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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
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. Review/Other-Tx N/A To examine recent trends in shoulder hemiarthroplasty and total shoulder arthroplasty along with the common reasons for these surgical procedures in the United States. While the annual number of hemiarthroplasties grew steadily, the number of total shoulder arthroplasties showed a discontinuous jump (p < 0.01) in 2004 and increased with a steeper linear slope (p < 0.01) since then. As a result, more total shoulder arthroplasties than hemiarthroplasties have been performed annually since 2006. Approximately 27,000 total shoulder arthroplasties and 20,000 hemiarthroplasties were performed in 2008. More than two-thirds of total shoulder arthroplasties were performed in adults with an age of sixty-five years or more. Osteoarthritis was the primary diagnosis for 43% of hemiarthroplasties and 77% of total shoulder arthroplasties in 2008, with fracture of the humerus as the next most common primary diagnosis leading to hemiarthroplasty. 4
2. Lee DH, Choi YS, Potter HG, et al. Reverse total shoulder arthroplasty: an imaging overview. Skeletal Radiol. 2020 Jan;49(1):19-30. Review/Other-Dx N/A To demonstrate the biomechanics of RTSA, prosthesis components, indications, and imaging features of the normal postoperative appearance and various complications after RTSA. No results stated in abstract. 4
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. Review/Other-Dx N/A To provide orthopaedic surgeons and radiologists with knowledge on the imaging methods used in shoulder arthroplasty and their role in presurgical planning, intraoperative guidance and postoperative assessment. No results stated in abstract. 4
5. Bohsali KI, Wirth MA, Rockwood CA, Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279-2292. Review/Other-Tx N/A To review complications of total shoulder arthroplasty. No results stated. 4
7. Vaswani D, Cohn RM, Walsh PJ. Shoulder Arthroplasty: Preoperative Evaluation and Postoperative Imaging. Semin Musculoskelet Radiol. 2025 Feb;29(1):45-59. Review/Other-Dx N/A To review the more common types of shoulder arthroplasties: their imaging appearances, multimodality imaging assessments for preoperative planning, and complications. No results stated in abstract. 4
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. Review/Other-Dx N/A To review combined labeled leukocyte and Tc-99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Combined WBC-marrow imaging is a very accurate technique for diagnosing osteomyelitis. 4
11. Wiater BP, Moravek JE, Jr., Wiater JM. The evaluation of the failed shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(5):745-758. Review/Other-Dx N/A To review failed shoulder arthroplasty. The failed shoulder arthroplasty is a complex clinical entity that requires a diligent workup and a thorough knowledge of mechanisms of failure. 4
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. Review/Other-Dx N/A To review the normal and abnormal appearances of shoulder arthroplasty and guide the radiology trainee and non-musculoskeletal radiologist in what to look for in the failing implant. No results stated. 4
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. Observational-Dx 283 patients (Group 1) 241 patients (Group 2) To determine whether (1) postanesthesia care unit (PACU) radiographs can reasonably serve as a baseline for future studies; and (2) routine PACU radiographs change clinical care. (3) also determined the charges associated with routine PACU radiographs and formal radiographic interpretation of these images. All images in Group 1 were single-view radiographs (88% internal rotation), most were underpenetrated (71%); no images changed postoperative management or were considered adequate to serve as a baseline. Group 2 radiographs were multiview radiographs, and 83% were deemed adequate to serve as baseline radiographs. Radiographic interpretation of immediate postoperative radiographs did not change the clinical course or treatment. The charges billed from radiographic evaluation in this study were $64,524 for Group 1. 3
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. Observational-Dx 160 patients To assess the medical relevance and cost-benefit of radiography after TSA during the first postoperative year. Patients underwent radiography at 1.8 +/- 0.2 weeks, 6.5 +/- 1.2 weeks, 14.9 +/- 2.9 weeks, and 46.8 +/- 19.5 weeks postoperatively. Findings on the radiologist's reading were normal/unremarkable for 100.0%, 96.8%, 95.9%, and 95.2%, respectively, at each visit. Results were documented in the note for 92.5%, 97.4%, 98.0%, and 92.4%, respectively, at each visit. Review of the radiographs yielded no change in management based on these parameters. The amount billed for radiographs was $284,281 ($1776.76 per patient). 4
