Management of painful reverse shoulder arthroplasty

Ekelund, Anders

doi:10.1177/1758573217702333

Cited by 11 publications

(9 citation statements)

References 50 publications

(140 reference statements)

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“…Time since surgery is a helpful tool in assessing the integrity of components. Aseptic component loosening and other component related complications are more likely to occur years after surgery, while complications such as post-operative infection, instability, nerve irritation, and soft tissue irritation/injury are more likely to be sources of pain acutely after surgery ( 1 , 7 ).…”

Section: Evaluation Algorithm ( Figure 1 )mentioning

confidence: 99%

A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

Gabriel¹,

Tucker²,

Boin³

2023

Ann Joint

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Background and Objective The prevalence of shoulder arthroplasty has increased significantly over the past two decades outpacing both total hip and total knee arthroplasty. Total shoulder arthroplasty (TSA) has been shown to significantly improve function and pain in most patients, however, complications after shoulder arthroplasty have been reported to be greater than 10% in anatomic shoulder arthroplasty and 10–47% in reverse shoulder arthroplasty leading to a painful shoulder. As the number of performed primary shoulder arthroplasty increases, the incidence of painful total shoulders and the need for revision shoulder arthroplasty will see a similar trend. Management of post-operative shoulder arthroplasty pain and complications will be even more essential for the orthopedic surgeon in this growing population. Potential sources of pain after shoulder arthroplasty are variable and include infection, implant related complications, hematoma, nerve injury, rotator cuff failure, instability, fracture, among other less prevalent complications. Treatment options for the painful shoulder arthroplasty differ depending on the source of pain, thus early identification of the cause will lead to expedited and appropriate definitive management. The objectives of this narrative review are to highlight the common causes of pain after TSA, provide surgeons an algorithmic approach for working up the painful total shoulder, and discuss treatment options for each source of pain. Methods A database search of PubMed and Google Scholar was conducted including studies relating to painful shoulder arthroplasty evaluation, management, and treatment. Key Content and Findings This review presents an in-depth evaluation to the non-infected, painful shoulder arthroplasty, providing treatment options for each source with the goal of assisting practicing physicians in the management of painful post-operative shoulder arthroplasty. Conclusions With increasing numbers of TSA being performed, a thorough understanding of the potential complications and their treatments is essential. A systematic approach to working up the painful TSA can help identify the source of symptoms more readily. Knowledge of the common complications and their specific causes can help surgeons avoid the painful TSA. This knowledge will also help to successfully treat the painful TSA when it is inevitably encountered.

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Section: Evaluation Algorithm ( Figure 1 )mentioning

confidence: 99%

A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

Gabriel¹,

Tucker²,

Boin³

2023

Ann Joint

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“…Pain around a stable implant is one of the most difficult diagnostic tasks [106][107][108][109]. All intrinsic (aseptic loosening, PPOL, PJI, periprosthetic fractures, pseudotumors, tendinitis, bursitis, instability, etc.)…”

Section: Differential Diagnosismentioning

confidence: 99%

Diagnosis and management of implant debris-associated inflammation

Goodman

Gallo

Gibon

et al. 2019

Expert Review of Medical Devices

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Introduction-Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered-We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion-The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.

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“…Multiple studies have elaborated on potential etiologies of pain specific to RSA, which include instability, scapular notching, acromial/scapular spine fractures, and anterior shoulder pain/subcoracoid pain. 7 , 9 , 11 Anterior shoulder pain after RSA is not well defined. It has been postulated to be secondary to coracoid fracture, 2 subcoracoid adhesions in the setting of multiple surgeries causing stiffness, excessive distalization of the humerus leading to tendinitis of the biceps brachii and coracobrachialis tendon, 24 and subcoracoid impingement due to the abutment of the humeral prosthesis.…”

mentioning

confidence: 99%

The subcoracoid distance is correlated with pain and internal rotation after reverse shoulder arthroplasty

Klosterman,

Tagliero,

Lenters

et al. 2024

JSES International

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Management of painful reverse shoulder arthroplasty

Cited by 11 publications

References 50 publications

A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

Diagnosis and management of implant debris-associated inflammation

The subcoracoid distance is correlated with pain and internal rotation after reverse shoulder arthroplasty

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