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Werner BC, Nauert R, Harmsen S, Denard PJ, Lederman E, Gobezie R, Goodloe JB. The effect of lateralization on clinical outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2025; 34:1498-1506. [PMID: 39617123 DOI: 10.1016/j.jse.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/11/2024] [Accepted: 09/14/2024] [Indexed: 02/14/2025]
Abstract
BACKGROUND Lateralization has been previously studied for reverse shoulder arthroplasty, but there is little clinical research investigating the independent effect of medialization or lateralization of the joint line, nor global medialization or lateralization for anatomic total shoulder arthroplasty (TSA). The goal of this study was to assess the impact of lateralization on clinical outcomes after anatomic TSA. METHODS A retrospective review of a multi-institutional registry was performed. All anatomic TSAs with postoperative radiographs and minimum 2-year clinical outcomes were included. Six measurements were made on postoperative radiographs: (1) humeral center of rotation (COR) shift from ideal, (2) acromion to glenoid distance, (3) glenoid to greater tuberosity distance, (4) acromion to greater tuberosity distance, (5) lateralization shoulder angle, and (6) critical shoulder angle. Linear regression analyses were performed to evaluate any associations between radiographic measures and patient reported outcomes, range of motion (ROM), and strength. RESULTS A total of 357 patients were included, of which mean age was 65 years and 61% were male. For PROs, the COR (P = .002) was significantly associated with the American Shoulder and Elbow Surgeons score. Additionally, COR was significantly associated with the Western Ontario Osteoarthritis of the Shoulder score. For ROM, COR shift was the only radiographic measure with a significant association with forward flexion (P = .002). Other significant associations with ROM in the regressions were: use of computed tomography based preoperative planning (forward flexion) and preoperative ROM. The acromion to glenoid distance distance (P = .008) and glenoid to greater tuberosity distance (P = .002) were both significantly associated with external rotation strength. CONCLUSIONS Increasing humeral COR shift negatively impacts PROs and ROM after anatomic TSA regardless of the joint line position. Increased glenoid lateralization and increased global lateralization were associated with increased ER strength.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
| | - Richard Nauert
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Samuel Harmsen
- Department of Orthopaedic Surgery, Banner Health, Phoenix, AZ, USA
| | | | - Evan Lederman
- Department of Orthopaedic Surgery, Banner Health, Phoenix, AZ, USA
| | | | - J Brett Goodloe
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Ranieri R, Cointat C, Lacouture-Suarez JD, Boileau P. B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty. J Shoulder Elbow Surg 2025; 34:726-738. [PMID: 39147269 DOI: 10.1016/j.jse.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Posterior humeral subluxation (PHS) in B2 and B3 glenoid is a cause of asymmetric long-term stress on the glenoid and the potential reason for glenoid loosening in anatomic total shoulder arthroplasty and painful glenoid erosion in hemiarthroplasty with metallic heads. We hypothesized that corrective and concentric (C2) reaming of the glenoid associated with pyrocarbon hemiarthroplasty (HA-PYC) could improve the centering of the humeral head and decrease the risk of persistent painful glenoid erosion in young and active patients with B2 and B3 glenoid. METHODS Between 2014 and 2020, 41shoulders (in 35 patients, mean age of 57.9 years) underwent HA-PYC combined with C2 reaming for B2 (n = 30) or B3 (n = 11) osteoarthritis. Patients were prospectively followed with computed tomography (CT) scans performed preoperatively, immediate postoperatively, and at last follow-up (>2 years). The primary outcomes were 3D-corrected CT scan measurements of glenoid version, PHS, and progression of glenoid erosion. Secondary outcomes included functional outcome scores, return to activities, and revision rate and complications. RESULTS At a mean follow-up of 4.5 years (2-9.5 years), the prosthesis survival was 95% (39 of 41). No patient has been reoperated for painful glenoid erosion. The mean glenoid retroversion decreased from 17.1° ± 7.5° preoperatively to 8.3° ± 8.2° at last follow-up (P = .001), and the mean PHS from 74% to 56.5% (P = .001) based on the scapular plane and from 59.9% to 50.3% based on the glenoid plane. The humeral head was recentered in 97% according to the glenoid surface and 71% according to the scapular plane. Correction of PHS in the scapular plane was highly correlated to correction of glenoid retroversion (P < .001). CT scan measurements showed that the average total medialization was 3.7 ± 3.2 mm (2.0 ± 1.8 mm due to reaming and only 1.7 ± 2.4 mm due to erosion). The adjusted Constant Score increased from 43% ± 13% to 97% ± 16% and the Subjective Shoulder Value from 38% ± 14% to 84% ± 12% (P < .001). Overall, 84% of active patients returned to work, and all patients returned to sports. CONCLUSION In B2 and B3 glenoid arthritis, corrective, concentric glenoid reaming combined with HA-PYC improves centering of the humeral head and shows a low risk of painful glenoid erosion at midterm follow-up. The combined procedure results in excellent functional outcomes and high prosthesis survivorship at midterm follow-up. HA-PYC and C2 reaming of the glenoid is an alternative shoulder arthroplasty for young/active patients with type B glenoid osteoarthritis who want to return to work or sports practice.
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Affiliation(s)
- Riccardo Ranieri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | | | - Pascal Boileau
- Institut de Chirugie Réparatrice (ICR) Locomoteur & Sport, Clinique Kantys Centre, Groupe Kantys, Nice, France.
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Crutcher WL, Dane I, Whitson AJ, Matsen Iii FA, Hsu JE. An accelerated deep learning model can accurately identify clinically important humeral and scapular landmarks on plain radiographs obtained before and after anatomic arthroplasty. INTERNATIONAL ORTHOPAEDICS 2025; 49:455-460. [PMID: 39760903 DOI: 10.1007/s00264-024-06401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 12/25/2024] [Indexed: 01/07/2025]
Abstract
PURPOSE Accurate identification of radiographic landmarks is fundamental to characterizing glenohumeral relationships before and sequentially after shoulder arthroplasty, but manual annotation of these radiographs is laborious. We report on the use of artificial intelligence, specifically computer vision and deep learning models (DLMs), in determining the accuracy of DLM-identified and surgeon identified (SI) landmarks before and after anatomic shoulder arthroplasty. MATERIALS & METHODS 240 true anteroposterior radiographs were annotated using 11 standard osseous landmarks to train a deep learning model. Radiographs were modified to allow for a training model consisting of 2,260 images. The accuracy of DLM landmarks was compared to manually annotated radiographs using 60 radiographs not used in the training model. In addition, we also performed 14 different measurements of component positioning and compared these to measurements made based on DLM landmarks. RESULTS The mean deviation between DLM vs. SI cortical landmarks was 1.9 ± 1.9 mm. Scapular landmarks had slightly lower deviations compared to humeral landmarks (1.5 ± 1.8 mm vs. 2.1 ± 2.0 mm, p < 0.001). The DLM was also found to be accurate with respect to 14 measures of scapular, humeral, and glenohumeral measurements with a mean deviation of 2.9 ± 2.7 mm. CONCLUSIONS An accelerated deep learning model using a base of only 240 annotated images was able to achieve low levels of deviation in identifying common humeral and scapular landmarks on preoperative and postoperative radiographs. The reliability and efficiency of this deep learning model represents a powerful tool to analyze preoperative and postoperative radiographs while avoiding human observer bias. LEVEL OF EVIDENCE IV.
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Sperling JW, Anderson MB, Jobin CM, Verborgt O, Duquin TR. Humeral and glenoid component malposition in patients requiring revision shoulder arthroplasty: a retrospective, cross-sectional study. J Shoulder Elbow Surg 2025:S1058-2746(25)00015-1. [PMID: 39814127 DOI: 10.1016/j.jse.2024.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 11/04/2024] [Accepted: 11/10/2024] [Indexed: 01/18/2025]
Abstract
BACKGROUND The purpose of this study was to assess the incidence of glenoid and humeral component malposition in failed primary shoulder arthroplasty requiring revision. We hypothesized that glenoid and humeral component malposition would be a prevalent feature in cases requiring revision arthroplasty for primary anatomic total shoulder arthroplasty (TSA), primary reverse shoulder arthroplasty (RSA), and primary hemiarthroplasty procedures. METHODS A retrospective cross-sectional study was performed focusing on identifying the incidence of malpositioned components in shoulder arthroplasty in quantitative and qualitative reviews. A total of 234 consecutive cases from 3 institutions were included in the study. Past surgical and radiographic data relative to the primary and revision surgeries were collected by each of the 3 investigative institutions, and radiographs were reviewed by an independent reviewer. Descriptive data are summarized as means, ± standard deviations, or frequency (%). An Exact McNemar's test was used to compare frequencies between the independent reviewer and the institutions when appropriate, with significance set at P = .05. RESULTS Quantitative analysis demonstrated that the majority of glenoid components in these revision cases were malpositioned in both TSA (51%) and RSA (93%) when all measures were considered. Similarly, there was humeral component malposition in 57% of TSA cases, 62% of RSA cases, and 54% of hemiarthroplasty cases when all measures were considered. When asked if there was glenoid component malposition, the independent reviewer considered 17% of glenoid components to be malpositioned in TSA cases and 54% in RSA cases. The investigative institutions reported similar rates (P = .585). For the humeral side, the independent reviewer felt that 71% of TSA cases, 24% of RSA cases, and 74% of hemiarthroplasty implants were malpositioned in some direction. The investigative institutions reported similar rates (P = .087). DISCUSSION AND CONCLUSION The data from this study suggest that component malposition is frequently present among patients requiring revision arthroplasty. Component malposition was not just frequently present, but also occurred in consistent patterns. Moreover, while significant attention has been placed on the impact of glenoid malposition, this study highlights the previously underappreciated high incidence of humeral component malposition in cases requiring revision arthroplasty.