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. Observational-Dx 150 anatomic TSAs (group 1) and 77 RSAs (group 2) To analyze the radiographic findings of a press-fit convertible short-stemmed humeral component in both TSA and RSA. At final follow-up, 49% of group 1 and 65% of group 2 had no evidence for radiographic changes. In those with radiographic changes, low bone adaptions were found in 83% and high adaptions in 17% in both groups. Larger stem sizes with higher filling ratios were associated with high radiographic adaptions in both groups (P = .02). The overall filling ratios were higher in group 2 (P = .002). Cortical contact of the stem led to higher bone adaptions (P = .014). 4
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. Observational-Dx 464 patients including 476 shoulders To determine whether the presence of a scapular notch negatively affects clinical outcomes and the rate of complications. Scapular notching was observed in 10.1% (48 of 476) of rTSAs and was associated with a longer clinical follow-up, lower body weight, lower body mass index, and when the operative side was the nondominant extremity. Patients with scapular notching had significantly lower postoperative scores on the Shoulder Pain and Disability Index, Constant, Simple Shoulder Test, and University of California, Los Angeles, Shoulder Rating Scale compared with patients without scapular notching. Patients with scapular notching also had significantly lower active abduction, significantly less strength, and trended toward significantly less active forward flexion (P = .0527). Finally, patients with scapular notching had a significantly higher complication rate and trended toward a significantly higher rate of humeral radiolucent lines (P = .0896) than patients without scapular notching. 3
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. Observational-Dx 151 shoulders To assess radiographic and clinical failure in shoulder arthroplasty, identifying factors predictive of loosening. Fifty-two of 151 glenoid components (34%) showed a shift in position or a complete lucent line >/=1.5 mm. Four humeral components (3%) shifted or showed a 2-mm lucency in 3 zones. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years were 99% (95% CI) (98-100%) and 67% (95% CI) (58-78%). Glenoid components with lines at the keel on initial radiographs were at risk for radiographic failure, hazard ratio 4.6 95% CI 1.2-17.2, P = .02. No associations were found between radiographic survival and age, gender, diagnosis, glenoid erosion, and preoperative or early subluxation. Late subluxation superiorly was associated with the glenoid at risk for radiographic failure (P = .006). Glenoid component survivals free from revision at 5 and 10 years for the 302 shoulders were 99% (95% CI) (97-100%) and 93% (95% CI) (90-97%). 2
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. Review/Other-Dx 28 patients To evaluate bone remodeling processes in the proximal humerus induced by the implantation of a stemless shoulder prosthesis with regard to time of response and type and extent of bone turnover. No difference within the 4 subgroups with respect to the time of local metabolic bone activity in the ROIs was found at 90 days after surgery. The highest initial metabolic activity and most temporal modifications were found in ROI 1, which was localized in the superior segment of the stem 4
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. Observational-Dx 953 patients To determine the rate of scapular fracture (acromial base and spine) after Grammont-style RSA and to report functional and radiographic results of patients with a minimum 5-year follow-up. Twenty-six patients (1.3%) had sustained a scapular fracture; of these, 19 (10 acromial base and 9 spine fractures) had minimum 5-year follow-up and were reviewed at a mean follow-up of 97 months. Three patients (15.8%) were diagnosed at the last follow-up after an undiagnosed fracture. There were 3 traumatic cases (15.8%) and 13 (68.4%) without antecedent trauma. These 16 patients underwent nonoperative treatment. The fracture was healed in 8 (4 acromion and 4 spine). The average active forward elevation was 109 degrees (range, 50 degrees -170 degrees ), and the Constant score was 47.0 points (range, 8-81 points). 4
