the guidelines were performed by a multidisciplinary expert panel. In those instances in which there was insufficient or equivocal data for recommending the appropriate imaging algorithm, expert opinion may have supplemented the available evidence.
New York University Medical Center, New York, New York. Electronic address: soterios.gyftopoulos@nyumc.org.
Soterios
S
Gyftopoulos
Hospital for Joint Diseases, New York, New York.
Zehava S
ZS
Rosenberg
Mayo Clinic, Phoenix, Arizona.
Catherine C
CC
Roberts
New York University School of Medicine, New York, New York.
Jenny T
JT
Bencardino
James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
Marc
M
Appel
UMass Memorial Medical Center, Worcester, Massachusetts.
Steven J
SJ
Baccei
UK Healthcare Spine and Total Joint Service, Lexington, Kentucky, American Academy of Orthopaedic Surgeons.
R Carter
RC
Cassidy
VA San Diego Healthcare System, San Diego, California.
Eric Y
EY
Chang
University of Virginia Health System, Charlottesville, Virginia.
Michael G
MG
Fox
Medical College of Georgia at Augusta University, Augusta, Georgia.
Bennett S
BS
Greenspan
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Mary G
MG
Hochman
University of Michigan Medical Center, Ann Arbor, Michigan.
Jon A
JA
Jacobson
Hospital for Special Surgery, New York, New York.
Douglas N
DN
Mintz
New England Baptist Hospital, Boston, Massachusetts.
Joel S
JS
Newman
Brigham and Women's Hospital, Boston, Massachusetts.
Nehal A
NA
Shah
Brigham and Women's Hospital, Boston, Massachusetts.
Kirstin M
KM
Small
Brigham and Women's Hospital, Boston, Massachusetts.
Barbara N
BN
Weissman
D000465:Algorithms; D000072228:Arthroplasty, Replacement, Shoulder; D003952:Diagnostic Imaging; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D014481:United States
Appropriateness Criteria; CT; MRI; aseptic loosening; periprosthetic infection; shoulder arthroplasty