Saturday, December 7, 2013

Evaluation of the failed shoulder arthroplasty

The approach to the evaluation of a failed arthroplasty

The evaluation of a patient with a failed arthroplasty should include an understanding of the condition of the shoulder prior to the procedure, the details of the procedure that was done, whether a nerve block anesthetic was used, patient factors or surgeon factors that may have affected the outcome, the current health and the social status of the patient, medications, and the current status of the shoulder. It is also important to know if the patient has been taking antibiotics before dental and other procedures and whether medications were modified before surgery. We are also interested in knowing if the patient has exceed the activities recommended after this type of surgery.

Since our objective is to see the shoulder from the perspective of the patient, we depend heavily on patient-reported shoulder assessment to document the status of the shoulder. To that end we developed the Simple Shoulder Test (SST) based on the most common complaints of individuals coming to us with shoulder problems. This simple test presents the data in a way that is easy for the patient to understand. It is useful for tracking the result of treatment.

The physical exam includes an assessment of the overall appearance of the shoulder, is neurologic, cutaneous and vascular status, as well as its range of motion, strength and stability.

High quality standardized plain radiographs are usually sufficient to reveal the important anatomy and evidence of glenoid component loosening.

In this way the type of problem resulting in the unsatisfactory result can be identified and a plan made for addressing it, either through non-operative or operative means.

A recent review of failed shoulder arthroplasty can be found here.

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