22. Steiner GM, Sprigg A. The value of ultrasound in the assessment of bone. Br J Radiol. 1992;65(775):589-593. Review/Other-Dx N/A Case report on the value of ultrasound in the assessment of bone. No results stated in abstract. 4
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. Review/Other-Dx 72 patients To describe our experience using ultrasound (US) to evaluate postoperative complications in the presence of in situ shoulder arthroplasty. Ninety-seven studies were performed in 72 patients following TSA, RTSA, or hemiarthroplasty. Thirty-seven exams were solely for diagnostic purposes, and 59 were for guiding joint or periarticular collection aspiration. Twenty-eight studies assessed the cuff tendons post TSA. The mean time between surgery and US examination was 29.2 months. Complete or high-grade tears were identified in 8/28 (28.6%) diagnostic exams. The most commonly torn tendon among TSA patients was the subscapularis, with 13/28 (46.4%) demonstrating at least partial tearing. Inter-reader agreement was excellent for presence of effusion (k = 0.79, p < .001) and periarticular collection (k = 0.87, p < .001), and excellent agreement for presence of subscapularis tear (k = 0.78, p < .001), with fair agreement for assessment of supraspinatus (k = 0.66, p < .001) and infraspinatus (k = 0.60, p < .001) tears. 4
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. Observational-Dx 144 patients To report our two year clinical experience with SPECT/CT and seek to determine if there is added diagnostic value to SPECT/CT over SPECT alone in a busy general nuclear medicine clinic. SPECT/CT provided additional information for image interpretation in 54% (78/144) of cases. In most of these (68/78), the CT data improved localization of abnormal and physiologic findings. Diagnostic certainty was improved in 34/144 cases (24%) and image interpretation was beneficially altered in 18/144 cases (13%). 3
25. Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009;39(1):66-78. Review/Other-Dx N/A To review hip and knee arthroplasties and differentiate aseptic loosening, the most common cause of prosthetic joint failure, from infection. No results stated in abstract. 4
26. Matin P. The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med. 1979;20(12):1227-1231. Review/Other-Dx 204 patients To examine the use of bone scans in determining how the pattern of radioactive uptake changes with time, and how soon the scan of a fracture site returns to normal. The minimum time for a bone scan to become abnormal following fracture was age-dependent; however, 80% of all fractures were abnormal by 24 hr, and 95% by 72 hr, after injury. Three distinct temporally related phases were noted on bone scans as sequential studies showed a gradual return to normal. The minimum time for a fracture to return to normal on a bone scan was 5 mo. Approximately 90% of the fractures returned to normal by 2 yr after injury. 4
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. Review/Other-Dx 52 patients To analyze clinical, radiographic, and histologic data from failed total shoulder arthroplasties (TSAs) to determine factors associated with osteolysis. In the osteolysis group, 20% had screw fixation compared with 2.5% without osteolysis (P = .039). The radiolucency score was significantly higher in the osteolysis group: 12.7 +/- 2.0 vs 8.7 +/- 3.7 (P = .003). Wear analysis of the osteolysis group demonstrated significant increases in third-body particles compared with those implants without osteolysis (P = .004). Histology available from retrieved implants demonstrated particulate debris in 62% of patients with osteolytic lesions vs 67% without osteolytic lesions (P > .05). 4
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. Observational-Dx 30 patients To evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [KXR] = 0.6018 and kappa value for CT [KCT] = 0.8316) and classification (KXR = 0.5300 and KCT = 0.6964). At a mean follow-up of 25 months (range, 12-54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively). 3
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. Review/Other-Dx 38 patients that underwent RTSA with structural bone graft To assess clinical and radiographic outcomes and report graft incorporation assessed on CT scan after RTSA where structural bone autograft or allograft was used to reconstruct the glenoid. Thirty-five patients were enrolled retrospectively (52.2%) and 32 prospectively (47.8%). Autograft was used in 46 cases (68.7%) and allograft in 21 cases. The mean American Shoulder and Elbow Surgeons score improved from 33.1 (SD 18.5) to 78.2 (SD 22.4), with P < 0.0001. On postoperative radiographs, 63 cases (94.0%) showed stable RTSA constructs while four cases (6.0%) developed glenoid baseplate subsidence. Postoperative CT scan demonstrated complete graft incorporation in 45 cases (90.0%) while partial incorporation was noted in 4 cases (8.0%), and in 1 case (2.0%), there was no graft incorporation. No correlation was observed between baseplate subsidence and graft type (autograft versus allograft) or primary versus revision surgery. 4
