THE ROLE OF ARTHROSCOPY FOR THE PROBLEM SHOULDER ARTHROPLASTY

Abstract

To assess the indication and role of shoulder arthroscopy for the problem shoulder arthroplasty.

Between 1995–2000, 28 patients who had excessive pain or limitation of motion following a shoulder arthroplasty underwent arthroscopy. A pre-operative diagnosis was made in 13 out of the 28 patients.

Of the 13 patients who had a pre-operative diagnosis an impingement syndrome was confirmed and successfully treated by arthroscopic subacromial decompression in 10, a rotator cuff tear was confirmed and debrided in two and in one loose bodies removed. Of the 15 patients who did not have a pre-operative diagnosis a post-arthroplasty capsular fibrosis was found in seven, six undergoing a successful arthroscopic capsular release. Loose or worn components were found in four of the shoulders, a small cuff tear was identified in one, a florid synovitis was present in another, loose cement was found in a further patient and in one no abnormality could be found. During the procedures orientation within the joint was often hindered by the reflection from the prosthesis making it difficult to differentiate between the real and mirror images of both the tissues and arthroscopic instruments. Access was also often compromised.

Arthroscopy following shoulder arthroplasty is useful for the diagnosis and treatment of pain and loss of motion in selected patients, but can be technically demanding. Diagnostic arthroscopy following shoulder arthroplasty should be considered for patients suffering from pain in whom no cause can be found using less invasive investigations.