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Affiliation(s)
| | | | - Charles M Jobin
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, New York, NY, USA
| | - Olivier Verborgt
- Orthopaedic Center Antwerp (ORTHOCA), AZ Monica, Antwerp, Belgium & Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Thomas R Duquin
- Department of Orthopedic Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, NY, USA
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Halm-Pozniak A, Riediger C, Kopsch E, Awiszus F, Lohmann CH, Berth A. Influence of humeral position of the Affinis Short stemless shoulder arthroplasty system on long-term survival and clinical outcome. J Shoulder Elbow Surg 2024; 33:2202-2212. [PMID: 38514008 DOI: 10.1016/j.jse.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of humeral position of the Affinis Short implant in stemless anatomic total shoulder arthroplasties (STSAs) on clinical and radiologic results and mid- to long-term survival in the treatment of primary osteoarthritis (OA) of the shoulder. METHODS Eighty patients treated with a stemless shoulder arthroplasty for OA of the shoulder were evaluated with a mean follow-up of 92 ± 14 months (range 69-116 months) by the Constant Score (CS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and active range of motion (ROM). Radiographic assessment for bone adaptations and humeral implant position was performed by plain radiographs. Comparison of the pre- and postoperative centers of rotation (CORs) was used to assess the restoration of the geometry of the humeral head. The appraisal of proper humeral component positioning was correlated with the functional outcomes. A Kaplan-Meier analysis was performed to investigate the influence of humeral implant position compared to survival time. Complications were noted. RESULTS The ROM (P < .001), CS (P < .001), and DASH scores (P < .001) showed significant improvements after surgery for the entire series. The COR restoration was anatomic in 75% (n = 60) of all implants and in 25% (n = 20) nonanatomic implants (pre- and postoperative COR deviation of 2.7 ± 1.8 mm vs. 5.1 ± 3.2 mm, P = .0380). The humeral component position did not affect the functional outcome whereas the 10-year unadjusted cumulative survival rate for the anatomic group was significantly higher in comparison with the nonanatomic group (96.7% vs. 75%, P = .002). The radiologic evaluation revealed minor periprosthetic bone adaptions in various forms without clinical significance or further intervention. No revision was necessary because of a failed fixation of the stemless humeral component. CONCLUSIONS Regarding the treatment of primary OA of the shoulder, STSA shows excellent long-term survival and clinical outcomes. In particular, STSA implants are able to restore the geometry of the humeral head. Nonanatomic reconstruction may influence the survival over the long term in different pathways. Further studies are necessary to elucidate the effect of humeral component position in STSA on function, pain, and implant survival rates.
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Affiliation(s)
| | - Christian Riediger
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Elisabeth Kopsch
- Department of Pediatrics, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
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Miettinen SSA, Liu Y, Kröger H. Long-term survival of resurfacing humeral hemiarthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2925-2932. [PMID: 38809422 PMCID: PMC11377525 DOI: 10.1007/s00590-024-04010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The indication for shoulder resurfacing arthroplasty is controversial, and survival of these implants is somewhat inconsistent. This study aimed to evaluate the long-term survivorship of resurfacing humeral head implants (RHHIs) and determine risk factors for complications and revisions. MATERIALS AND METHODS This retrospective cohort study consisted of 275 cases and two types of RHHIs. The survival rate was evaluated using the Kaplan-Meier method and Cox regression for risk factor analysis. Demographic factors were studied, and the change in the humerus centre of rotation (COR) was measured. RESULTS The mean follow-up time was 8.7 years (SD 2.7 months, range 2.8-15.9 years). The mean age of the patients was 67.6 years (SD 9.6, range 33.5-84.9). Ten-year cumulative RHHI survival was 94.1%. The cumulative estimate without any complication was 98.9% at 5 years, 80.0% at 10 years and at 15 years it was 61.5%. The most common complication was persistent pain in 13.8% of the RHHIs. The risk factors for complications and revisions were implant type, preoperative conditions and change of COR > 5 mm. CONCLUSIONS RRHIs showed excellent long-term survival, but many complications were found. The most common complication was persistent pain, which seemed to be caused by a change of COR and was more related to one type of implant.
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Affiliation(s)
- Simo S A Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland.
- Kuopio Musculoskeletal Research Unit (KMRU), Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
| | - Yang Liu
- Kuopio Musculoskeletal Research Unit (KMRU), Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit (KMRU), Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
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Panther EJ, Hao KA, Patrick MR, King JJ, Wright TW, Struk AM, Wright JO, Schoch BS. A reproducible method for evaluating the degree and direction of overstuffing of the humeral head component in anatomic total shoulder arthroplasty. Shoulder Elbow 2024:17585732241258069. [PMID: 39552655 PMCID: PMC11562209 DOI: 10.1177/17585732241258069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 11/19/2024]
Abstract
Background Improper sizing of the humeral head component in anatomic total shoulder arthroplasty (ATSA) can overstuff the joint, potentially compromising outcomes. The purpose of this study was to validate a novel method of evaluating glenohumeral joint overstuffing in which superoinferior and mediolateral overstuffing can be evaluated independently relative to the native humeral anatomy. Methods We identified 25 patients who underwent ATSA and the best Grashey radiograph taken within 1 year of follow-up was assessed using our proposed technique. First, a circle overlaying the implanted humeral head was made. Then, Iannotti's Perfect Circle (IPC) was drawn as originally described. Measurements of superior and medial overstuffing were made using our proposed axes. Inter-rater reliability was assessed by computing interclass correlation coefficients (ICC) using a one-way model. Measurements were summarized as the mean and range, with positive values denoting overstuffing. Results The inter-rater reliability for all measurements was excellent (ICC > 0.9). Compared to our method, the IPC method would have missed 77% of overstuffed cases. Conclusion We present a reproducible method to assess glenohumeral joint overstuffing in ATSA. This technique addresses limitations of other methods that underestimate overstuffing. Further study is needed to establish a clinically significant value of overstuffing based on the proposed method.
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Affiliation(s)
- Eric J Panther
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew R Patrick
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Hoffman RA, Covarrubias O, Agaisse T, Portnoff B, Green A. How anatomic should anatomic total shoulder arthroplasty be? Evaluation of humeral head reconstruction with the best-fit circle. J Shoulder Elbow Surg 2024; 33:S43-S48. [PMID: 38554996 DOI: 10.1016/j.jse.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Humeral implant designs for anatomic total shoulder arthroplasty (aTSA) focus on anatomic reconstruction of the articular segment. Likewise, the pathoanatomy of advanced glenohumeral osteoarthritis often results in humeral head deformity. We hypothesized the anatomic reconstruction of the humeral head in aTSA risks overstuffing the glenohumeral joint. METHODS Ninety-seven cases (52 females) of primary glenohumeral osteoarthritis in patients treated with aTSA were evaluated. Preoperative computed tomography scans were used to classify glenoid morphology according to the Walch classification. Coronal plane images in the plane of the humerus were used to determine the anatomic best-fit circle as described by Youderian et al. Humeral head thinning was determined as the distance from the center of rotation of the best-fit circle to the nearest point along the humeral articular surface. aTSA was modeled with a predicted anatomic humeral head and a simulated 4-mm polyethylene glenoid component. The change in the position of the native humerus was determined. Wilcoxon Rank Sum tests were used to evaluate differences in humeral head thinning and humeral lateralization between monoconcave and biconcave glenoid morphologies. Spearman's rank correlation coefficients were used to assess the relationship between humeral head thinning with preoperative active forward elevation and external rotation. RESULTS The mean radius of the best-fit circle was 25.0 ± 2.1 mm. There was a mean thinning of 2.4 ± 2.0 mm (range -1.7 to 8.3). The mean percent thinning of the humeral head was 9.4% ± 7.7%. The mean humeral lateralization was 6.4 ± 2.0 mm. Humeral head thinning was not significantly associated with active forward elevation (r = -0.15, P = .14) or active external rotation (r = -0.12, P = .25). There were no significant differences in the percentage of humeral head thinning (P = .324) or humeral lateralization (P = .350) between concentric and eccentric glenoid wear patterns. CONCLUSIONS Utilization of the best-fit circle as a guide in aTSA may risk excessive lateralization of the humerus and overstuffing the glenohumeral joint. This may have implications for subscapularis repair and healing, as well as glenoid implant and rotator cuff longevity. These findings call into question whether recreation of normal glenohumeral anatomy in aTSA is appropriate for all patients. Humeral head reconstruction in aTSA should account for glenohumeral joint volume and soft tissue contracture.
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Affiliation(s)
- Ryan A Hoffman
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Oscar Covarrubias
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ty Agaisse
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Brandon Portnoff
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA.
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Smith AF, Schmidt CM, Tabbaa A, Gutiérrez S, Simon P, Mighell MA, Frankle MA. Glenoid-based reference system to differentiate shoulder pathologies on plain radiographs. J Shoulder Elbow Surg 2024; 33:S111-S121. [PMID: 37777046 DOI: 10.1016/j.jse.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Shoulder radiographs are used for evaluation and the planning of treatment of various pathologies. Making a diagnosis of these pathologies on plain radiographs occurs by recognizing the relationship of the humeral head on the registry of the glenoid. Quantification of these changes in registry does not currently exist. We hypothesize that a geometric relationship of the humeral head and the glenoid exists that is defined on an anteroposterior Grashey view radiograph by the relationship of the best-fit circle of the humeral head relative to the best-fit circle of the glenoid such that relative measurements will define the normal shoulder and the pathologic shoulder. METHODS One hundred fifty-six shoulders were included: 53 normal shoulders, 51 with primary glenohumeral osteoarthritis (GHOA), and 52 with cuff tear arthropathy (CTA). Humeral head best-fit circle was used to define the circle of the humeral head (cHH). A glenoid best-fit circle (cG) was defined by the following rules: (1) best fit of the glenoid articular surface and (2) was limited by the acromion such that either (a) it reaches maximal interaction with the inferior surface of the acromion or (b) the perimeter of the circle is at the lateralmost point of the acromion. The relationship between cHH and cG is defined by measurement of cHH in horizontal and vertical planes relative to the glenoid circle reference. The horizontal displacement angle (HDA) measures the horizontal position of cHH relative to cG, representing the degree of medialization toward the glenoid. The vertical displacement angle (VDA) measures the vertical position of cHH relative to cG, representing the degree of superiorization toward the acromion. Angles were compared by diagnosis and sex. RESULTS The mean HDA was 61.0° (95% confidence interval [CI] 60.3°-61.7°) in normal shoulders, 79.9° (95% CI 76.9°-82.9°) in GHOA, and 63.4° (95% CI 61.7°-65.1°) in CTA (P < .001). The mean VDA was 43.1° (95% CI 42.2°-44.0°) in normal shoulders, 40.9° (95% CI 39.9°-42.0°) in GHOA, and 59.7° (95% CI 57.6°-61.7°) in CTA (P < .001). Interobserver reliability was 0.991 (95% CI 0.94-1.0) and intraobserver reliability was 0.998 (95% CI 0.99-1.0). The geometric relationship of cHH to the glenoid circle reference was plotted for each group. CONCLUSION A geometric relationship exists of the humeral head in reference to the glenoid circle. Together, the HDA and the VDA distinguish between a normal shoulder and those with GHOA or CTA. This suggests that this novel methodology may provide a preoperative planning tool that is easily accessible.