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. Review/Other-Dx 100 patients (104 CT scans) To explore the bony integration of a hybrid glenoid component based on an analysis of CT scans. From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score. 4
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. Review/Other-Dx 11 patients To review a series of patients diagnosed with Propionibacterium acnes infection after shoulder arthroplasty in order to describe its clinical presentation, the means of diagnosis, and provide options for treatment. Five patients had an initial diagnosis of infection and underwent implant removal, placement of an antibiotic spacer, and staged reimplantation after a course of intravenous antibiotics. In the remaining 6 patients, surgical treatment varied according to the clinical diagnosis. When infection was recognized by intraoperative cultures, antibiotics were initiated. The average initial ESR and CRP values were 33 mm/h and 2 mg/dL, respectively. The average number of days from collection to a positive culture was 9. All cultures were sensitive to penicillin and clindamycin and universally resistant to metronidazole. 4
35. Jerosch J, Schneppenheim M. Management of infected shoulder replacement. Arch Orthop Trauma Surg. 2003;123(5):209-214. Review/Other-Tx 12 patients To present treatment options and  results for patients with infected shoulder alloarthroplasties. The time between explantation and reimplantation ranged between 4 weeks and 6 months. With the temporary spacer, an anatomically stable condition could be established for all patients, and reconstruction of the humeral length even in long implants was possible. All patients underwent physiotherapy with the temporary spacer in place. A positive intraoperative microbiologic specimen was only found in 4 patients. In both group 1 and 2 patients, the infection healed, and thus the original implant could be kept in situ. In 8 patients, the temporary spacer was removed and exchanged for a regular implant. The postoperative raw Constant score at the time of the last follow-up examination was 48, due mainly to a loss of motion and power. All shoulders were stable, and the elbow function was good. 4
36. Sofka CM, Adler RS. Original report. Sonographic evaluation of shoulder arthroplasty. AJR Am J Roentgenol. 2003;180(4):1117-1120. Review/Other-Dx 11 patients The authors reviewed their experience using sonography to evaluate the rotator cuff after arthroplasty. Sonography is a useful method of imaging the rotator cuff after arthroplasty. Extended field-of-view imaging and tissue harmonic imaging aided in diagnosis by improving visualization of regional anatomic landmarks and increasing conspicuity of small tendon tears. 4
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. Review/Other-Dx N/A To illustrate and discuss the value of ultra-sound screening before joint aspiration. Before joint aspiration, ultrasound assessment of the overlying and surrounding soft tissues requires little time and is relatively inexpensive. Bursal fluid collections, soft-tissue abscesses, and other fluid collections that would be undetected with fluoroscopy or blind aspiration can thus be identified. Ultrasound screening before joint aspiration can aid diagnosis and decrease the risk of iatrogenic complications. 4
38. Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: a guide for radiologists on call. Radiographics. 2009;29(4):1139-1158. Review/Other-Dx N/A To review the clinical and imaging findings of septic arthritis and briefly discuss various other disease entities that may have a similar appearance at imaging. Thus, the article provides a guide for radiologists who may be asked to perform emergent aspirations either during their daily work or while on call. No results stated in abstract 4
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. Meta-analysis Seventeen studies including 1443 cases To evaluate the diagnostic accuracy of the a-defensin lateral flow test in PJI. Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of a-defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post-test probability of 94% and a low negative post-test probability of 15%. Good
