Preoperative planning for revision arthroplasty: Imaging, instruments, and implants

A successful revision shoulder replacement surgery is based on four fundamentals: knowledge of the implant to be explanted, good preoperative planning, choice of materials, and analysis of possible complications. Preoperative planning should start with an accurate medical history, good knowledge of the implant to be explanted, and first-level imaging (radiographs); second-level examinations (computed tomography (CT), especially with artifact subtraction, magnetic resonance imaging (MRI), bone scintigraphy) will be chosen based on the diagnostic suspicion. It is necessary to exclude the presence of infection with laboratory tests and diagnostic arthrocentesis. Great attention must be paid to the correct positioning of the glenoid component, and CT is the gold standard for measuring glenoid version and inclination. Nowadays, these measurements can be performed through CT-based software that allows having a three-dimensional (3D) rendering of the CT image and position of the implant. The choice of prosthetic implant is one of the features on which the long-term success of revision prosthetic surgery is based: cemented or uncemented, long/modular stems, convertible system, use of allograft, custom-made implants. Preoperative planning is the key step before entering the operating room with the correct diagnosis and all the necessary materials for the surgery to obtain a satisfactory result.