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Affiliation(s)
- Austin F Smith
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; OrthoArizona, Phoenix, AZ, USA
| | - Christian M Schmidt
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ameer Tabbaa
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Sergio Gutiérrez
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Mark A Mighell
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Giraudon T, Morvan Y, Walch A, Walch G, Werthel JD. Premorbid glenoid anatomy reconstruction from contralateral shoulder 3-dimensional measurements: a computed tomography scan analysis of 260 shoulders. J Shoulder Elbow Surg 2024; 33:792-797. [PMID: 37852431 DOI: 10.1016/j.jse.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) aims to reconstruct the premorbid anatomy of a pathologic shoulder. A healthy contralateral shoulder could be useful as a template in planning TSA. The symmetry between the left and right shoulders in healthy patients remains to be proved. The purpose of this study was to compare the 3-dimensional anatomy of the glenoid between sides in a healthy population. METHODS A multinational computed tomography scan database was retrospectively reviewed for all healthy bilateral shoulders in patients aged between 18 and 50 years. One hundred thirty pairs of healthy shoulder computed tomography scans were analyzed, and glenoid version, inclination, width, and height, as well as glenoid lateral offset and scapula lateral offset, were measured. All anatomic measures were computed with Blueprint, validated 3-dimensional planning software. The intraclass correlation coefficient was determined for each measure between left and right shoulders. The minimal detectable change (MDC) was calculated using the following formula: MDC=2×1.96×Standarderrorofmeasurement. RESULTS The comparison between 130 pairs of healthy scapulae showed statistically significant differences in absolute values between right and left glenoid version (-5.3° vs. -4.6°, P < .01), inclination (8.4° vs. 9.3°, P < .01), and width (25.6 mm vs. 25.4 mm, P < .01), as well as scapula offset (105.8 mm vs. 106.2 mm, P < .01). Glenoid height was comparable between right and left shoulders (33.3 mm vs. 33.3 mm, P = .9). The differences between the means were always inferior to the MDC regarding glenoid version, inclination, height, and width, as well as scapula offset. Very strong intraclass correlation coefficients between the left and right shoulders were found for all evaluated paired measures. CONCLUSION Healthy contralateral scapulae are highly reliable to predict inclination, height, width, and scapula offset and are reliable to predict version of a given scapula. Paired right and left scapulae were not statistically symmetrical regarding mean glenoid version, inclination, and width, as well as scapula offset. Nevertheless, the reported differences were not higher than the MDC for this cohort, confirming that healthy contralateral shoulders can be a useful template in TSA preoperative planning.
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Affiliation(s)
| | | | - Arnaud Walch
- Hôpital Pierre Zobda-Quitman, Fort-de-France, France
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Hasler A, Ker A, Grubhofer F, El Nashar R, Ernstbrunner L, Gerber C, Wieser K. Clinical and radiographic long-term outcomes of hemiarthroplasty for complex proximal humeral fractures. J Shoulder Elbow Surg 2024; 33:698-706. [PMID: 37611843 DOI: 10.1016/j.jse.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Hemiarthroplasty (HA) is a treatment option for complex proximal humeral fractures not suitable for conservative treatment or open reduction-internal fixation. Long-term outcomes using a large-metaphyseal volume prosthesis in the management of proximal humeral fractures have not been reported thus far. METHODS Between 2006 and 2010, 41 patients with proximal humeral fractures were treated with HA at our institution (average age, 62 years; age range, 38-85 years). Nine patients underwent revision surgery, 3 were lost to follow-up, and 7 died unrelated to the index surgical procedure. Twenty-two patients were reviewed clinically and radiographically after a mean period of 10.4 years (range, 9-13 years). RESULTS Of the 9 HA failures, 7 occurred within the first 2 postoperative years: 2 patients had infections and 5 had greater tuberosity nonunions or malunions. The other 2 patients underwent revision for rotator cuff deficiency >5 years after initial surgery. Among the patients available for final follow-up, the implant survival rate was 71% (22 of 31 patients). At final follow-up, these patients showed a mean relative Constant score of 76% (range, 49%-96%), mean active elevation of 116° (range, 60°-170°), and mean external rotation of 28° (range, 0°-55°). The majority had good or excellent internal rotation, with internal rotation to the 12th thoracic vertebra in 13 patients (59%) and to the eighth thoracic vertebra in 7 (31%). The mean Subjective Shoulder Value was 76% (range, 40%-100%). Clinical outcomes did not significantly deteriorate over a period of 10 years, except for flexion (P < .001) and internal rotation (P = .002). On analysis of greater tuberosity healing, 1 patient had a nonunion and 10 patients (45%) had a malunion, whereas the greater tuberosity had healed in an anatomic position in 12 patients (55%). Patients with a displaced malunion of the greater tuberosity did not have inferior clinical results at last follow-up. Only 2 patients showed glenoid erosion, and in no patients could stem loosening be identified at final follow-up. CONCLUSION The revision rate following large-metaphyseal volume HA to treat a proximal humeral fracture was 29% after 10 years postoperatively, with failure within 2 years largely related to greater tuberosity nonunion or malunion and failure later related to rotator cuff insufficiency. Patients with a retained implant showed good clinical and radiographic long-term results, without relevant deterioration over time even when the greater tuberosity healed in a nonanatomic position.
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Affiliation(s)
- Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrew Ker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rany El Nashar
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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12
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Jennewine BR, James NF, Polio WP, Naser AM, Nieboer MJ, Schoch BS, Throckmorton TW, Bernholt DL, Azar FM, Brolin TJ. Superior humeral head osteophytes are associated with rotator cuff insufficiency in glenohumeral osteoarthritis: a retrospective analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:893-900. [PMID: 37770594 DOI: 10.1007/s00590-023-03727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE The primary goal of this study was to investigate whether superior humeral head osteophyte (SHO) size is associated with rotator cuff insufficiency, including rotator cuff tear (RCT), supraspinatus tendon thickness, and fatty infiltration of the rotator cuff muscles. METHODS Patients ≥ 18 years who were diagnosed with glenohumeral osteoarthritis were retrospectively reviewed. SHO size was determined by radiograph. MRI measured SHO and RCT presence, type, and size; supraspinatus tendon thickness; and fatty infiltration of rotator cuff musculature. RESULTS A total of 461 patients were included. Mean SHO size was 1.93 mm on radiographs and 2.13 mm on MRI. Risk ratio for a RCT was 1.14. For each 1-mm increase in SHO size on radiograph, supraspinatus tendon thickness decreased by 0.20 mm. SHO presence was associated with moderate-to-severe fatty infiltration of the supraspinatus with a risk ratio of 3.16. CONCLUSION SHOs were not associated with RCT but were associated with higher risk of supraspinatus FI and decreased tendon thickness, which could indicate rotator cuff insufficiency. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brenton R Jennewine
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - Nicholas F James
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - William P Polio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN, USA
| | - Micah J Nieboer
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - David L Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA.
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Warren E, Levin JM, Rechenmacher AJ, Hurley ET, Lassiter T, Klifto CS, Anakwenze O. Radiographic comparison of eccentric stemmed vs. concentric stemless prosthetic humeral head positioning after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:90-98. [PMID: 37419439 DOI: 10.1016/j.jse.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Maintaining premorbid proximal humeral positioning is an essential consideration of anatomic total shoulder arthroplasty (aTSA), as malposition of the prosthetic humeral head can result in poor clinical outcomes. Stemless aTSA prosthetic heads are usually concentric, while stemmed aTSA prosthetic heads are typically eccentric in nature. Therefore, the purpose of this study was to compare the ability to restore native humeral head position between stemmed (eccentric) vs. stemless (concentric) aTSA. MATERIALS AND METHODS Postoperative anteroposterior radiographs of 52 stemmed and 46 stemless aTSAs were analyzed. A best-fit circle was created using previously published and validated techniques to represent the premorbid humeral head position and axis of rotation. This circle was juxtaposed with another circle following the arc of the implant head. Next, the offset in center of rotation (COR), radius of curvature (RoC), and humeral head height above the greater tuberosity (HHH) were measured. Additionally, based on prior studies, an offset of >3 mm at any point between the implant head surface and premorbid best-fit circle was considered significant and further classified as overstuffed or understuffed. RESULTS RoC deviation was significantly greater in the stemmed cohort than the stemless cohort (1.19 ± 1.37 mm vs. 0.65 ± 1.17 mm, P = .025). There was no statistically significant difference in deviation from premorbid humeral head between the stemmed and stemless cohorts for COR (3.20 ± 2.28 mm vs. 3.23 ± 2.09 mm, P = .800) or HHH (1.12 ± 3.27 mm vs. 0.92 ± 2.70 mm, P = .677). When comparing overstuffed implants to appropriately placed implants, there was a significant difference in overall COR deviation in stemmed implants (3.93 ± 2.51 mm vs. 1.92 ± 1.05 mm, P < .001). Superoinferior COR deviation (stemmed: 2.38 ± 3.01 mm vs. -0.61 ± 1.59 mm, P < .001; stemless: 2.70 ± 1.75 mm vs. -0.16 ± 1.87 mm, P < .001), mediolateral COR deviation (stemmed: 0.79 ± 2.65 mm vs. -0.62 ± 1.27 mm, P = .020; stemless: 0.40 ± 1.41 mm vs. -1.13 ± 1.96 mm, P = .020), and HHH (stemmed: 3.61 ± 2.73 mm vs. 0.50 ± 1.31 mm, P < .001; stemless: 3.98 ± 1.18 mm vs. 0.53 ± 1.41 mm, P < .001) were significantly different between overstuffed implants and appropriate implants in both the stemmed and stemless cohorts. DISCUSSION Stemless and stemmed aTSA implants have similar rates of reproducing satisfactory postoperative humeral head COR with both producing COR deviation most commonly in the superomedial direction. Deviation in HHH contributes to overstuffing in both stemmed and stemless implants, COR deviation contributes to overstuffing in stemmed implants, while RoC (humeral head size) is not associated with overstuffing. Based on this study, it appears that neither eccentric nor concentric prosthetic heads are superior in recreating premorbid humeral head position.
