Infection, including osteomyelitis and septic arthritis, after total shoulder arthroplasty is an uncommon albeit potentially devastating complication, with a prevalence of 0.7% to 2.9%. Infection is more common in males and a younger age group [3,26,27]. A 97% infection-free rate at 20 years has been reported [28]. Predisposing underlying conditions may include rheumatoid arthritis, corticosteroid use, diabetes, repeated intra-articular steroid injections, and prior shoulder surgery [26]. Infection rates are higher in the setting of reverse total shoulder arthroplasties, with a range of 0.8% to 10% [29]. Proposed causes for this higher prevalence include longer procedural time and steeper learning curve to perform the surgery, large dead space, multiple previous operations, and advanced patient age [29]. Imaging After Shoulder Arthroplasty 3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Shoulder For infection imaging, In-111-labeled WBC with a Tc-99m sulfur colloid bone marrow study is a sensitive and specific test for acute osteomyelitis. An isolated In-111 WBC study is a sensitive but nonspecific technique for the evaluation of acute neutrophilic dominant periprosthetic infection [11]. Its specificity can be increased when interpreted in conjunction with a Tc-99m sulfur colloid study or, less optimally, a bone scan, which may not be indicated if both In-111 WBC and sulfur colloid studies have been performed [11,30]. Tc-99m 3-phase bone scan is a highly sensitive modality for identifying osteolysis and increased osteoblastic activity from postoperative bony remodeling, aseptic loosening, acute osteomyelitis, and periprosthetic fractures. The specificity of bone scans increases in older prostheses once postoperative remodeling has stabilized. Concordant increased labeled WBC and marrow activity is consistent with reactive marrow seen in postoperative change, aseptic loosening, and fractures. Postoperative change and fracture healing tend to decrease over time.
Imaging After Shoulder Arthroplasty PCAs. Infection, including osteomyelitis and septic arthritis, after total shoulder arthroplasty is an uncommon albeit potentially devastating complication, with a prevalence of 0.7% to 2.9%. Infection is more common in males and a younger age group [3,26,27]. A 97% infection-free rate at 20 years has been reported [28]. Predisposing underlying conditions may include rheumatoid arthritis, corticosteroid use, diabetes, repeated intra-articular steroid injections, and prior shoulder surgery [26]. Infection rates are higher in the setting of reverse total shoulder arthroplasties, with a range of 0.8% to 10% [29]. Proposed causes for this higher prevalence include longer procedural time and steeper learning curve to perform the surgery, large dead space, multiple previous operations, and advanced patient age [29]. Imaging After Shoulder Arthroplasty 3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Shoulder For infection imaging, In-111-labeled WBC with a Tc-99m sulfur colloid bone marrow study is a sensitive and specific test for acute osteomyelitis. An isolated In-111 WBC study is a sensitive but nonspecific technique for the evaluation of acute neutrophilic dominant periprosthetic infection [11]. Its specificity can be increased when interpreted in conjunction with a Tc-99m sulfur colloid study or, less optimally, a bone scan, which may not be indicated if both In-111 WBC and sulfur colloid studies have been performed [11,30]. Tc-99m 3-phase bone scan is a highly sensitive modality for identifying osteolysis and increased osteoblastic activity from postoperative bony remodeling, aseptic loosening, acute osteomyelitis, and periprosthetic fractures. The specificity of bone scans increases in older prostheses once postoperative remodeling has stabilized. Concordant increased labeled WBC and marrow activity is consistent with reactive marrow seen in postoperative change, aseptic loosening, and fractures. Postoperative change and fracture healing tend to decrease over time.