Purpose
To determine whether arthroscopy is an effective means to diagnose and treat postoperative
pain in anatomic total shoulder arthroplasty (TSA) and reverse TSA patients.
Methods
A 2-year retrospective chart review of patients with a painful shoulder arthroplasty
was performed. Patients included in the study had a painful shoulder after previous
shoulder arthroplasty without gross signs of infection, severely elevated laboratory
markers, implant loosening, or glenoid arthrosis after hemiarthroplasty. Visual analog
scale scores, physical examination findings, laboratory studies, culture results,
pathology reports, operative records, and postoperative treatment data were collected.
Results
The study cohort included 6 male and 7 female patients. Between 2016 and 2018, 7 TSA
and 6 reverse TSA patients underwent arthroscopic debridement of adhesions and synovitis
with tissue biopsy for cultures and fresh-frozen sections. We arthroscopically treated
adhesive capsulitis, subacromial impingement, and acromioclavicular joint arthritis
in 3 patients. Three patients required extensive debridement for profound synovitis.
All 6 patients had negative findings of cultures and frozen sections, and none required
revision arthroplasty. Their average follow-up period was 18.6 months (range, 9-32
months), with improvement in the mean visual analog scale score from 8.2 of 10 (range,
6-10) to 2.5 of 10 (range, 2-8). Two patients had arthroscopic cultures showing Cutibacterium acnes infection. Both required revision with an antibiotic spacer. Findings of cultures
and fresh-frozen sections at revision were consistent with arthroscopic findings.
Arthroscopic evaluation in 5 additional patients identified mechanical implant failure
or a rotator cuff tear.
Conclusions
Arthroscopy is a viable option to evaluate and treat painful shoulder arthroplasty.
We were able to successfully treat 46% of patients (6 of 13) with arthroscopic procedures,
preventing the need for revision arthroplasty. Arthroscopic frozen section and culture
results had a 100% correlation with open frozen section and culture results in patients
who had cultures obtained. Level of Evidence: Level IV, case series.
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Article info
Publication history
Published online: February 10, 2020
Accepted:
January 14,
2020
Received:
April 16,
2019
Footnotes
See commentary on page 1515
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Does the Scope Have a Role in Painful Shoulder Arthroplasty?ArthroscopyVol. 36Issue 6
- PreviewArthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present. Patients may present with a painful shoulder arthroplasty due to a number of causes—occult infection, instability, component loosening, malposition, or rotator cuff pathology. In certain cases, advanced imaging may not be diagnostic, given the presence of metal artifact. It is our routine clinical practice to evaluate arthroscopically such cases in which the diagnosis is not readily evident.
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