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Affiliation(s)
- Eric Warren
- Duke University School of Medicine, Duke University, Durham, NC, USA.
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tally Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Giannotti S, Troiano E, Saviori M, Crippa Orlandi N, Greco T, Perisano C, Colasanti GB, Mondanelli N. Humeral Resurfacing Arthroplasty: Clinical, Functional and Radiological Assessment at a Mean Follow-Up of 11 Years. PROSTHESIS 2023; 5:1312-1321. [DOI: 10.3390/prosthesis5040090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Humeral resurfacing arthroplasty (HRA) entails the substitution of the articular surface alone with a prosthetic cap without a humeral stem. It is a more conservative procedure which can be easily converted in a total (anatomical or reverse) arthroplasty, if necessary. The present study aimed to evaluate the clinical and radiographical outcomes in a series of patients treated with HRA by a single surgeon. Thirty-three patients with a mean follow-up of 11 years were clinically (Constant score; disability of the arm, shoulder and hand score, DASH) and radiographically assessed before and after surgery. The Constant and DASH scores improved significantly after surgery, and only two cases needed revision surgery. HRA represents a valid therapeutic option in selected cases to improve the quality of life and prevents the need for more invasive procedures.
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Affiliation(s)
- Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Elisa Troiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Marco Saviori
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Nicholas Crippa Orlandi
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Tommaso Greco
- Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Perisano
- Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Battista Colasanti
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
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15
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Papadopoulos DV, Nikolaou VS, Masouros P, Babis GC, Imbriglia JE. The impact of glenoid parameters and implant overstuffing on functional outcomes of shoulder hemiarthroplasty in patients with glenohumeral joint arthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3531-3538. [PMID: 37212913 DOI: 10.1007/s00590-023-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty. METHODS We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes. RESULTS The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001). CONCLUSION Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.
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Affiliation(s)
| | - Vasileios S Nikolaou
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | | | - George C Babis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Mathon P, Chivot M, Galland A, Airaudi S, Gravier R. Pyrolytic carbon head shoulder arthroplasty: CT scan glenoid bone modeling assessment and clinical results at 3-year follow-up. JSES Int 2023; 7:2476-2485. [PMID: 37969536 PMCID: PMC10638580 DOI: 10.1016/j.jseint.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study is to report the radiological glenoid modifications and clinical outcomes at 3 years mean follow-up of hemi shoulder arthroplasty (HA) with pyrocarbon (PYC) humeral head. Our hypothesis was that the PYC implants would provide good outcomes without major glenoid erosion. Additionally, we hypothesized that HA-PYC allowed for remodeling of the bone. Methods Patients underwent HA with PyC humeral head for treatment of primary or secondary osteoarthritis, excluding post-traumatic cases. All patients had a Constant Score assessed preoperatively and at the last follow-up. Preoperative and postoperative computed tomography scans at the last follow-up were performed to achieve 3-dimensional reconstructions of the scapulae. Deformities of the glenoid surface were analyzed as a distance differential between postoperative and preoperative to investigate potential bone remodeling vs. glenoid erosion. The subluxation index (SLI) was measured. Results We included 41 patients implanted with a HA-PYC. Average age at the time of implant was 63.8 (40 to 79 years). All patients were followed for ≥2 years with an average follow-up of 36.3 months (24 to 60 months). Constant Scores increased from 34 at baseline to 80 at the last follow-up points on average (P < .01). Return to work rate was 100% and 96% had resumed their physical activity. Ten (77%) of the 13 patients with posterior head subluxation had normalized their SLI. Furthermore, no significant differences were detected between the individuals having corrected their posterior subluxation and the others (preoperative SLI between 0.45 and 0.55). Glenoid wear is less than 0.6 mm at 3 years mean follow-up, ie, 5 times less than metallic implants. A tendency to recenter the head in the anteroposterior plane was found in type B glenoid, without increased erosion of the glenoid, with very good clinical results. We did not find any difference according to age or glenoid type for clinical and radiological results. Conclusion HA-PYCs give, in the short term, excellent clinical results in terms of pain and function. The development of a precise and objective measurement method has made it possible to demonstrate that the glenoid surface is the site of modifications that may be part of bone remodeling or progression of the osteoarthritis disease.
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Affiliation(s)
- Pauline Mathon
- Aix-Marseille University, CNRS, ISM UMR 7287, Marseille 13288, France
| | - Matthieu Chivot
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Hopital Privé Clairval (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Alexandre Galland
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Stéphane Airaudi
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Renaud Gravier
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
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17
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Ardebol J, Pak T, Kiliç AĪ, Hwang S, Menendez ME, Denard PJ. Secondary Rotator Cuff Insufficiency After Anatomic Total Shoulder Arthroplasty. JBJS Rev 2023; 11:01874474-202309000-00005. [PMID: 37729463 DOI: 10.2106/jbjs.rvw.23.00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
» Secondary rotator cuff insufficiency is a challenging complication after anatomic total shoulder arthroplasty.» Acute tears may be amenable to open or arthroscopic repair in some instances.» Chronic attritional tears are best managed with revision to reverse shoulder arthroplasty, especially in the elderly.» Increased glenoid inclination, larger critical shoulder angle, oversized humeral components, thicker glenoid components, and rotator cuff muscle fatty infiltration have all shown to contribute to tear risk.
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Affiliation(s)
| | | | - Ali Īhsan Kiliç
- Oregon Shoulder Institute, Medford, Oregon
- Izmir Bakircay University, Izmir, Turkey
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18
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Baumgarten KM. Patients who have intraoperative deviations in their preoperative plan have inferior clinical and radiographic outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:e451-e463. [PMID: 36868298 DOI: 10.1016/j.jse.2023.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Three-dimensional computed tomography preoperative planning has become adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients in whom the surgeon implanted prostheses that deviated from the preoperative plan compared with patients in whom the surgeon followed the preoperative plan. The hypothesis of this study was that clinical and radiographic outcomes would be equivalent between patients undergoing anatomic total shoulder arthroplasty that had a deviation in the components predicted in the preoperative plan and patients who did not have a change in the components predicted in the preoperative plan. METHODS A retrospective review of patients who had preoperative planning for anatomic total shoulder arthroplasty from March 2017 through October 2022 was performed. Patients were stratified into 2 groups: patients in whom the surgeon used components that deviated from those anticipated by the preoperative plan (changed group), and patients in whom the surgeon used all of the components anticipated by the preoperative plan (planned group). Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test (SST), and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. RESULTS A total of 159 patients had intraoperative changes to their preoperative plan, and 136 patients underwent arthroplasty without changes to their preoperative plan. The planned group had higher scores than the group that had a deviation in the preoperative plan for every patient-determined outcome metric at every postoperative time point with statistically significant improvements found in the SST and Single Assessment Numeric Evaluation at 1-year and the SST and American Shoulder and Elbow Surgeons score at 2-year follow-up. No differences were found in range of motion metrics between the groups. Patients who did not have a deviation in their preoperative plan had more optimal restoration of their postoperative radiographic center of rotation than patients who did have a deviation in their preoperative plan. CONCLUSIONS Patients who have intraoperative changes to their preoperative plan have (1) inferior postoperative patient-determined outcome scores at 1 and 2 years after surgery and (2) a larger deviation in the postoperative radiographic restoration of the humeral center of rotation than patients who did not have intraoperative changes from the initial plan.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Kim K, Ju S, Jeong J. Best-Fit Circle for the Replication of Humeral Head Anatomy in Total Shoulder Arthroplasty. Orthop J Sports Med 2023; 11:23259671231188695. [PMID: 37655240 PMCID: PMC10467389 DOI: 10.1177/23259671231188695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
Background Anatomic restoration of the humeral head is critical for successful shoulder replacement. Accurate measurements of the humeral head are essential for anatomic substitution. Purpose To evaluate whether a best-fit circle of the humeral head, as determined from different projections of plain radiographs, can predict the humeral head implant size for either the left or right shoulder. Study Design Descriptive laboratory study. Methods Bilateral shoulder radiographs of 200 patients without arthropathy or other abnormal findings of the humeral head were evaluated. The best-fit circle was obtained based on 3 points: the medial and lateral endpoints of the anatomic neck and the lateral cortex below the greater tuberosity. This circle was drawn on 5 different radiographic projections (shoulder anteroposterior [AP], glenoid AP, outlet, axillary, and 30° caudal tilt) of the left and right shoulders of each patient, and the radius of each circle was measured. Agreement in the best-fit circle radius between the left and right shoulders was statistically analyzed using the intraclass correlation coefficient (ICC). There were 2 independent blinded observers who performed each measurement twice to evaluate inter- and intraobserver reliability. Results Overall agreement in the radius between the right and left shoulders was excellent (all ICCs ≥0.990). The ICCs according to the radiographic view were 0.990 (95% CI, 0.986-0.993) for shoulder AP, 0.992 (95% CI, 0.989-0.995) for glenoid AP, 0.996 (95% CI, 0.994-0.997) for outlet, 0.994 (95% CI, 0.991-0.996) for axillary, and 0.993 (95% CI, 0.990-0.995) for 30° caudal tilt. Interobserver ICCs demonstrated a high level of precision: 0.987 (95% CI, 0.978-0.993) for shoulder AP, 0.986 (95% CI, 0.974-0.992) for glenoid AP, 0.974 (95% CI, 0.954-0.985) for outlet, 0.991 (95% CI, 0.984-0.995) for axillary, and 0.987 (95% CI, 0.977-0.993) for 30° caudal tilt. Intraobserver ICCs demonstrated excellent test-retest reliability: 0.983 (95% CI, 0.970-0.991) for shoulder AP, 0.989 (95% CI, 0.980-0.994) for glenoid AP, 0.987 (95% CI, 0.978-0.993) for outlet, 0.985 (95% CI, 0.973-0.991) for axillary, and 0.970 (95% CI, 0.947-0.983) for 30° caudal tilt. Conclusion The best-fit circle to calculate the ideal size of a humeral head implant was able to be determined from different projections of plain radiographs. Clinical Relevance Anatomic restoration of a deformed humeral head can be achieved using the best-fit circle of the contralateral humeral head as obtained from plain radiographs. This method can facilitate preoperative planning and postoperative evaluation in the anatomic restoration of the shoulder to avoid the problems of overstuffing.
