What’s the Diagnosis – Case 63
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What’s the Diagnosis – Case 63
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What’s the Diagnosis – Case 63
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What’s the Diagnosis – Case 63
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What’s the Diagnosis – Case 63
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Findings •
Initial studies demonstrate a left shoulder hemiarthroplasty with superior and anterior positioning of the component. CT study also demonstrates disruption through the base of the coracoid. Subsequent radiographs demonstrate a reverse type total shoulder arthroplasty which shows anatomic positioning on CT, particularly as relates to the metalglene or base plate to the native glenoid. Repeat CT demonstrates on the scout topogram, the often very complex nature of these cases with multiple sites of pathology. The repeat CT demonstrates a very subtle defect of the scapular spine.
What’s the Diagnosis – Case 63
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What’s the Diagnosis – Case 63
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Diagnosis: Complications of shoulder arthroplasty with multiple periprosthetic fractures •
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This case demonstrates only a couple of the complications that can come in the setting of joint arthroplasty and especially in this case shoulder arthroplasty. Hemiarthroplasties are known to be at risk for progression of instability often related to progressed degeneration and tearing of the rotator cuff as seen in this case. In addition, patients often suffer from propagation of arthritis necessitating total shoulder arthroplasty as seen in this case. One other complication related to progressive disease of the cuff is a loss of the acromiohumeral interval yielding increased stress on the coracoacromial arch and precipiating fractures as in this case of the coracoid. Total shoulder arthroplasties and in particular in this case, reverse total shoulder arthroplasties, can have complications. Scapular notching, difficulty in seating the base plate, dissociation, infection, and loosening are well known complications. In addition, particularly in the setting of the reverse TSA, acromial and scapular spine fractures are becoming more recognized. These fractures may of course be painful but may necessitate additional fixation as well.
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Resources •
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Crosby LA, Hamilton A, Twiss T (2011) Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res 469(9):2544–2549. Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU. Long-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 2012 Nov 21;94. Scarlat MM. Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop. 2013 Mar 3. Special thanks to Frank Cordasco, MD and Larry Gulotta, MD for their insight and assistance on this case.
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