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Imaging After Shoulder Arthroplasty

Variant: 1   Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
Procedure Appropriateness Category Relative Radiation Level
Radiography shoulder Usually Appropriate ☢
US shoulder Usually Not Appropriate O
Image-guided aspiration shoulder Usually Not Appropriate Varies
MRI shoulder without and with IV contrast Usually Not Appropriate O
MRI shoulder without IV contrast Usually Not Appropriate O
3-phase bone scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢
Bone scan shoulder Usually Not Appropriate ☢☢☢
CT shoulder with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without and with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without IV contrast Usually Not Appropriate ☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢☢
CT arthrography shoulder Usually Not Appropriate ☢☢☢☢
Fluoride PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢

Variant: 2   Adult. Symptomatic shoulder prosthesis. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
Radiography shoulder Usually Appropriate ☢
US shoulder Usually Not Appropriate O
Image-guided aspiration shoulder Usually Not Appropriate Varies
MRI shoulder without and with IV contrast Usually Not Appropriate O
MRI shoulder without IV contrast Usually Not Appropriate O
3-phase bone scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢
Bone scan shoulder Usually Not Appropriate ☢☢☢
CT shoulder with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without and with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without IV contrast Usually Not Appropriate ☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢☢
CT arthrography shoulder Usually Not Appropriate ☢☢☢☢
Fluoride PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢

Variant: 3   Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
Procedure Appropriateness Category Relative Radiation Level
US shoulder Usually Appropriate O
Image-guided aspiration shoulder Usually Appropriate Varies
MRI shoulder without and with IV contrast May Be Appropriate O
MRI shoulder without IV contrast May Be Appropriate O
3-phase bone scan with SPECT or SPECT/CT shoulder May Be Appropriate ☢☢☢
CT shoulder with IV contrast May Be Appropriate ☢☢☢
CT shoulder without IV contrast May Be Appropriate ☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan shoulder May Be Appropriate ☢☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder May Be Appropriate ☢☢☢☢
WBC scan and sulfur colloid scan shoulder May Be Appropriate ☢☢☢☢
Bone scan shoulder Usually Not Appropriate ☢☢☢
CT shoulder without and with IV contrast Usually Not Appropriate ☢☢☢
CT arthrography shoulder Usually Not Appropriate ☢☢☢☢
Fluoride PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢

Variant: 4   Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
Procedure Appropriateness Category Relative Radiation Level
MRI shoulder without IV contrast Usually Appropriate O
CT shoulder without IV contrast Usually Appropriate ☢☢☢
3-phase bone scan with SPECT or SPECT/CT shoulder May Be Appropriate ☢☢☢
CT arthrography shoulder May Be Appropriate ☢☢☢☢
US shoulder Usually Not Appropriate O
Image-guided aspiration shoulder Usually Not Appropriate Varies
MRI shoulder without and with IV contrast Usually Not Appropriate O
Bone scan shoulder Usually Not Appropriate ☢☢☢
CT shoulder with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without and with IV contrast Usually Not Appropriate ☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢☢
Fluoride PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢

Variant: 5   Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
Procedure Appropriateness Category Relative Radiation Level
US shoulder Usually Appropriate O
MRI shoulder without IV contrast Usually Appropriate O
CT arthrography shoulder Usually Appropriate ☢☢☢☢
Image-guided aspiration shoulder Usually Not Appropriate Varies
MRI shoulder without and with IV contrast Usually Not Appropriate O
3-phase bone scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢
Bone scan shoulder Usually Not Appropriate ☢☢☢
CT shoulder with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without and with IV contrast Usually Not Appropriate ☢☢☢
CT shoulder without IV contrast Usually Not Appropriate ☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢
3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder Usually Not Appropriate ☢☢☢☢
Fluoride PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan and sulfur colloid scan shoulder Usually Not Appropriate ☢☢☢☢

Panel Members
Donna G. Blankenbaker, MDa, Nicholas C. Nacey, MDb, Cristy N. French, MDc, Matthew A. Frick, MDd, Ricardo D. Garza-Gongora, MDe, Steven J. Hattrup, MDf, Molly Kresin, DOg, Mary Kristin Lowry, MDh, Megan Mills, MDi, Michael G. Fox, MD, MBAj
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Initial Imaging Definition

Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when:

  • There are procedures that are equivalent alternatives (ie, only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care)