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. Observational-Dx 89 participants suspected of having PSI To determine the reliability, repeatability, and diagnostic performance of advanced MARS-MRI findings for diagnosing PSI. The interreader reliability and intrareader repeatability of advanced MARS-MRI findings, including lymphadenopathy, joint effusion, synovitis, extra-articular fluid collection, a sinus tract, rotator cuff muscle edema, and periprosthetic bone resorption, were good (? = 0.61 to 0.80) to excellent (? > 0.80). Lymphadenopathy, complex joint effusion, and edematous synovitis had sensitivities of >85%, specificities of >90%, odds ratios of >3.6, and AUC values of >0.90 for diagnosing PSI. The presence of all 3 findings together yielded a PSI probability of >99%, per logistic regression analysis. 3
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. Observational-Dx 122 patients To evaluate the quality of images obtained with a prototype imaging technique, multiacquisition variable-resonance image combination, compared with fast spin-echo images in the evaluation of patients who have undergone hip, shoulder, or knee arthroplasty. Visualization of the synovium was significantly better on multiacquisition variable-resonance image combination images than on fast spin-echo images of the hip (P<0.0001), shoulder (P<0.01), and knee (P<0.01). Synovitis was detected only on the multiacquisition variable-resonance image combination images of 9 subjects (12%) who had undergone hip arthroplasty and 5 subjects (18%) who had undergone shoulder arthroplasty. Visualization of the periprosthetic bone was significantly better on multiacquisition variable-resonance image combination images of the hip (P<0.0001), shoulder (P<0.0001), and knee (P<0.01). Osteolysis was detected only on the multiacquisition variable-resonance image combination images of 12 subjects (16%) who had undergone hip arthroplasty, 6 (22%) who had undergone shoulder arthroplasty, and 5 (24%) who had undergone knee arthroplasty. Visualization of the supraspinatus tendon was significantly better on multiacquisition variable-resonance image combination images (P<0.0001). Supraspinatus tendon tears in 12 subjects (44%) were detected only on multiacquisition variable-resonance image combination images. 3
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. Review/Other-Dx 33 articles To illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process. No results stated in abstract. 4
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. Observational-Dx 42 shoulder arthroplasties To determine the utility of a modified magnetic resonance technique in identifying pathology after shoulder arthroplasty. At the time of revision surgery, there were full-thickness rotator cuff tears in 11 of 21 shoulders; MRI correctly predicted these in 10 of 11 shoulders. Full-thickness subscapularis tears were the most common finding (8/11 shoulders). Of the 21 shoulders, 10 did not have a rotator cuff tear, and MRI correctly predictedthe absence of a tear in 8 of 10. MRI also correctly predicted glenoid cartilage wear in 8 of 9 shoulders. 3
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. Review/Other-Dx N/A To review how SPECT/CT can be of significant clinical value for shoulder surgeons. No results stated in abstract. 4
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. Observational-Dx 21 patients To investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate (99mTc-MDP) for diagnosing osteomyelitis (OM). OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. 2
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. Observational-Dx 6 phantoms and 4 patients To describe a method of reducing the SPECT/CT acquisition time to approximately 3 min, which we refer to as fewer-angle SPECT/CT, or FASpecT/CT. The FASpecT/CT acquisition protocol required 1.3–3.5 min, including camera movement time. This was a reduction of 72%–90% from the time required for the standard 60-angle, 20-s SPECT/ CT acquisition. 3
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. Review/Other-Dx 2 patients To report where blood-pool SPECT/CT had a high added value compared with standard 3-phase bone scintigraphy with only delayed SPECT/CT for the etiological diagnosis of painful ankles. Although standard planar blood-pool imaging and delayed SPECT/CT were inconclusive, blood-pool SPECT/CT showed markedly increased uptake along posterior tibial tendon and peroneal tendon, respectively, leading to diagnose tendonitises. 4
