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DOI: 10.1148/rg.271065076
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Right arrow Musculoskeletal Radiology

Radiologic Assessment of Reverse Shoulder Arthroplasty1

Catherine C. Roberts, MD, Anders L. Ekelund, MD, Kevin J. Renfree, MD, Patrick T. Liu, MD and Felix S. Chew, MD

1 From the Departments of Radiology (C.C.R., P.T.L.) and Orthopedics (K.J.R.), Mayo Clinic College of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259; the Department of Orthopedics, Capio St Goran Hospital, Stockholm, Sweden (A.L.E.); and the Department of Radiology, University of Washington, Seattle, Wash (F.S.C.). Recipient of a Cum Laude award for an education exhibit at the 2005 RSNA Annual Meeting. Received April 24, 2006; revision requested May 30 and received June 26; accepted June 28. A.L.E. is a consultant with DePuy; all remaining authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Drawings illustrate normal reverse shoulder arthroplasty (left) and standard total shoulder arthroplasty (right). (Reprinted with permission from the Mayo Foundation for Education and Research, Rochester, Minn.)

 

Figure 2
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  		Figure 2.  Photograph shows the Delta CTA Reverse Shoulder System. (Reprinted with permission from DePuy Orthopaedics.)

 

Figure 3
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  		Figure 3.  Photograph shows the Reverse Shoulder Prosthesis. (Reprinted with permission from Encore Medical.)

 

Figure 4
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  		Figure 4.  Photograph shows the Aequalis Reversed Shoulder Prosthesis. (Reprinted with permission from Tornier.)

 

Figure 5
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  		Figure 5.  Photograph shows the components of the Delta CTA Reverse Shoulder System, which includes a humeral component (H), lateralized polyethylene cup (P), glenosphere (G), and metaglene (M). (Reprinted with permission from DePuy Orthopaedics.)

 

Figure 6
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  		Figure 6.  Preoperative anteroposterior radiograph demonstrates sequelae of a chronic full-thickness rotator cuff tear, including superior subluxation of the humeral head and secondary erosion of the acromion.

 

Figure 7
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  		Figure 7.  Preoperative photograph obtained in a 67-year-old woman shows anterior and superior subluxation of the humeral head (arrows) due to unopposed pull of the deltoid muscle.

 

Figure 8
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  		Figure 8a.  (a) Anteroposterior radiograph shows a squared-off axillary scapular border (arrows). A metaglene with fixed screw angles must be placed higher than normal on the glenoid to avoid having the inferior screw extend outside the bone. (b) Anteroposterior radiograph obtained in a different patient shows the gently curving axillary border of a normal scapula (arrowheads).

 

Figure 8
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  		Figure 8b.  (a) Anteroposterior radiograph shows a squared-off axillary scapular border (arrows). A metaglene with fixed screw angles must be placed higher than normal on the glenoid to avoid having the inferior screw extend outside the bone. (b) Anteroposterior radiograph obtained in a different patient shows the gently curving axillary border of a normal scapula (arrowheads).

 

Figure 9
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  		Figure 9.  CT scan shows a normal shoulder. The glenoid bone should be at least 2 cm in depth (double-headed arrow) to provide a solid attachment for the metaglene anchoring screws.

 

Figure 10
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  		Figure 10.  CT scan obtained in a different patient shows marked erosion of the glenoid (arrow), which excluded the patient from being a candidate for reverse shoulder arthroplasty. However, as bone grafting techniques continue to improve, more patients with significant glenoid erosion will become eligible for this procedure.

 

Figure 11
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  		Figure 11.  Anteroposterior axillary

 

Figure 12
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  		Figure 12.  Anteroposterior and scapular Y-view

 

Figure 13
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  		Figure 13.  Anteroposterior radiographs show a normal reverse shoulder prosthesis. The mildly posterior position of the humeral component (H) with respect to the glenosphere (G) is a common but clinically insignificant finding on the axillary view. These two components should align as shown on the scapular Y view. The coracoid process (C) projects anteriorly on the axillary view.