OR

  • There are complementary procedures (ie, more than one procedure is ordered as a set or simultaneously wherein each procedure provides unique clinical information to effectively manage the patient’s care).
Discussion of Procedures by Variant
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
A. 3-phase bone scan and WBC scan and sulfur colloid scan shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
B. 3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
C. 3-phase bone scan with SPECT or SPECT/CT shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
D. Bone scan shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
E. CT arthrography shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
F. CT shoulder with IV contrast
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
G. CT shoulder without and with IV contrast
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
H. CT shoulder without IV contrast
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
I. Fluoride PET/CT skull base to mid-thigh
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
J. Image-guided aspiration shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
K. MRI shoulder without and with IV contrast
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
L. MRI shoulder without IV contrast
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
M. Radiography shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
N. US shoulder
Variant 1:Adult. Asymptomatic shoulder prosthesis. Routine surveillance.
O. WBC scan and sulfur colloid scan shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
A. 3-phase bone scan and WBC scan and sulfur colloid scan shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
B. 3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
C. 3-phase bone scan with SPECT or SPECT/CT shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
D. Bone scan shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
E. CT arthrography shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
F. CT shoulder with IV contrast
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
G. CT shoulder without and with IV contrast
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
H. CT shoulder without IV contrast
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
I. Fluoride PET/CT skull base to mid-thigh
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
J. Image-guided aspiration shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
K. MRI shoulder without and with IV contrast
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
L. MRI shoulder without IV contrast
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
M. Radiography shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
N. US shoulder
Variant 2:Adult. Symptomatic shoulder prosthesis. Initial imaging.
O. WBC scan and sulfur colloid scan shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
A. 3-phase bone scan and WBC scan and sulfur colloid scan shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
B. 3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
C. 3-phase bone scan with SPECT or SPECT/CT shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
D. Bone scan shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
E. CT arthrography shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
F. CT shoulder with IV contrast
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
G. CT shoulder without and with IV contrast
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
H. CT shoulder without IV contrast
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
I. Fluoride PET/CT skull base to mid-thigh
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
J. Image-guided aspiration shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
K. MRI shoulder without and with IV contrast
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
L. MRI shoulder without IV contrast
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
M. US shoulder
Variant 3:Adult. Symptomatic shoulder prosthesis. Infection not excluded. Radiography performed. Next imaging study.
N. WBC scan and sulfur colloid scan shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
A. 3-phase bone scan and WBC scan and sulfur colloid scan shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
B. 3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
C. 3-phase bone scan with SPECT or SPECT/CT shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
D. Bone scan shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
E. CT arthrography shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
F. CT shoulder with IV contrast
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
G. CT shoulder without and with IV contrast
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
H. CT shoulder without IV contrast
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
I. Fluoride PET/CT skull base to mid-thigh
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
J. Image-guided aspiration shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
K. MRI shoulder without and with IV contrast
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
L. MRI shoulder without IV contrast
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
M. US shoulder
Variant 4:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected loosening. Radiography performed. Next imaging study.
N. WBC scan and sulfur colloid scan shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
A. 3-phase bone scan and WBC scan and sulfur colloid scan shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
B. 3-phase bone scan and WBC scan and sulfur colloid scan with SPECT or SPECT/CT shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
C. 3-phase bone scan with SPECT or SPECT/CT shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
D. Bone scan shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
E. CT arthrography shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
F. CT shoulder with IV contrast
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
G. CT shoulder without and with IV contrast
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
H. CT shoulder without IV contrast
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
I. Fluoride PET/CT skull base to mid-thigh
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
J. Image-guided aspiration shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
K. MRI shoulder without and with IV contrast
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
L. MRI shoulder without IV contrast
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
M. US shoulder
Variant 5:Adult. Symptomatic shoulder prosthesis. Infection excluded or considered unlikely. Suspected rotator cuff tear or other soft tissue abnormality. Radiography performed. Next imaging study.
N. WBC scan and sulfur colloid scan shoulder
Summary of Highlights
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Gender Equality and Inclusivity Clause