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. Observational-Dx 86 patients To determine the diagnostic accuracy of 18F-FDG PET/CT in diagnosing chronic PJI of the shoulder. Nine patients were 18F-FDG PET/CT positive for infection, with only three true positive. Using the gold standard, infection was diagnosed after revision surgery in 22 cases. All infections were chronic and caused by low-virulent microbes. The sensitivity of 18F-FDG PET/CT was 0.14 95% CI (0.03-0.36), specificity 0.91 95% CI (0.81-0.97), positive predictive value was 0.40 95% CI (0.15-0.71) and negative predictive value 0.71 95% CI (0.67-0.75). The inter-observer agreement was 0.56 (Fleiss' kappa), indicating moderate agreement of the visual FDG-PET evaluation using the shoulder-specific criteria. 2
54. Zanetti M, Hodler J. MR imaging of the shoulder after surgery. Radiol Clin North Am. 2006;44(4):537-551, viii. Review/Other-Dx N/A To describe postoperative MR findings relating to surgery in shoulder impingement syndrome, including rotator cuff lesions, shoulder instability, and arthroplasty. No results stated in abstract. 4
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. Observational-Dx 11 patients To evaluate whether computed tomography (CT) using a specific patient position in the CT scanner provides a better method for assessing radiolucencies in TSA. The protocol almost completely eliminated metal artifacts in the CT images and allowed accurate assessment of periprosthetic lucency of the glenoid fixation. Positioning of the patient within the CT scanner as described was possible for all 11 patients. A radiolucent line was identified in 54 of the 55 observed CT scans and osteolysis was identified in 25 observations. The average radiolucent line Mole score was 3.4 (SD 2.7) points with plain radiographs and 9.5 (SD 0.8) points with CT scans (p = 0.001). The mean intra-observer variance was lower in the CT scan group than in the plain radiograph group (p = 0.001). 3
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. Review/Other-Dx 20 patients To evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. Of the patients, 7 (35%) showed evidence of glenoid components at risk of loosening on CT3, 6 with component shift (3 with increased inclination alone, 1 with increased retroversion alone, and 2 with both increased inclination and retroversion). Significantly more patients with glenoid component shift had grade 1 central peg osteolysis on CT3 compared with those without shift (83% vs 7%, P = .002). One clinical failure occurred, with the patient undergoing revision to reverse TSA for rotator cuff deficiency. 4
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. Review/Other-Dx N/A To review the theory of VMS imaging and describe our clinical experience with a single-source dual-energy scanner with fast kilovoltage switching (ie, rapid alternation between high- and low-kilovoltage settings) to reduce beam-hardening artifact, using optimized protocols to improve diagnostic performance inpatients with metal implants. Despite advances in detector technology and computer software, artifacts from metal implants can seriously degrade the quality of CT images, sometimes to the point of making them diagnostically unusable. Several factors may help reduce the number and severity of artifacts at multidetector CT, including decreasing the detector collimation and pitch, increasing the kilovolt peak and tube charge, and using appropriate reconstruction algorithms and section thickness. More recently, dual-energy CT has been proposed as a means of reducing beam-hardening artifacts. The use of dual-energy CT scanners allows the synthesis of virtual monochromatic spectral (VMS) images. Monochromatic images depict how the imaged object would look if the x-ray source produced x-ray photons at only a single energy level. For this reason, VMS imaging is expected to provide improved image quality by reducing beam-hardening artifacts. 4
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. Observational-Dx 40 shoulder and 21 hip arthroplasties. To compare iterative metal artifact reduction (iMAR), a new single-energy metal artifact reduction technique, with filtered back projection (FBP) in terms of attenuation values, qualitative image quality, and streak artifacts near shoulder and hip arthroplasties and observer ability with these techniques to detect pathologic lesions near an arthroplasty in a phantom model. For both readers, iMAR had more accurate attenuation values (p < 0.001), qualitatively better image quality (p < 0.001), and less streak artifact (p < 0.001) in all locations near arthroplasties compared with FBP. Both readers detected more lesions (p </= 0.04) with higher confidence (p </= 0.01) with iMAR than with FBP in the phantom model. 2