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Affiliation(s)
- Kyungil Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Sunghun Ju
- Department of Orthopedic Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinyoung Jeong
- Department of Orthopedic Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Chawla L, Kumar K, Barker S, Ismail A. Restoration of the joint geometry after stemless shoulder arthroplasty. Shoulder Elbow 2023; 15:321-327. [PMID: 37325383 PMCID: PMC10268137 DOI: 10.1177/17585732221088999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 09/20/2023]
Abstract
Aim This study aims to evaluate restoration of anatomy following Total Shoulder Arthroplasty (TSA) with the Mathys Affinis Short prosthesis. Background Over the last decade stemless shoulder arthroplasty has increased in popularity. One of the reported advantages of the stemless designs is the ability to restore anatomy following surgery. However, very few studies have evaluated restoration of anatomy following stemless shoulder arthroplasty. Methods The study included all patients who had undergone TSA using the Affinis Short (Mathys Ltd, Bettlach, Switzerland) prosthesis for primary osteoarthritis between 2010 and 2016. The mean follow up was 42.8 months (range 9.4 to 83.4 months). Pre and post-operative radiographs were assessed for Centre of Rotation (COR), Humeral Head Height (HHH), Humeral Head Diameter (HHD), Humeral Height (HH) and, Neck Shaft Angle (NSA) using the best fit circle method on PACS software. Measurements were scored and compared to assess the accuracy of the implant in restoring the native geometry, including the intraobserver variability. The same data was collected by another experienced observer to measure the interobserver variability. Results The deviation of COR of the prosthesis from the anatomical centre was less than 3 mm in 58 cases (85%). Humeral head height and humeral head diameter showed a variation of less than 3 mm in 66 cases (97%) and 43 cases (63%) respectively. Humeral height followed a similar trend, with 62 cases (91.2%) showing a difference of less than 5 mm. The neck shaft angle showed a variation of more than 8 degrees in 38 cases (55%), and 29 cases (42.6%) had a postoperative angle of less than 130 degrees. Conclusion Overall, stemless total shoulder arthroplasty with the Affinis Short prosthesis allows excellent restoration of anatomy confirmed by most of the measured radiographic parameters. The variability in neck shaft angle might be due to differing surgical techniques, with some surgeons preferring a slightly vertical neck cut to protect the rotator cuff insertion.
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21
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Evaluation of the Painful Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2023; 31:440-449. [PMID: 36853881 DOI: 10.5435/jaaos-d-22-01006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/29/2023] [Indexed: 03/01/2023] Open
Abstract
Despite the overall success of anatomic and reverse total shoulder arthroplasties (aTSA and rTSA), some patients continue to have or develop pain postoperatively. As the number of shoulder arthroplasties continues to increase in the United States, it is important that surgeons are able to recognize, diagnose, and treat the various pathologies. Some painful etiologies are specific to either aTSA or rTSA, and others can occur with both implant types. Infections, stiffness, neurologic syndromes, polyethylene wear, aseptic implant loosening, and metal allergies occur, regardless of implant choice. However, after an aTSA, subscapularis repair failure, superior rotator cuff tear, and joint overstuffing can result in shoulder pain. After a rTSA, specific causes of postoperative pain include instability, scapular notching, acromial or scapular spine fractures, subcoracoid pain, and neurologic injury. Regardless of the diagnosis, the surgeon must be methodical in the evaluation and, when appropriate, use blood work, advanced imaging studies, joint aspirations, shoulder arthroscopy, and nerve studies. Once diagnosed, appropriate treatment should be undertaken to resolve the cause of the pain or at least minimize the effect of the pain on the patient's outcome.
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22
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Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and elliptical humeral head results in both improved early range of motion and radiographic center of rotation compared with standard total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:318-325. [PMID: 36049701 DOI: 10.1016/j.jse.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of the native glenohumeral anatomy is an important consideration in obtaining optimal range of motion (ROM) after anatomic total shoulder arthroplasty (TSA). Recently, a new stemless TSA system has been developed that uses both a multiplanar osteotomy (MPO), to improve the surgeon's ability to restore humeral center of rotation (COR), and an elliptical humeral head to improve ROM. The purpose of our study was to compare the difference in early postoperative ROM and restoration of radiographic COR, between this stemless TSA and standard stemmed TSAs. METHODS This was a retrospective review of 50 consecutive primary TSAs performed by a single surgeon for glenohumeral osteoarthritis. The initial cohort underwent TSA with a standard stemmed humeral component with a circular humeral head (n = 25), whereas the subsequent cohort underwent stemless TSA using an MPO and an elliptical humeral head (n = 25). Postoperative data collection included active shoulder ROM as measured by goniometer, complications or revision surgery, and measurements of radiographic COR. Patients were assessed at 6 weeks, 12 weeks, 6 months, and 12 months after surgery. Change in COR was determined on postoperative radiographs by 2 fellowship-trained surgeons on 2 separate occasions. Intra- and interrater reliability were computed using intraclass correlation coefficients. RESULTS For both mean forward flexion (FF) and external rotation (ER), there was greater ROM in the MPO-elliptical group at all time points, which was statistically significant. Mean change in FF favored the MPO group at 6 and 12 weeks and was statistically significant and above the minimal clinically important difference (MCID): 6 weeks, standard -15.8° vs. MPO 8.4° (P = .004); 12 weeks, standard 6.4° vs. MPO 29.2° (P = .001). Mean change in ER favored the MPO group at 6 weeks and was statistically significant: standard 5.4° vs. MPO 14.0° (P = .02). There were no revision surgeries in either group. Average change in COR was 2.7 mm in the standard group and 1.8 mm in the MPO-elliptical group, which was statistically significant (P < .001). Number of patients with >3 mm of difference in COR was 10 (40%) in the standard group and 1 (5%) in the MPO-elliptical group, which was statistically significant (P = .002). Average intraclass correlation coefficient was 0.75, indicating good reliability within and between surgeon measurements. CONCLUSION The use of a multiplanar osteotomy and elliptical humeral head was associated with improved early range of motion and better reproduction of the radiographic COR compared with standard stemmed TSA.
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23
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Sears BW, Creighton RA, Denard PJ, Griffin JW, Lichtenberg S, Lederman ES, Werner BC. Stemless components lead to improved radiographic restoration of humeral head anatomy compared with short-stemmed components in total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:240-246. [PMID: 36115615 DOI: 10.1016/j.jse.2022.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoring the native center of rotation (COR) in total shoulder arthroplasty (TSA) has been shown to improve postsurgical function, subjective outcomes, and implant longevity. The primary purpose of this study was to compare postoperative radiographic restoration of the humeral COR between short-stem and stemless humeral implants by evaluating the mean COR shift between the 2 techniques. Secondary outcomes evaluated were comparisons of COR shift outliers, humeral head implant thickness and diameter, direction of COR shift, and neck-shaft angle (NSA). METHODS This study was a multicenter retrospective comparative study using a consecutive series of primary anatomic TSA patients who received either a short-stem or stemless humeral implant. Radiographically, COR and NSA were measured by 2 fellowship-trained surgeons using the best-fit circle technique on immediate postoperative Grashey radiographs. RESULTS A total of 229 patients formed the final cohort for analysis that included 89 short stems and 140 stemless components. The mean COR shift for short stems was 2.7 mm (±1.4 mm) compared with 2.1 mm (±0.9 mm) for stemless implants (P < .001). The percentage of short-stem implant patients with a >2 mm COR difference from native was 66.0% (n = 62) compared with 47.4% (n = 64) for stemless (P = .006). The percentage of short-stem patients with a >4 mm COR difference from native was 17.0% (n = 16) compared with 3.0% (n = 4) for stemless (P < .001). The mean humeral implant head thickness for short stems was 18.7 ± 2.2 mm compared with 17.2 ± 1.3 mm for stemless implants (P < .001). The mean humeral head diameter for short stems was 48.7 ± 4.4 mm compared with 45.5 ± 3.5 mm for stemless implants (P < .001). The NSA for the short-stem cohort was 136.7° (±3.6°) compared with 133.5° (±6.0°) for stemless (P < .001). CONCLUSIONS Stemless prostheses placed during TSA achieved improved restoration of humeral head COR and were less likely to have significant COR outliers compared with short-stem implants.
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Affiliation(s)
| | - Robert A Creighton
- Orthopaedics and Sports Medicine, UNC Orthopaedics, Chapel Hill, NC, USA
| | | | - Justin W Griffin
- Shoulder Surgery/Sports Medicine, Jordan-Young Institute, Virginia Beach, VA, USA
| | | | - Evan S Lederman
- Orthopedic Sports Medicine, Orthopedic Surgery, Shoulder Orthopedic Surgery, Sports Medicine, Banner Health, Phoenix, AZ, USA
| | - Brian C Werner
- Orthopaedic Surgery, Department of Sports Medicine, UVA Health, Charlottesville, VA, USA
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24
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Tøttrup M, Thillemann JK, Thillemann TM, Mechlenburg I, Klebe T, Søballe K, Stilling M. Early offset-increasing migration predicts later revision for humeral head resurfacing implants. A randomized controlled radiostereometry trial with 10-year clinical follow-up. J Orthop Res 2022; 40:2688-2697. [PMID: 35220595 DOI: 10.1002/jor.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
In a randomized controlled setting, medium-term implant migration and long-term clinical outcomes were compared for the Copeland and the Global C.A.P. humeral head resurfacing implants (HHRI). Thirty-two patients (mean age 63 years) were randomly allocated to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were followed for 5 years with radiostereometry, Constant Shoulder Score, and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). WOOS and revision status were also obtained cross-sectionally at a mean 10-year follow-up. At the 5-year follow-up, total translation (TT) was 0.75 mm (95% confidence interval [CI]: 0.53-0.97) for the Copeland HHRIs and 1.15 mm (95% CI: 0.85-1.46) for the Global C.A.P. HHRIs (p = 0.04), but the clinical scores were similar at all follow-ups. The cumulative risks of revision at 5 and 10 years were 29% and 43% for Copeland and 35% and 41% for Global C.A.P HHRIs (p > 0.7). No implants were loose at revision, but HHRIs that were later revised followed an early offset-increasing migration pattern with medial translation and lift-off resulting in a mean 0.53 mm (95% CI: 0.18-0.88) higher TT at the 1-year follow-up compared to non-revised HHRIs. In conclusion, the Global C.A.P. HHRI had higher TT compared with the Copeland HHRI, but clinical scores and revision rates were similar. Nonetheless, revision rates were high and challenge the use of HHRIs. Interestingly, an early radiostereometry evaluated HHRI migration pattern with increased off-set predicted later implant revision.