The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations

Relative Radiation Level*

Adult Effective Dose Estimate Range

Pediatric Effective Dose Estimate Range

O

0 mSv

 0 mSv

☢

<0.1 mSv

<0.03 mSv

☢☢

0.1-1 mSv

0.03-0.3 mSv

☢☢☢

1-10 mSv

0.3-3 mSv

☢☢☢☢

10-30 mSv

3-10 mSv

☢☢☢☢☢

30-100 mSv

10-30 mSv

*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”
References
1. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249-2254.
2. Lee DH, Choi YS, Potter HG, et al. Reverse total shoulder arthroplasty: an imaging overview. Skeletal Radiol. 2020 Jan;49(1):19-30.
3. Dykhouse, G, Finocchiaro A, Cirino CM, Mahesh A, Gulotta LW, Dines JS, Fu MC. Trends in total shoulder arthroplasty utilization and implant pricing. Seminars in Arthroplasty (35) 2025:42-47.
4. Mettu S, Shirodkar K, Hussein M, Iyengar KP, Chapala S, Botchu R. Imaging in shoulder arthroplasty: Current applications and future perspectives. J Clin Orthop Trauma. 2024 Jun;53():102472.
5. Bohsali KI, Wirth MA, Rockwood CA, Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279-2292.
6. Ha AS, Petscavage JM, Chew FS. Current concepts of shoulder arthroplasty for radiologists: Part 2--Anatomic and reverse total shoulder replacement and nonprosthetic resurfacing. AJR Am J Roentgenol. 2012;199(4):768-776.
7. Vaswani D, Cohn RM, Walsh PJ. Shoulder Arthroplasty: Preoperative Evaluation and Postoperative Imaging. Semin Musculoskelet Radiol. 2025 Feb;29(1):45-59.
8. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 2011;19:439-49.
9. Anakwenze O, Fokin A, Chocas M, et al. Complications in total shoulder and reverse total shoulder arthroplasty by body mass index. J Shoulder Elbow Surg. 26(7):1230-1237, 2017 Jul.
10. Palestro CJ, Love C, Tronco GG, Tomas MB, Rini JN. Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Radiographics. 2006;26:859-70.
11. Wiater BP, Moravek JE, Jr., Wiater JM. The evaluation of the failed shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(5):745-758.
12. Sheridan BD, Ahearn N, Tasker A, Wakeley C, Sarangi P. Shoulder arthroplasty. Part 2: normal and abnormal radiographic findings. Clin Radiol. 2012;67(7):716-721.
13. Namdari S, Hsu JE, Baron M, Huffman GR, Glaser D. Immediate postoperative radiographs after shoulder arthroplasty are often poor quality and do not alter care. Clin Orthop Relat Res. 2013;471(4):1257-1262.
14. Dempsey IJ, Kew ME, Cancienne JM, Werner BC, Brockmeier SF. Utility of postoperative radiography in routine primary total shoulder arthroplasty. J Shoulder Elbow Surg. 26(7):e222-e226, 2017 Jul.
15. Raiss P, Schnetzke M, Wittmann T, et al. Postoperative radiographic findings of an uncemented convertible short stem for anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg. 28(4):715-723, 2019 Apr.
16. Mollon B, Mahure SA, Roche CP, Zuckerman JD. Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elbow Surg. 26(7):1253-1261, 2017 Jul.
17. Fox TJ, Foruria AM, Klika BJ, Sperling JW, Schleck CD, Cofield RH. Radiographic survival in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(9):1221-1227.
18. Berth A, Marz V, Wissel H, Awiszus F, Amthauer H, Lohmann CH. SPECT/CT demonstrates the osseointegrative response of a stemless shoulder prosthesis. [Review]. J Shoulder Elbow Surg. 25(4):e96-103, 2016 Apr.
19. Gonzalez JF, Alami GB, Baque F, Walch G, Boileau P. Complications of unconstrained shoulder prostheses. J Shoulder Elbow Surg. 2011;20(4):666-682.
20. Singh JA, Sperling J, Schleck C, Harmsen W, Cofield R. Periprosthetic fractures associated with primary total shoulder arthroplasty and primary humeral head replacement: a thirty-three-year study. J Bone Joint Surg Am. 2012;94(19):1777-1785.
21. Neyton L, Erickson J, Ascione F, Bugelli G, Lunini E, Walch G. Grammont Award 2018: Scapular fractures in reverse shoulder arthroplasty (Grammont style): prevalence, functional, and radiographic results with minimum 5-year follow-up. Journal of Shoulder & Elbow Surgery. 28(2):260-267, 2019 Feb.
22. Steiner GM, Sprigg A. The value of ultrasound in the assessment of bone. Br J Radiol. 1992;65(775):589-593.