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. Observational-Dx 65 patients To evaluate the effect of the metal artifact reduction algorithm for orthopedic implants (O-MAR) on CT image quality for patients with reverse total shoulder arthroplasty (RTSA), with emphasis placed on the evaluation of bone in the vicinity of prostheses. O-MAR images showed less metal streak artifact and noise and provided better visualization of the axillary neurovascular bundle compared with FBP images, with a statistically significant difference (p < 0.001 for all). FBP images were found to be statistically significantly better than O-MAR images, offering better visualization of bone cortex, bone trabeculae, and the bone-prosthesis interface (p < 0.001 for all). Scapular pseudonotching was observed on 4.6% of FBP images and 36.9% of O-MAR images. The pseudocemented appearance was noted on 47.7% of O-MAR images but was not seen on FBP images. 2
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. Observational-Dx 21 patients To evaluate traumatized bone marrow with a dual-energy CT virtual noncalcium technique. After exclusion of 16 regions owing to artifacts, MRI revealed 59 bone bruises in the remaining 236 regions (19/114 femoral, 40/122 tibial). Fractures were present in 8 patients. Visual rating revealed areas under the curve of 0.886 and 0.897 in the femur and 0.974 and 0.953 in the tibia for observers 1 and 2, respectively. For CT numbers, the respective areas under the curve were 0.922 and 0.974. If scores of 1 and 2 (strong or mild bone bruise) were counted as positive, sensitivities were 86.4% and 86.4% and specificities were 94.4% and 95.5% for observers 1 and 2, respectively. The kappa statistic demonstrated good to excellent agreement (femur, kappa = 0.78; tibia, kappa = 0.87). 1
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. Observational-Dx 3 human cadavers and a total of six glenoid bones. To determine to what extent clinical CT imaging of intact upper extremities can describe variations of trabecular bone architectures at anatomic and peri-implant regions by comparing trabecular bone architectures as measured by high-resolution, micro CT imaging of same excised glenoid bones. Bone volume fraction (BVF), trabecular bone thickness (TbTh), number of trabecular bone (TbN), spacing (TbS), pattern factor (TbPf), bone surface area (BSA), and skeletal connectivity (Conn.), in addition to bone mineral content (BMC) and bone mineral density (BMD), were quantified from both clinical and micro CT images using whole bone, anatomic, and peri-implant bone masks. Strong correlations of BVF, TbTh, TbSp, BMC, and BMD were found between clinical CT and micro CT imaging methods. The variations in BVF, TbTh, TbSp, TbN, BMC, and BMD at anatomical and peri-implant regions were larger than those at whole bone regions. 4
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. Review/Other-Dx 26 patients (27 shoulders) To evaluate the bone integration of the flanged central peg, using CT scan to measure bone ingrowth, and to show a correlation with good clinical results and longevity of the glenoid component. Improvement of postoperative Constant score and radiographic good results were correlated with satisfactory subjective results reported by patients. The authors observed radiolucent lines under glenoid component in 3 cases. Twenty-six CT scans were available at 1 year: it showed complete bone integration around the central peg in 21 cases and partial peripheral bone integration in four cases. Only one patient had any tissue integration around the peg, probably because of his implantation near cortical bone of scapular spine. 4
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. Observational-Dx 14 patients To assess the accuracy of computed tomography (CT) arthrography when evaluating glenoid component stability in the setting of postarthroplasty shoulder pain. CT arthrography suggested glenoid component loosening in 8 of 14 patients (57.1%), and arthroscopic inspection identified loosening in 10 of 14 patients (71.4%). In 3 of 10 patients (30%), CTA suggested a well-fixed glenoid component, but gross loosening was identified during arthroscopy. In this study, CTA yielded a sensitivity of 70%, a specificity of 75%, a positive predictive value of 87.5%, and a negative predictive value of 50.0%. 3