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Affiliation(s)
- Mikkel Tøttrup
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Farsø, Denmark
| | - Janni Kjaergaard Thillemann
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Hospital Unit West, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark
| | - Theis Muncholm Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thomas Klebe
- Department of Orthopaedics, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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25
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Marigi EM, Elahi MA, Cancio-Bello AM, Duquin TR, Sperling JW. Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:442-450. [PMID: 37588463 PMCID: PMC10426651 DOI: 10.1016/j.xrrt.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally, key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ali Elahi
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Thomas R. Duquin
- Department of Orthopaedics, State University of New York, Buffalo, NY, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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26
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Strony JT, LaBelle M, McMellen CJ, Golden ML, Chalmers P, Tashjian RZ, Gillespie RJ. Restoration of the native humeral anatomy during stemless anatomic total shoulder arthroplasty: a radiographic comparison of intramedullary versus freehand resection. J Shoulder Elbow Surg 2022; 31:2225-2232. [PMID: 35569754 DOI: 10.1016/j.jse.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND During anatomic total shoulder arthroplasty (aTSA), the humeral head can be resected with or without the use of an intramedullary cutting guide, the former referred to as intramedullary (IM) resection and the latter referred to as freehand (FH) resection. Outcomes following aTSA are predicated upon the restoration of the native humeral anatomy, which can be more challenging with stemless implants. To date, no studies have determined which method of humeral head resection is superior in restoring native anatomy. Our purpose was to determine whether FH or IM resection was superior in restoring native anatomy during aTSA with stemless implants. METHODS A review of all patients who underwent aTSA using the stemless Tornier Simpliciti Shoulder System at two academic institutions by two separate surgeons between January 2017 and June 2020 was performed. One surgeon at one institution performed stemless aTSA using the IM resection technique, while the second surgeon utilized the FH resection technique. Patients were excluded if they underwent surgery for an indication other than glenohumeral osteoarthritis, if they received a short-stem or standard-stem implant, or if they lacked adequate preoperative and postoperative Grashey radiographs. One hundred eleven patients across both institutions (51 IM, 60 FH) were included for the final radiographic assessment. The humeral head height (HH) and neck-shaft angle (NSA) were measured on preoperative and postoperative Grashey radiographs. The centers of rotation (CORs) were measured on postoperative Grashey radiographs. Patients were classified as having acceptable restoration of their native anatomy if the change (Δ) in COR or HH was ≤3 mm and ≤ 5 mm, respectively, or if the postoperative NSA was ≥130°. RESULTS IM resection had the greatest acceptable restoration of COR (90.2% IM versus 70% FH, P = .009), HH (96.1% IM vs. 63.3% FH, P < .001), and NSA (96.1% IM vs. 78.3% FH, P = .006) relative to FH resection. The mean postoperative NSAs for the IM and FH cohorts were 134.4° (±2.1°) and 133.8° (±5.4°), respectively (P = .208). The mean ΔCORs for the IM and FH groups were 1.2 (±1.5) and 2.3 (±1.2) mm, respectively (P < .001). Finally, the mean ΔHHs for the IM and FH cohorts were 1.7 (±1.4) and 4.4 (±2.9) mm, respectively (P < .001). CONCLUSIONS Restoration of the native humeral anatomy following stemless aTSA occurred at a significantly higher rate when using IM vs. FH resection.
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Affiliation(s)
- John T Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Mark LaBelle
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher J McMellen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael L Golden
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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27
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Clinical and Radiologic Outcomes after Anatomical Total Shoulder Replacement Using a Modular Metal-Backed Glenoid after a Mean Follow-Up of 5.7 Years. J Clin Med 2022; 11:jcm11206107. [PMID: 36294428 PMCID: PMC9604620 DOI: 10.3390/jcm11206107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan−Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14−77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1−10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1−9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8−119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5−13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0−4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study.
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28
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Preoperative Planning for Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1207-e1216. [PMID: 36135930 DOI: 10.5435/jaaos-d-21-01119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.
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29
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Rojas JT, Jost B, Hertel R, Zipeto C, Van Rooij F, Zumstein MA. Patient-specific instrumentation reduces deviations between planned and postosteotomy humeral retrotorsion and height in shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1929-1937. [PMID: 35346846 DOI: 10.1016/j.jse.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) may potentially improve humeral osteotomy in shoulder arthroplasty. The purpose of this study was to compare the deviation between planned and postosteotomy humeral inclination, retrotorsion, and height in shoulder arthroplasty, using PSI vs. standard cutting guides (SCG). METHODS Twenty fresh-frozen cadaveric specimens were allocated to undergo humeral osteotomy using either PSI or SCG, such that the 2 groups have similar age, gender, and side. Preosteotomy computed tomography (CT) scan was performed and used for the 3-dimensional (3D) planning. The osteotomy procedure was performed using a PSI designed for each specimen or an SCG depending on the group. A postosteotomy CT scan was performed. The preosteotomy and postosteotomy 3D CT scan reconstructions were superimposed to calculate the deviation between planned and postosteotomy inclination, retrotorsion, and height. Outliers were defined as cases with 1 or more of the following deviations: >5° inclination, >10° retrotorsion, and >3 mm height. The deviation and outliers in inclination, retrotorsion, and height were compared between the 2 groups. RESULTS The deviations between planned and postosteotomy parameters were similar among the PSI and SCG groups for inclination (P = .260), whereas they were significantly greater in the SCG group for retrotorsion (P < .001) and height (P = .003). There were 8 outliers in the SCG group, compared with only 1 outlier in the PSI group (P = .005). Most outliers in the SCG group were due to deviation >10° in retrotorsion. CONCLUSION After 3D planning, PSI had less deviation between planned and postosteotomy humeral retrotorsion and height, relative to SCG.
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Affiliation(s)
- J Tomás Rojas
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital, St.Gallen, Switzerland
| | - Ralph Hertel
- Department of Orthopaedics and Trauma Surgery, Lindenhofspital, Bern, Switzerland
| | - Claudio Zipeto
- Shoulder R & D Department, Medacta International SA, Castel San Pietro, Switzerland
| | | | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland; Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland; Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
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Joyce CD, Patel MS, Stoll K, Singh AM, Stone MA, Horneff JG, Austin L, Lazarus MD. Fixed- vs. variable-angle humeral neck cut in anatomic total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg 2022; 31:1674-1681. [PMID: 35537570 DOI: 10.1016/j.jse.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Variable neck-shaft angle (NSA) stemmed humeral components have been incorporated into certain implant designs to better re-create normal anatomy in total shoulder arthroplasty (TSA). The purpose of this study was to determine if premorbid glenohumeral joint anatomy is better restored with a fixed- vs. variable-NSA prosthesis. METHODS A randomized controlled trial was performed including 50 patients with osteoarthritis indicated for primary anatomic TSA. Patients were randomized preoperatively to receive either a variable- (n = 26) or fixed-NSA (n = 24) prosthesis. Humeral neck cut in the variable-NSA group matched the patient's anatomic neck, with prosthetic NSA of 127.5°, 132.5°, and 137.5° available. Fixed-NSA cuts were made with an intramedullary guide of 132.5°. Preoperative and postoperative radiographs were evaluated for specific radiographic anatomic variables: NSA, head thickness, tuberosity-to-head height, head offset, articular arc, greater tuberosity offset, and center of rotation (COR). Postoperative radiographic criteria were compared between groups. RESULTS No differences were found between groups in demographics or preoperative radiographic measures. When comparing average difference in preoperative and postoperative measurements in the fixed-NSA group, the humeral head offset from the humeral shaft axis significantly decreased by 1.4 mm (P = .046), and the COR moved superiorly (3.0 mm, P = .002) without significant medialization or lateralization. In the variable angle group, humeral head offset decreased but did not reach significance (1.2 mm, P = .091), and the COR also moved superiorly (2.9 mm, P < .001) without significant medialization or lateralization. All remaining radiographic parameters did not significantly change from pre- to postoperative imaging. In comparing the fixed- and variable-NSA groups' net change from the premorbid measurements, no significant differences were found in tuberosity-to-head height, head offset, or COR position in both the horizontal and vertical planes. CONCLUSIONS Both fixed- and variable-NSA anatomic TSA humeral components demonstrate adequate restoration of premorbid anatomy radiographically.
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Affiliation(s)
| | - Manan S Patel
- Department of Orthopedic Surgery, Cooper Health, Cherry Hill, NJ, USA
| | - Kurt Stoll
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arjun M Singh
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Michael A Stone
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Luke Austin
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Moroder P, Lacheta L, Minkus M, Karpinski K, Uhing F, De Souza S, van der Merwe M, Akgün D. Implant Sizing and Positioning in Anatomical Total Shoulder Arthroplasty Using a Rotator Cuff-Sparing Postero-Inferior Approach. J Clin Med 2022; 11:jcm11123324. [PMID: 35743395 PMCID: PMC9224587 DOI: 10.3390/jcm11123324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/29/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The goal of this study was to compare the effectiveness of a rotator cuff-sparing postero-inferior (PI) approach with subdeltoidal access to the traditional subscapularis-takedown deltopectoral approach, in terms of implant sizing and positioning in anatomical total shoulder arthroplasty (aTSA). Methods: This study involved 18 human cadaveric shoulders with intact rotator cuffs and no evidence of head deforming osteoarthritis. An Eclipse stemless aTSA (Arthrex, Naples, FL, USA) was implanted in nine randomly selected specimens using a standard subscapularis-tenotomy deltopectoral approach, and in the other nine specimens using the cuff-sparing PI approach. Pre- and postoperative antero-posterior (AP) and axillary fluoroscopic radiographs were analyzed by two independent, blinded raters for the following parameters: (1) anatomic and prosthetic neck-shaft angle (NSA); (2) the shift between the anatomic and prosthetic center of rotation (COR); (3) anatomical size matching of the prosthetic humeral head; (4) the calculated Anatomic Reconstruction Score (ARS); (5) glenoid positioning; as well as (6) glenoid inclination and version. Results: While the COR was slightly but significantly positioned (p = 0.031) to be more medial in the PI approach group (3.7 ± 3.4%, range: −2.3% to 8.7%) than in the deltopectoral approach group (−0.2 ± 3.6%, range: −6.9% to 4.1%), on average, none of the remaining measured radiographic parameters significantly differed between both groups (PI approach group vs. deltopectoral group: NSA 130° vs. 127°, p = 0.57; COR supero-inferior, 2.6% vs. 1.0%, p = 0.35; COR antero-posterior, 0.9% vs. 1.7%, p = 0.57; head size supero-inferior, 97.3% vs. 98.5%, p = 0.15; head size antero-posterior, 101.1% vs. 100.6%, p = 0.54; ARS, 8.4 vs. 9.3, p = 0.13; glenoid positioning supero-inferior, 49.1% vs. 51.1%, p = 0.33; glenoid positioning antero-posterior, 49.3% vs. 50.4%, p = 0.23; glenoid inclination, 86° vs. 88°, p = 0.27; and glenoid retroversion, 91° vs. 89°, p = 0.27). Conclusions: A PI approach allows for sufficient exposure and orientation to perform rotator-cuff sparing aTSA with acceptable implant sizing and positioning in cadaveric specimens.