23. Goldman L, Walter W, Adler RS, Kaplan D, Burke CJ. Ultrasound of the symptomatic shoulder arthroplasty: Spectrum and prevalence of periarticular soft tissue pathology. J Clin Ultrasound. 2021 Nov;49(9):969-975.
24. Jacene H, Goetze S, Patel H, Wahl R, Ziessman H. Advantages of Hybrid SPECT/CT vs SPECT Alone. The Open Medical Imaging Journal 2008;2:67-79.
25. Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009;39(1):66-78.
26. Matin P. The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med. 1979;20(12):1227-1231.
27. Kepler CK, Nho SJ, Bansal M, et al. Radiographic and histopathologic analysis of osteolysis after total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(4):588-595.
28. Lim TK, Choi YS, Jeong GM, Kim DK, Kim MS. Computed Tomography Versus Simple Radiography for Detecting and Classifying Heterotopic Ossification after Reverse Shoulder Arthroplasty. Clin Orthop Surg. 2024 Dec;16(6):962-970.
29. Chamberlain AM, Aleem AW, Zmistowski BM, Sefko JA, Hillen T, Keener JD. Clinical and Radiographic Outcomes and Graft Incorporation Rate Assessed by CT Scan After Reverse Shoulder Arthroplasty With Glenoid Structural Bone Graft Reconstruction. J Am Acad Orthop Surg. 2024 Aug 01;32(15):e777-e784.
30. Barret H, Tiercelin J, Godenèche A, et al. Bony integration of a hybrid glenoid component in anatomical shoulder arthroplasty : short-term CT scan analysis. Bone Joint J. 2025 Feb 01;107-B(2):181-187.
31. Singh JA, Sperling JW, Schleck C, Harmsen WS, Cofield RH. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg. 2012;21(11):1534-1541.
32. Sperling JW, Hawkins RJ, Walch G, Zuckerman JD. Complications in total shoulder arthroplasty. J Bone Joint Surg Am. 2013;95(6):563-569.
33. Dodson CC, Craig EV, Cordasco FA, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010;19(2):303-307.
34. Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. [Review]. Int Orthop. 34(8):1075-82, 2010 Dec.
35. Jerosch J, Schneppenheim M. Management of infected shoulder replacement. Arch Orthop Trauma Surg. 2003;123(5):209-214.
36. Sofka CM, Adler RS. Original report. Sonographic evaluation of shoulder arthroplasty. AJR Am J Roentgenol. 2003;180(4):1117-1120.
37. Hadduck TA, van Holsbeeck MT, Girish G, et al. Value of ultrasound before joint aspiration. AJR Am J Roentgenol. 2013;201(3):W453-459.
38. Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: a guide for radiologists on call. Radiographics. 2009;29(4):1139-1158.
39. Zeng YQ, Deng S, Zhu XY, et al. Diagnostic Accuracy of the Synovial Fluid a-Defensin Lateral Flow Test in Periprosthetic Joint Infection: A Meta-analysis. Orthop Surg. 2021 May;13(3):708-718.
40. Fritz J, Meshram P, Stern SE, Fritz B, Srikumaran U, McFarland EG. Diagnostic Performance of Advanced Metal Artifact Reduction MRI for Periprosthetic Shoulder Infection. J Bone Joint Surg Am. 2022 Aug 03;104(15):1352-1361.
41. Hayter CL, Koff MF, Shah P, Koch KM, Miller TT, Potter HG. MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques. AJR Am J Roentgenol. 2011;197(3):W405-411.
42. Nwawka OK, Konin GP, Sneag DB, Gulotta LV, Potter HG. Magnetic resonance imaging of shoulder arthroplasty: review article. HSS J. 2014 Oct;10(3):213-24.
43. Sperling JW, Potter HG, Craig EV, Flatow E, Warren RF. Magnetic resonance imaging of painful shoulder arthroplasty. J Shoulder Elbow Surg. 2002;11(4):315-321.
44. Thélu-Vanysacker M, Frédéric P, Charles-Edouard T, Alban B, Nicolas B, Tanguy B. SPECT/CT in Postoperative Shoulder Pain. Semin Nucl Med. 2018 Sep;48(5):S0001-2998(18)30041-2.
45. Lee SJ, Won KS, Choi HJ, Choi YY. Early-Phase SPECT/CT for Diagnosing Osteomyelitis: A Retrospective Pilot Study. Korean Journal of Radiology. 22(4):604-611, 2021 04.Korean J Radiol. 22(4):604-611, 2021 04.
46. Phillips WT, Gorzell BC, Martinez RA, et al. Fewer-Angle SPECT/CT Blood Pool Imaging for Infection and Inflammation. J Nucl Med Technol. 49(1):39-43, 2021 Mar.
47. Cuvilliers C, Icard N, Meneret P, Palard-Novello X, Girard A. Blood-Pool SPECT/CT in Chronic Ankle Tendinopathy. Clin Nucl Med. 45(10):e457-e458, 2020 Oct.
