Our Summary

This research paper discusses the increased use of artificial shoulder replacements over the last 20 years, and the subsequent rise in complications and need for additional surgeries. The authors explore how a certain imaging technique, known as SPECT/CT, can be beneficial for surgeons working on shoulders. This technique can accurately diagnose various mechanical issues that can happen after shoulder replacement surgery, such as inflammation, loosening of the artificial joint, or damage to the shoulder blade. The paper also mentions several methods that can identify infection in the artificial joint. The authors believe the best method involves scanning for labeled white blood cells along with bone marrow scanning. Another method, FDG-PET, can also be useful when there’s conflict between the results of the white blood cell scan and other tests or clinical observations.

FAQs

  1. What is the increasing incidence of prosthetic shoulder replacements leading to?
  2. How can SPECT/CT be of significant clinical value for shoulder surgeons?
  3. What methods are available for detecting prosthesis infection in shoulder replacements?

Doctor’s Tip

One helpful tip a doctor might tell a patient about shoulder replacement is to follow their post-operative rehabilitation plan diligently. This includes doing prescribed exercises, attending physical therapy sessions, and avoiding certain movements that could put excessive strain on the shoulder joint. Consistent rehabilitation can help improve range of motion, strength, and overall function of the shoulder after surgery. It is important for patients to communicate with their healthcare team about any concerns or difficulties they may be experiencing during the recovery process.

Suitable For

Patients who are typically recommended for shoulder replacement surgery are those with severe shoulder pain and limited mobility that has not responded to conservative treatments such as physical therapy, medication, and corticosteroid injections. Common conditions that may warrant shoulder replacement include osteoarthritis, rheumatoid arthritis, severe fractures, rotator cuff tears, and avascular necrosis.

It is important for patients to have realistic expectations about the outcomes of shoulder replacement surgery and be committed to following a post-operative rehabilitation program to maximize the success of the procedure. Additionally, patients should be in good overall health and free from conditions that may increase the risk of complications during surgery and recovery.

Ultimately, the decision to undergo shoulder replacement surgery should be made in consultation with a shoulder surgeon who can evaluate the specific needs and circumstances of each individual patient.

Timeline

Before shoulder replacement:

  1. Patient experiences chronic shoulder pain, stiffness, and limited range of motion.
  2. Patient undergoes physical therapy, corticosteroid injections, and other conservative treatments to manage symptoms.
  3. Imaging tests such as X-rays, MRI, and CT scans are performed to assess the extent of damage to the shoulder joint.
  4. Orthopedic surgeon recommends shoulder replacement surgery as a last resort for severe cases.

After shoulder replacement:

  1. Patient undergoes pre-operative evaluations, including blood tests, ECG, and anesthesia consultation.
  2. Shoulder replacement surgery is performed, which may involve total shoulder replacement, reverse shoulder replacement, or partial shoulder replacement depending on the patient’s condition.
  3. Patient stays in the hospital for a few days post-surgery for monitoring and pain management.
  4. Physical therapy and rehabilitation exercises are started to help the patient regain strength and range of motion in the shoulder.
  5. Follow-up appointments with the surgeon are scheduled to monitor healing and address any complications or concerns.
  6. Over time, the patient experiences improved shoulder function and reduced pain, allowing them to return to daily activities and enjoy a better quality of life.

What to Ask Your Doctor

  1. What type of shoulder replacement procedure do you recommend for my specific condition?
  2. What are the potential risks and complications associated with shoulder replacement surgery?
  3. How long is the recovery period after shoulder replacement surgery?
  4. What type of physical therapy or rehabilitation will be needed after the surgery?
  5. How long can I expect the shoulder replacement to last?
  6. What limitations or restrictions will I have after the surgery?
  7. How often will follow-up appointments be needed after the surgery?
  8. What signs or symptoms should I watch out for that may indicate a complication or problem with the shoulder replacement?
  9. Are there any alternative treatments or options to consider before proceeding with shoulder replacement surgery?
  10. What is your experience and success rate with shoulder replacement surgeries?

Reference

Authors: Thélu-Vanysacker M, Frédéric P, Charles-Edouard T, Alban B, Nicolas B, Tanguy B. Journal: Semin Nucl Med. 2018 Sep;48(5):469-482. doi: 10.1053/j.semnuclmed.2018.05.004. Epub 2018 Aug 17. PMID: 30193652