 

Figure 14
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  		Figure 14a.  Postoperative photographs obtained in the same patient as in Figure 7 show full range of motion by abduction with internal rotation (a) and extension (b). The patient was unable to raise her arm prior to undergoing surgery.

 

Figure 14
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  		Figure 14b.  Postoperative photographs obtained in the same patient as in Figure 7 show full range of motion by abduction with internal rotation (a) and extension (b). The patient was unable to raise her arm prior to undergoing surgery.

 

Figure 15
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  		Figure 15a.  Anteroposterior (a) and axillary (b) radiographs show an anteriorly dislocated reverse shoulder prosthesis. On the anteroposterior view, the humeral component lies higher than an anteriorly dislocated native humerus would lie; the axillary view shows anterior dislocation of the humeral component.

 

Figure 15
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  		Figure 15b.  Anteroposterior (a) and axillary (b) radiographs show an anteriorly dislocated reverse shoulder prosthesis. On the anteroposterior view, the humeral component lies higher than an anteriorly dislocated native humerus would lie; the axillary view shows anterior dislocation of the humeral component.

 

Figure 17
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  		Figure 17.  Anteroposterior radiograph shows bone resorption (arrows) along the proximal aspect of the humeral component due to a Staphylococcus epidermidis infection. Inferior scapular notching (arrowheads) is also present.

 

Figure 16
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  		Figure 16.  Anteroposterior radiograph obtained in an asymptomatic patient at 1-year follow-up shows early loosening of the humeral component of the prosthesis. Irregular regions of radiolucency have developed at the cement-bone interface (arrows) of the proximal humerus.

 

Figure 18
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  		Figure 18.  Anteroposterior radiograph obtained in an 81-year-old woman who had injured herself in a fall shows a periprosthetic fracture of the midhumeral shaft (arrows).

 

Figure 20
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  		Figure 20.  Anteroposterior radiograph shows malpositioning of the metaglene, the back of which (black arrow) is not fully seated against the native glenoid (white arrow).

 

Figure 19
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  		Figure 19.  Anteroposterior radiograph shows metaglene loosening and migration. The posterior aspect of the metaglene (black arrows) should lie parallel to the native glenoid (white arrows), which, in this case, has been eroded from contact with the medial aspect of the humeral component.

 

Figure 21
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  		Figure 21.  Anteroposterior radiograph shows malpositioning of the most inferior fixation screw (arrow), which lies in the soft tissues beyond the border of the scapula (arrowheads).

 

Figure 22
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  		Figure 22a.  Anteroposterior radiographs show partial (a) and complete (b) disassembly of the humeral component (arrows). Metaphyseal unscrewing will typically be accompanied by humeral loosening and polyethylene wear.

 

Figure 22
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  		Figure 22b.  Anteroposterior radiographs show partial (a) and complete (b) disassembly of the humeral component (arrows). Metaphyseal unscrewing will typically be accompanied by humeral loosening and polyethylene wear.

 

Figure 23
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  		Figure 23a.  Serial anteroposterior radiographs show erosion of the humeral component into the inferior scapula (white arrow) and, over time, damage to the metaglene fixation screw (black arrow in b).

 

Figure 23
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  		Figure 23b.  Serial anteroposterior radiographs show erosion of the humeral component into the inferior scapula (white arrow) and, over time, damage to the metaglene fixation screw (black arrow in b).

 

Figure 24
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  		Figure 24.  Anteroposterior radiograph shows a mature osteophyte (arrows) along the inferior border of the scapula simulating scapular erosion.

 

Figure 25
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  		Figure 25.  Anteroposterior radiograph obtained in an asymptomatic patient at routine 1-year follow-up shows heterotopic bone (arrowheads) that has developed in the deltoid muscle. Either an additional focus of heterotopic bone or an osteophyte is present along the inferior scapula (arrow).

 




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