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. Observational-Dx 23 patients (30 shoulders) To document the subscapularis healing rate by use of postoperative ultrasound and correlate healing to physical examination findings. Of 30 shoulders, 26 (87%) had an intact subscapularis as determined by ultrasound. By use of ultrasound as the gold standard, the abdominal-compression test had 7 false-positive results, 3 false-negative results, 19 true-negative results, and 1 true-positive result. The sensitivity of the abdominal-compression test was 25%, and the specificity was 73%. The negative predictive value was 86%, and the positive predictive value was 13%. The abdominal-compression test demonstrated a low sensitivity, specificity, and positive predictive value in this study for the assessment of subscapularis function after total shoulder arthroplasty. 3
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. Observational-Dx 43 patients To assess subscapularis integrity after RSA using sonography and to evaluate the effect of tendon integrity on shoulder function and patient outcome. The study included 43 patients (48 shoulders). Median length of follow-up was 19 months (range, 4-132 months). On sonography, the subscapularis was graded intact in 6 shoulders (13%), intact with mild attenuation in 16 (33%), severely attenuated in 15 (31%), and not intact or absent in 11 (23%). Differences in Disabilities of the Arm, Shoulder and Hand, Constant-Murley, or Oxford Shoulder scores between intact and attenuated or absent subscapularis shoulders were not significant. Internal rotation scores were significantly higher in the intact and mildly attenuated tendon group than in the absent tendon group (U = 1.0, P = .001 and U = 28.5, P = .007, respectively). 4
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. Review/Other-Dx DSCT - 42 patients, 6 healthy volunteers, 2 cadaver shoulders Axial CT - 41 patients To compare the accuracy of Axial CT and DSCT in the evaluation of rotator cuff lesions of the shoulder. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions. 4
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. Review/Other-Dx 63 patients A preoperative CT scan grading muscular fatty degeneration in five stages was done in 63 patients scheduled for repair of a torn rotator cuff. The results were compared with postoperative evaluation done after a mean of 17.7 months in 57 patients. Postoperative arthrographies were also performed in 56 patients. Preoperative CT scans demonstrated that infraspinatus fatty degeneration can occur in the presence of large anterosuperior tears even when the infraspinatus tendon is not torn; it worsens with time. The subscapularis rarely degenerates, and when it does it degenerates moderately, even when its tendon is not torn. After an effective surgical repair, moderate supraspinatus degeneration regressed in six of 14 patients; that of the infraspinatus never regressed but rather, increased, in three patients. 4
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. Experimental-Dx 30 shoulders To determine whether a quantitative measurement of muscle density using CT was more reliable and reproducible. A strong correlation was found between the quantitative measure and the visual rating (R2 = 0.94; P < 0.0001). The SDD in muscle density did not exceed 2.3 Hounsfield units, and the mean rotator cuff ICC (0.98) was substantially greater than that of the visual rating (0.63). 3
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. Observational-Tx 7 patients To investigate impingement-free range of motion (ROM) of the glenohumeral joint following reverse total shoulder arthroplasty (RTSA) with three types of implant models using computational motion analysis. The all lateralization group (group III) showed significantly greatest maximal adduction, abduction and external rotation (ER). Adduction and abduction were significantly increased by the glenoid component inferior translation in all three groups. (In group I, p < 0.001 for adduction, p = 0.002 for abduction, respectively; in group II, p = 0.025, p < 0.001, respectively; in group III, p = 0.038, p = 0.011, respectively). Increasing humerus retroversion might have some effect on increasing abduction. In group II and III, internal rotation (IR) and ER were significantly affected by the humerus retroversion (in group II, p = 0.033 for IR, p = 0.007 for ER, respectively; in group III, p = 0.004, p < 0.001, respectively). In group III, ER was also significantly affected by the glenoid component inferior translation (p = 0.003). 3
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