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Affiliation(s)
| | - Lucca Lacheta
- Arthrex GMBH, D-81249 Munich, Germany; (L.L.); (M.M.); (K.K.)
| | - Marvin Minkus
- Arthrex GMBH, D-81249 Munich, Germany; (L.L.); (M.M.); (K.K.)
| | | | - Frank Uhing
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; (F.U.); (S.D.S.); (M.v.d.M.)
| | - Sheldon De Souza
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; (F.U.); (S.D.S.); (M.v.d.M.)
| | - Michael van der Merwe
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; (F.U.); (S.D.S.); (M.v.d.M.)
| | - Doruk Akgün
- Arthrex GMBH, D-81249 Munich, Germany; (L.L.); (M.M.); (K.K.)
- Correspondence: ; Tel.: +49-304-5065-2319; Fax: +49-304-5051-5905
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Long-term results of the uncemented resurfacing shoulder hemiarthroplasty (Global Conservative Anatomic Prosthesis). J Shoulder Elbow Surg 2022; 31:839-846. [PMID: 34592409 DOI: 10.1016/j.jse.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment with uncemented resurfacing shoulder hemiarthroplasty has proved to be viable for patients with end-stage osteoarthritis at short- and mid-term follow-up. This study was essential to determine whether those outcomes will endure. This study presents the long-term results of the Global Conservative Anatomic Prosthesis (CAP) uncemented resurfacing shoulder hemiarthroplasty (DePuy Synthes, Warsaw, IN, USA). METHODS All patients with a diagnosis of glenohumeral osteoarthritis and an intact and clinically sufficient rotator cuff who underwent uncemented resurfacing shoulder hemiarthroplasty between 2007 and 2009 were included. The data of all patients who completed the 10-year follow-up assessments were used for analysis. The visual analog scale pain score, Dutch version of the Simple Shoulder Test score, Constant score, Short Form 12 scores, and physical examination findings were evaluated preoperatively and postoperatively on an annual basis. All complications and revisions were documented. Radiographs were evaluated for loosening, luxation or subluxation, migration, and glenoid erosion. RESULTS Of 48 shoulders, 23 (48%, 18 women and 5 men) were available for the 10-year follow-up assessments and their data were used for analysis. The main reasons for dropout were revision (27%) and death (10%). The mean follow-up period of the remaining patients was 10.9 years (range, 9-13 years). The visual analog scale pain score (from 6.5 ± 2.1 to 0.7 ± 1.6, P < .001), Simple Shoulder Test (Dutch version) score (from 22% ± 22% to 79% ± 22%, P < .001), Constant score (from 40 ± 29 to 70 ± 8, P < .001), and Short Form 12 physical score (from 36 ± 7 to 41 ± 12, P = .001) improved significantly compared with preoperative scores. Revision surgery was performed in 13 of the initial 48 shoulders (27%). Most revisions were seen within 7 years postoperatively. CONCLUSION Two revisions have been performed in the mid-term to long term because of increased functional outcome scores and the absence of signs of loosening. Nevertheless, the high overall revision rate of 27% between short- and long-term follow-up reflects the need to limit the use of uncemented resurfacing shoulder hemiarthroplasty for the treatment of glenohumeral osteoarthritis.
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Cointat C, Raynier JL, Vasseur H, Lareyre F, Raffort J, Gauci MO, Boileau P. Short-term outcomes and survival of pyrocarbon hemiarthroplasty in the young arthritic shoulder. J Shoulder Elbow Surg 2022; 31:113-122. [PMID: 34280573 DOI: 10.1016/j.jse.2021.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose was to report the short-term outcomes and survival of hemiarthroplasty with a pyrocarbon head (HA-PYC) for the treatment of shoulder osteoarthritis in patients aged ≤ 60 years. We hypothesized that HA-PYC could be an alternative to hemi-metal (avoiding the risk of rapid glenoid erosion) and total shoulder arthroplasty (TSA) (avoiding the risk of rapid glenoid loosening) in an active patient population. METHODS Sixty-four consecutive patients (mean age, 53 years) who underwent HA-PYC for glenohumeral osteoarthritis were included. The primary outcome was revision to TSA or reverse shoulder arthroplasty. Secondary outcome measures included functional outcome scores; return to work and sports; and radiographic evaluation of humeral reconstruction quality using the "circle method" of Mears, as well as glenoid erosion severity and progression using the Sperling classification. Patients were reviewed and underwent radiography at an average follow-up of 33 months (range, 24-60 months). RESULTS At last follow-up, the rate of survival of the HA-PYC prosthesis was 92%. Revision was performed in 5 patients, with a mean delay of 24 months (range, 15-37 months): 1 conversion to TSA and 4 conversions to reverse shoulder arthroplasty. The Constant score and Subjective Shoulder Value increased from 36 points (range, 26-50 points) to 75 points (range, 69-81 points) and from 35% (range, 20%-50%) to 80% (range, 75%-90%), respectively (P < .001). Postoperatively, 91% of the patients (42 of 46) returned to work and 88% (15 of 17) returned to sport. The severity of preoperative and postoperative glenoid wear (Sperling grade 3 or 4) had no influence on the functional results. Patients who underwent associated concentric glenoid reaming (n = 23) had similar Constant scores and Subjective Shoulder Values (P = .95) to other patients and did not show more progression of glenoid wear. Nonanatomic reconstruction of the proximal humerus (center of rotation of the prosthesis > 3 mm from the anatomic center) occurred in 29% (18 of 62 patients) and was associated with significantly lower functional and subjective results, more complications (subscapularis insufficiency and/or symptomatic glenoid erosion), and a higher risk of revision. The additional 1.5-mm thickness of the metal disc under the pyrocarbon head was found to be the main reason for oversizing of the prosthetic head. CONCLUSION HA-PYC is a reliable procedure to treat shoulder osteoarthritis and allows return to work and sports in a young (≤60 years) and active patient population. The severity of glenoid bone erosion or the association with glenoid reaming does not affect functional outcomes and failure risk. By contrast, nonanatomic reconstruction of the proximal humerus after HA-PYC (because of humeral head oversizing) occurred in one-third of the cases and is associated with lower functional outcomes, as well as higher risks of complications and revision.
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Affiliation(s)
- Caroline Cointat
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | - Jean Luc Raynier
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | | | | | | | - Marc Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
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Monir JG, Hao KA, Abeyewardene D, O'Keefe KJ, King JJ, Wright TW, Schoch BS. Extra-short humeral heads reduce glenohumeral joint overstuffing compared with short heads in anatomic total shoulder arthroplasty. JSES Int 2021; 6:209-215. [PMID: 35252915 PMCID: PMC8888178 DOI: 10.1016/j.jseint.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Rotator cuff tears and glenoid loosening remain the two most common causes for revision after anatomic total shoulder arthroplasty. Oversizing of the humeral head leads to increased contact force across the glenohumeral joint and is hypothesized to contribute to clinical and radiographic failure. The purpose of this study is to compare the rate of radiographic overstuffing between standard short humeral heads and newer extra-short heads with decreased lateral offset. Methods Fifty-five consecutive anatomic total shoulder arthroplasties performed using extra-short humeral heads were retrospectively reviewed and compared with age- and sex-matched controls receiving standard short heads. A total of 110 postoperative radiographs were analyzed using the Iannotti's perfect circle method to compare the prosthesis' center of rotation (COR) with the native humeral head COR. A difference in the COR of >3.0 mm was considered malpositioned. Malpositioning medially was considered overstuffed, and malpositioning laterally was considered understuffed. The direction of displacement of malpositioned prostheses was categorized using a quadrant system. Furthermore, we used a novel method to evaluate medial and superior overstuffing by measuring the displacement between the anatomic and prosthetic head positions along perpendicular axes. Results Using the Iannotti's perfect circle method, 56% of heads were malpositioned. Overstuffing occurred more frequently with short heads compared with extra-short heads (47% vs. 4%, P < .001). Conversely, understuffing occurred more frequently with extra-short heads (47% vs. 15%, P = .001). Malpositioned extra-short heads were most frequently placed in the inferomedial quadrant (93% vs. 24%, P < .001), whereas malpositioned short heads were most commonly placed in the superomedial quadrant (56% vs. 7%, P < .001). Our novel measurement method demonstrated that extra-short heads reduced medial overstuffing (2.8 ± 2.8 mm vs. 0.3 ± 2.0 mm, P < .001). Both extra-short and short heads had similar rates of superior malpositioning (1.6 ± 2.2 mm vs. 1.4 ± 1.5 mm, P = .683). Conclusion Routine use of extra-short humeral head sizes reduces the rate of medial glenohumeral joint overstuffing but not superior malpositioning. This is hypothesized to improve clinical outcomes, but future studies are needed to assess the relationship between improved humeral head fit and clinical outcomes.
