Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
MidAmerica Hand to Shoulder Clinic, Palos Hills, IL, USA.
J Shoulder Elbow Surg. 2014 May;23(5):745-58. doi: 10.1016/j.jse.2013.12.003. Epub 2014 Mar 4.
As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial.
随着肩关节置换术的发病率不断上升，矫形肩关节外科医生将越来越多地面临评估肩关节置换失败这一难题。患者通常会因疼痛对先前的关节置换效果不满意，但由于活动范围受限或不稳定，可能会抱怨功能不佳。需要采取全面而系统的方法，以便启动最合适的治疗途径。全面的病史和体格检查是评估的第一步。诊断研究很多，包括实验室值、普通 X 射线、计算机断层扫描、超声成像、关节抽吸、核扫描和肌电图。肩关节置换术后早期疼痛的常见原因包括与手术相关的技术问题，例如假体位置不当或大小不合适、假体周围感染、神经损伤和复杂性区域疼痛综合征。在无症状间隔后出现的疼痛可能与慢性假体周围感染、组件磨损和松动、肩胛盂侵蚀、肩袖变性和骨折有关。活动范围不足可能是由于术后康复不足、植入物相关因素和异位骨化所致。不稳定通常是由肩袖缺损和植入物相关因素引起的。不幸的是，确定肩关节置换失败的原因可能很困难，在许多情况下，疼痛和残疾的根源是多因素的。
