Do I need to order additional imaging for a patient with a left reverse gleno-humeral arthroplasty (reverse shoulder replacement) without acute hardware complications or fractures?

Follow-Up Imaging After Uncomplicated Reverse Shoulder Arthroplasty

No additional imaging is needed at this time for these normal X-ray findings showing an intact reverse shoulder arthroplasty without complications. The current radiographs have already served their surveillance purpose and show no acute issues requiring further workup 1.

Clinical Context and Imaging Strategy

Your patient's X-rays demonstrate:

• Intact reverse glenohumeral arthroplasty hardware without loosening
• No acute fractures (periprosthetic or otherwise)
• No hardware complications

This represents a normal postoperative appearance that does not warrant additional imaging studies 1.

Evidence-Based Follow-Up Recommendations

For Asymptomatic Patients (Current Scenario)

• No CT, MRI, bone scan, ultrasound, or nuclear medicine studies are indicated for asymptomatic patients with normal radiographs 1
• The American College of Radiology explicitly states that CT, MRI, bone scans, and ultrasound examinations are not typically ordered for evaluation of the asymptomatic patient 1

Routine Surveillance Schedule

If this patient remains asymptomatic, the standard follow-up imaging protocol is:

• Yearly radiographs to monitor for interval changes in bone surrounding the prosthesis 1
• Long-term surveillance is important because late complications (loosening, infection, fracture) can occur up to 15 years postoperatively and may be asymptomatic initially 1
• Scapular notching on serial radiographs is particularly important to monitor in reverse total shoulder arthroplasty, as it has been associated with poor clinical outcomes 1

Important Caveats

The routine use of radiographic imaging in the first postoperative year in asymptomatic patients has been questioned in recent assessments 1. However, given that complications can be detected early when asymptomatic, yearly surveillance remains the standard recommendation 1.

When Additional Imaging IS Needed

Only order additional imaging if the patient develops symptoms:

• New or worsening pain (activity-related or at rest)
• Decreased range of motion
• Apprehension or instability symptoms
• Signs of infection (fever, warmth, erythema)

For symptomatic patients, radiography remains the first-line imaging modality, with CT or advanced imaging reserved for specific clinical questions that radiographs cannot answer 1.

Common Pitfalls to Avoid

• Do not order "routine" CT or MRI after normal shoulder arthroplasty radiographs in asymptomatic patients—this adds cost and radiation exposure without clinical benefit 1
• Do not confuse immediate postoperative imaging protocols (which may include radiographs at 3-6 weeks) with long-term surveillance needs 1
• Remember that reverse shoulder arthroplasty has specific complications to monitor (scapular notching, baseplate failure, acromial fractures) that differ from anatomic total shoulder arthroplasty 1, 2, 3