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Shoulder Implant
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Total shoulder arthroplasty (TSA): Implant replaces both glenoid and humeral head
          • Used for several decades to replace arthritic shoulders
          • Humeral component is metal, with ball at end to act as humeral head
            • Either cemented or cementless
          • Glenoid component may be metal backed with polyethylene insert or may be entirely polyethylene (often containing metal markers)
            • Either cemented (cement surrounds flat backing and its pegs) or cementless (bone ingrowth, stabilized by pegs and cancellous screws)
        • Shoulder hemiarthroplasty: Implant replaces only humeral head, native glenoid retained
          • Used for several decades, though infrequently
            • Primarily used for humeral head damage (osteonecrosis, severely comminuted fracture) without arthritic change
          • Stem and humeral head are metal
            • Either cemented or cementless
        • Reverse shoulder arthroplasty (RSA): Implant replaces both glenoid and humeral head but reverses normal ball-and-socket relationship
          • Used in patients with irreparable rotator cuff tear and secondary arthropathy, pain, and pseudoparalysis (inability to lift arm above 90°)
          • Reversing glenoid and head components changes center of rotation
            • Arm lowered (lengthened) and medialized: Moves center of rotation distally and medially
              • Allows greater control of shoulder motion by anterior and posterior deltoid
          • 4 main components: Humeral stem, polyethylene cup, glenosphere (ball), and metaglene (base for glenoid)
            • Humeral stem: Metal, either cemented or cementless, with cup-shaped proximal portion
            • Polyethylene cup: Fits within proximal end of humeral component, deepening cup
            • Glenosphere: Metal ball, attached into metaglene
            • Metaglene: Metal base with flat attachment on glenoid surface, secured by cancellous screws

      IMAGING

      • Radiographic Findings

        • CT Findings

          • Imaging Recommendations

            CLINICAL ISSUES

            • Natural History & Prognosis

              Selected References

              1. Ha AS et al: Current concepts of shoulder arthroplasty for radiologists: Part 2--Anatomic and reverse total shoulder replacement and nonprosthetic resurfacing. AJR Am J Roentgenol. 199(4):768-76, 2012
              2. Petscavage JM et al: Current concepts of shoulder arthroplasty for radiologists: Part 1--Epidemiology, history, preoperative imaging, and hemiarthroplasty. AJR Am J Roentgenol. 199(4):757-67, 2012
              3. Frankle MA et al: Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg. 18(6):874-85, 2009
              4. Grassi FA et al: Six-year experience with the Delta III reverse shoulder prosthesis. J Orthop Surg (Hong Kong). 17(2):151-6, 2009
              5. Levy J et al: Inferior scapular notching following encore reverse shoulder prosthesis. Orthopedics. 32(10), 2009
              6. Merolla G et al: Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty. Chir Organi Mov. 93 Suppl 1:S29-34, 2009
              7. Wiater JM et al: Shoulder arthroplasty: prosthetic options and indications. J Am Acad Orthop Surg. 17(7):415-25, 2009
              8. Levy JC et al: Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br. 89(2):189-95, 2007
              9. Neyton L et al: Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 16(3 Suppl):S71-8, 2007
              10. Roberts CC et al: Radiologic assessment of reverse shoulder arthroplasty. Radiographics. 27(1):223-35, 2007
              11. Frankle M et al: The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 87(8):1697-705, 2005
              Related Anatomy
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              Related Differential Diagnoses
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              References
              Tables

              Tables

              KEY FACTS

              • Terminology

                • Imaging

                  TERMINOLOGY

                  • Definitions

                    • Total shoulder arthroplasty (TSA): Implant replaces both glenoid and humeral head
                      • Used for several decades to replace arthritic shoulders
                      • Humeral component is metal, with ball at end to act as humeral head
                        • Either cemented or cementless
                      • Glenoid component may be metal backed with polyethylene insert or may be entirely polyethylene (often containing metal markers)
                        • Either cemented (cement surrounds flat backing and its pegs) or cementless (bone ingrowth, stabilized by pegs and cancellous screws)
                    • Shoulder hemiarthroplasty: Implant replaces only humeral head, native glenoid retained
                      • Used for several decades, though infrequently
                        • Primarily used for humeral head damage (osteonecrosis, severely comminuted fracture) without arthritic change
                      • Stem and humeral head are metal
                        • Either cemented or cementless
                    • Reverse shoulder arthroplasty (RSA): Implant replaces both glenoid and humeral head but reverses normal ball-and-socket relationship
                      • Used in patients with irreparable rotator cuff tear and secondary arthropathy, pain, and pseudoparalysis (inability to lift arm above 90°)
                      • Reversing glenoid and head components changes center of rotation
                        • Arm lowered (lengthened) and medialized: Moves center of rotation distally and medially
                          • Allows greater control of shoulder motion by anterior and posterior deltoid
                      • 4 main components: Humeral stem, polyethylene cup, glenosphere (ball), and metaglene (base for glenoid)
                        • Humeral stem: Metal, either cemented or cementless, with cup-shaped proximal portion
                        • Polyethylene cup: Fits within proximal end of humeral component, deepening cup
                        • Glenosphere: Metal ball, attached into metaglene
                        • Metaglene: Metal base with flat attachment on glenoid surface, secured by cancellous screws

                  IMAGING

                  • Radiographic Findings

                    • CT Findings

                      • Imaging Recommendations

                        CLINICAL ISSUES

                        • Natural History & Prognosis

                          Selected References

                          1. Ha AS et al: Current concepts of shoulder arthroplasty for radiologists: Part 2--Anatomic and reverse total shoulder replacement and nonprosthetic resurfacing. AJR Am J Roentgenol. 199(4):768-76, 2012
                          2. Petscavage JM et al: Current concepts of shoulder arthroplasty for radiologists: Part 1--Epidemiology, history, preoperative imaging, and hemiarthroplasty. AJR Am J Roentgenol. 199(4):757-67, 2012
                          3. Frankle MA et al: Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg. 18(6):874-85, 2009
                          4. Grassi FA et al: Six-year experience with the Delta III reverse shoulder prosthesis. J Orthop Surg (Hong Kong). 17(2):151-6, 2009
                          5. Levy J et al: Inferior scapular notching following encore reverse shoulder prosthesis. Orthopedics. 32(10), 2009
                          6. Merolla G et al: Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty. Chir Organi Mov. 93 Suppl 1:S29-34, 2009
                          7. Wiater JM et al: Shoulder arthroplasty: prosthetic options and indications. J Am Acad Orthop Surg. 17(7):415-25, 2009
                          8. Levy JC et al: Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br. 89(2):189-95, 2007
                          9. Neyton L et al: Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 16(3 Suppl):S71-8, 2007
                          10. Roberts CC et al: Radiologic assessment of reverse shoulder arthroplasty. Radiographics. 27(1):223-35, 2007
                          11. Frankle M et al: The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 87(8):1697-705, 2005