The Role of Arthroscopy in Painful Shoulder Arthroplasty: Is Revision Always Necessary?

Purpose To determine if arthroscopy is an effective means to diagnose and treat postoperative pain in anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) patients. Methods A two-year retrospective chart review for patients with a painful shoulder arthroplasty was performed. Patients included in the study had a painful shoulder after previous shoulder arthroplasty without gross signs of infection, severely elevated laboratory markers, implant loosening, or glenoid arthrosis following hemiarthroplasty. VAS scores, physical exam findings, laboratory studies, culture results, pathology reports, operative records and postoperative treatment data were collected. Results The study cohort included six males and seven females. Seven TSA and six rTSA patients underwent arthroscopic debridement of adhesions and synovitis with tissue biopsy for culture and fresh frozen section between 2016 – 2018. We arthroscopically treated adhesive capsulitis, subacromial impingement and AC joint arthritis in three patients. Three patients required extensive debridement for profound synovitis. All six had negative cultures and frozen sections, and none required revision arthroplasty. Their average follow-up was 18.6 months (range 9-32) with mean VAS score improving from 8.2/10 (range 6-10) to 2.5/10 (range 2-8). Two patients had arthroscopic cultures revealing C. acnes infection. Both required revision with an antibiotic spacer. Cultures and fresh frozen sections at revision were consistent with arthroscopic findings. Arthroscopic evaluation in five additional patients identified mechanical implant failure or rotator cuff tear. Conclusion Arthroscopy is a viable option to evaluate and treat painful shoulder arthroplasty. We were able to successfully treat 46% (6/13) of patients with arthroscopic procedures preventing the need for revision arthroplasty. Arthroscopic frozen section and culture results had 100% correlation with open frozen section and culture results in patients who had cultures obtained.