48. Falstie-Jensen T, Lange J, Daugaard H, et al. 18F FDG-PET/CT has poor diagnostic accuracy in diagnosing shoulder PJI. Eur J Nucl Med Mol Imaging. 2019 Sep;46(10):2013-2022.
49. Amstutz HC, Campbell P, Kossovsky N, Clarke IC. Mechanism and clinical significance of wear debris-induced osteolysis. Clin Orthop Relat Res. 1992(276):7-18.
50. Schmalzried TP, Jasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992;74(6):849-863.
51. Zmistowski B, Carpenter DP, Chalmers PN, Smith MJ, Keener JD. Symptomatic aseptic loosening of a short humeral stem following anatomic total shoulder arthroplasty. [Review]. Journal of Shoulder & Elbow Surgery. 30(12):2738-2744, 2021 Dec.J Shoulder Elbow Surg. 30(12):2738-2744, 2021 Dec.
52. Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976;58(5):612-618.
53. Wirth MA, Agrawal CM, Mabrey JD, et al. Isolation and characterization of polyethylene wear debris associated with osteolysis following total shoulder arthroplasty. J Bone Joint Surg Am. 1999;81(1):29-37.
54. Zanetti M, Hodler J. MR imaging of the shoulder after surgery. Radiol Clin North Am. 2006;44(4):537-551, viii.
55. Gregory T, Hansen U, Khanna M, et al. A CT scan protocol for the detection of radiographic loosening of the glenoid component after total shoulder arthroplasty. Acta Orthop. 2014;85(1):91-96.
56. Ricchetti ET, Jun BJ, Cain RA, et al. Sequential 3-dimensional computed tomography analysis of implant position following total shoulder arthroplasty. J Shoulder Elbow Surg. 27(6):983-992, 2018 Jun.
57. Pessis E, Campagna R, Sverzut JM, et al. Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 2013;33(2):573-583.
58. Subhas N, Polster JM, Obuchowski NA, et al. Imaging of Arthroplasties: Improved Image Quality and Lesion Detection With Iterative Metal Artifact Reduction, a New CT Metal Artifact Reduction Technique. AJR Am J Roentgenol. 207(2):378-85, 2016 Aug.
59. Shim E, Kang Y, Ahn JM, et al. Metal Artifact Reduction for Orthopedic Implants (O-MAR): Usefulness in CT Evaluation of Reverse Total Shoulder Arthroplasty. AJR Am J Roentgenol. 209(4):860-866, 2017 Oct.
60. Pache G, Krauss B, Strohm P, et al. Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions--feasibility study. Radiology. 2010;256(2):617-624.
61. Jun BJ, Vasanji A, Ricchetti ET, et al. Quantification of regional variations in glenoid trabecular bone architecture and mineralization using clinical computed tomography images. J Orthop Res. 36(1):85-96, 2018 01.
62. Vidil A, Valenti P, Guichoux F, Barthas JH. CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties. Eur J Orthop Surg Traumatol. 2013;23(5):521-525.
63. Mallo GC, Burton L, Coats-Thomas M, Daniels SD, Sinz NJ, Warner JJ. Assessment of painful total shoulder arthroplasty using computed tomography arthrography. J Shoulder Elbow Surg. 24(10):1507-11, 2015 Oct.
64. Armstrong A, Lashgari C, Teefey S, Menendez J, Yamaguchi K, Galatz LM. Ultrasound evaluation and clinical correlation of subscapularis repair after total shoulder arthroplasty. J Shoulder Elbow Surg. 2006;15(5):541-548.
65. Dedy NJ, Gouk CJ, Taylor FJ, Thomas M, Tan SLE. Sonographic assessment of the subscapularis after reverse shoulder arthroplasty: impact of tendon integrity on shoulder function. J Shoulder Elbow Surg. 27(6):1051-1056, 2018 Jun.
66. Beltran J, Gray LA, Bools JC, Zuelzer W, Weis LD, Unverferth LJ. Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography. Radiology. 1986;160(1):161-165.
67. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994(304):78-83.
68. van de Sande MA, Stoel BC, Obermann WR, Tjong a Lieng JG, Rozing PM. Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography. Invest Radiol. 2005;40(5):313-319.
69. Kim SJ, Jang SW, Jung KH, Kim YS, Lee SJ, Yoo YS. Analysis of impingement-free range of motion of the glenohumeral joint after reverse total shoulder arthroplasty using three different implant models. J Orthop Sci. 24(1):87-94, 2019 Jan.
Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.