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Affiliation(s)
- Joseph G. Monir
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A. Hao
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Dilhan Abeyewardene
- Orthopaedic Care Specialists, Hand & Upper Extremity Surgery, North Palm Beach, FL, USA
| | | | - Joseph J. King
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W. Wright
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S. Schoch
- Department of Orthopedics, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Bradley S. Schoch, MD, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
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Comparison of Postoperative Anatomy Using Anatomic Total Shoulder Arthroplasty Versus Soft-Tissue Balancing Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2021; 29:848-854. [PMID: 34101702 DOI: 10.5435/jaaos-d-20-00782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/09/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The importance of anatomic reconstruction of the proximal humerus on shoulder biomechanics and kinematics after anatomic total shoulder replacement (aTSR) has been highlighted by a number of investigations. The humeral head designs of current-generation shoulder arthroplasty emphasize either anatomic or soft-tissue balancing total shoulder arthroplasty (sbTSR) philosophies. The purpose of this study was to compare the postoperative anatomy of TSR systems used to treat primary glenohumeral osteoarthritis. METHODS This was a matched cohort study of 60 patients treated with either press-fit aTSR or sbTSR by two shoulder surgeons. The analysis of postoperative true AP radiographs was performed to calculate multiple representative anatomic parameters of the TSR. RESULTS A significant difference was observed in the average measurements between the sbTSR and aTSR designs about the humeral head center offset (5.2 ± 0.4 mm versus 3.9 ± 0.3 mm; P = 0.02), implant-humeral shaft angle (0.3 ± 0.3 varus versus 1.7 ± 0.3 valgus, P < 0.001), and humeral head to tuberosity height (8.8 ± 0.4 mm versus 6.2 ± 0.4, P < 0.001), respectively. No significant difference was observed in the average measurements between the two systems' designs regarding the head-shaft angle (133.4° ± 0.8° versus 135.0° ± 1.0°, P = 0.16) and the relation of humeral head to lateral humeral cortex (0.15 ± 0.6 mm inside the lateral cortex versus 0.19 ± 0.6 outside the lateral cortex; P = 0.69), respectively. CONCLUSIONS Despite differing design philosophies of these systems, and some notable differences, the absolute differences between the measured anatomic parameters were small and not likely clinically relevant. Anatomic and soft-tissue balancing humeral arthroplasty implants can both reliably reconstruct proximal humeral anatomy.
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Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse shoulder arthroplasty. EFORT Open Rev 2021; 6:918-931. [PMID: 34760291 PMCID: PMC8559568 DOI: 10.1302/2058-5241.6.210014] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Cavinatto L, Khatib O, Martusiewicz A, Koueiter DM, Wiater BP, Wiater JM. Radiographic evaluation of humeral head reconstruction with stemmed and stemless spherical implants compared with stemless elliptical head implants. JSES Int 2021; 5:889-893. [PMID: 34505101 PMCID: PMC8411049 DOI: 10.1016/j.jseint.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study was to compare the accuracy of anatomic reconstruction of three different humeral head designs after anatomic total shoulder arthroplasty. Methods Postoperative radiographs of 117 patients who underwent anatomic total shoulder arthroplasty with three different implant designs (stemmed spherical, stemless spherical, and stemless elliptical) were analyzed for landmarks that represented the prearthritic state and final implant position. We assessed the change in center of rotati7on and humeral head height on the anteroposterior view and the percentage of prosthesis overhang on the axillary lateral view. A modified anatomic reconstruction index, a compound score that rated each of the 3 parameters from 0 to 2, was created to determine the overall accuracy of the reconstruction. Results Excellent modified anatomic reconstruction index scores (5 or 6 points) were achieved by 68.1% of the cases in the stemless elliptical group compared with 33.3% of the cases in the stemless spherical group and by 28.3% of the cases in the stemmed spherical group (P = .001).The mean difference in restoration of humeral head height (P < .001) and percentage of prosthesis overhang (P < .001) was superior for the stemless elliptical group compared with the two other spherical head groups. There was no difference between groups for the shift in center of rotation (P = .060). Conclusions In this radiographic investigation comparing three different humeral head designs with respect to anatomic restoration parameters, the stemless elliptical implant more closely restored the geometry of the prearthritic humeral head as assessed by humeral head height, prosthesis overhang, and a compound reconstruction score.
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Affiliation(s)
| | - Omar Khatib
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | | | - Denise M Koueiter
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
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Ross JP, Lee A, Neeley R, Mighell MA, Frankle MA. The subscapularis-sparing windowed anterior technique for total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:S89-S99. [PMID: 33887479 DOI: 10.1016/j.jse.2021.03.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditionally, total shoulder arthroplasty (TSA) involves detaching the subscapularis tendon through either tenotomy or lesser tuberosity osteotomy. A subscapularis-sparing approach avoids detachment but may make re-creation of the anatomy more difficult because of limited exposure. The primary aim of this study was to evaluate the ability to re-create the proximal humeral geometry and assess for osteophyte removal with this technique. The secondary aim was to assess for complications or an inability to complete the procedure with this technique. METHODS We performed a retrospective review of a consecutive series of 47 patients (100% with osteoarthritis; 59% Walch type A and 41% Walch type B; 50% male and 50% female patients; and average body mass index, 28.21 ± 4.6) who underwent the subscapularis-sparing windowed anterior technique for TSA. The ability to reconstruct the proximal humeral geometry and remove the inferior osteophytes was assessed by 2 independent observers using the center-of-rotation difference (ΔCOR) between the native and prosthetic humeral heads. The ability to complete the procedure was recorded, and a chart review was performed to assess for complications. RESULTS The procedure was successfully completed in 44 of the 47 patients. Radiographic review demonstrated an average ΔCOR of 2.28 mm (range, 0.2-6.05 mm; intraclass correlation coefficient, 0.971), below the previously reported acceptable ΔCOR of 3 mm. The ΔCOR was >3 mm in 31.8% of patients (14 of 44; 8 Walch type A and 6 Walch type B; 9 male and 5 female patients). There was no difference in ΔCOR based on Walch type (P = .824). Male patients on average showed a higher ΔCOR (2.62 mm) than female patients (1.94 mm) (P = .099) and more commonly had a ΔCOR > 3 mm (P = .195). Body mass index was not significantly correlated with ΔCOR (r = 0.077, P = .619). For all cases in which the ΔCOR was >3 mm, the prosthetic humeral head was undersized. Osteophytes were successfully removed in 75% of cases (33 of 44) and had no effect on average ΔCOR (P = .468). No revisions or mechanical failures in the early postoperative period were identified in the treatment group of 44 patients (range, 3-15 months). In the group with unsuccessful treatment, there was 1 case of infection treated with 1-stage revision reverse TSA. DISCUSSION The subscapularis-sparing windowed anterior technique is an effective approach to TSA that allows for early unrestricted motion. Over 90% of cases can be completed using this technique. Radiographic analysis demonstrated that this approach can be used successfully without compromising anatomic reconstruction of the proximal humerus. Further study is necessary to identify patient factors that would favor a traditional deltopectoral approach and to assess the functional outcomes of this technique.
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Affiliation(s)
- John P Ross
- Florida Orthopedic Institute/Foundation for Orthopaedic Research and Education (FOI/FORE), Tampa, FL, USA.
| | - Andrew Lee
- Florida Orthopedic Institute/Foundation for Orthopaedic Research and Education (FOI/FORE), Tampa, FL, USA
| | - Ryan Neeley
- Florida Orthopedic Institute/Foundation for Orthopaedic Research and Education (FOI/FORE), Tampa, FL, USA
| | - Mark A Mighell
- Florida Orthopedic Institute/Foundation for Orthopaedic Research and Education (FOI/FORE), Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopedic Institute/Foundation for Orthopaedic Research and Education (FOI/FORE), Tampa, FL, USA
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Tsitlakidis S, Doll J, Westhauser F, Wolf M, Hetto P, Maier M, Sowa B. Promising results after hemi-shoulder arthroplasty using pyrolytic carbon heads in young and middle-aged patients. Orthop Traumatol Surg Res 2021; 107:102896. [PMID: 33753266 DOI: 10.1016/j.otsr.2021.102896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/03/2020] [Accepted: 10/30/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The objective of this prospective cohort study was the assessment of short-term outcome results of shoulder hemiarthroplasty (HA) using pyrolytic carbon (PC) heads. PC has been introduced as a new material to avoid surgical revision due to glenoid erosion after HA. Glenoid erosion due to the use of metallic heads is known to reduce durability. HYPOTHESIS HA using PC heads shows comparable or better radiographic and clinical outcome compared to the conventional HA using metallic heads in the short-term. PATIENTS AND METHODS This study was conducted as a single center prospective cohort follow-up study including a total number of 16 consecutive HA with PC heads. Inclusion criteria were indication for HA, an intact rotator cuff, no proximal humeral fractures in patient's history and age>18years. Mean age at the time of arthroplasty was 52.8±10.8years. The mean follow-up was 24.3±8.1months. Baseline and follow-up Numeric Rating Scale (NRS), Constant Scores (CS), Range of Motion (ROM) and radiographs were assessed. RESULTS At a mean follow-up of 24.3months the mean CS (p<0.001), mean NRS (p<0.001) and mean ROM (p<0.05) improved statistically significant. Subgroup analysis revealed no differences between subgroups (sex, age, diagnosis, and handedness). Survival rate was high (94.1%). One periprosthetic fracture occurred as the only complication during follow-up. Radiographs showed glenoid erosion in one case and subacromial space reduction in two cases. DISCUSSION PC heads in HA show satisfying short-term results at a mean follow-up of two years, which are comparable to those of conventional HA. The clinical improvements were highly significant with good implant survival. However, long-term follow-up results are necessary, especially compared to conventional HA. LEVEL OF EVIDENCE IV; observational therapeutic cohort study.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Julian Doll
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Matthias Wolf
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Pit Hetto
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Michael Maier
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; Schwaebisches Gelenkzentrum Stuttgart, Hohenheimer Str. 91, 70184 Stuttgart, Germany
| | - Boris Sowa
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
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Does computerized CT-based 3D planning of the humeral head cut help to restore the anatomy of the proximal humerus after stemless total shoulder arthroplasty? J Shoulder Elbow Surg 2021; 30:e309-e316. [PMID: 32950671 DOI: 10.1016/j.jse.2020.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of proximal humeral anatomy (RPHA) after total shoulder arthroplasty (TSA) has been shown to result in better clinical outcomes than is the case in nonanatomic humeral reconstruction. Preoperative virtual planning has mainly focused on glenoid component placement. Such planning also has the potential to improve anatomic positioning of the humeral head by more accurately guiding the humeral head cut and aid in the selection of anatomic humeral component sizing. It was hypothesized that the use of preoperative 3-dimensional (3D) planning helps to reliably achieve RPHA after stemless TSA. METHODS One hundred consecutive stemless TSA (67 males, 51 right shoulder, mean age of 62 ±9.4 years) were radiographically assessed using pre- and postoperative standardized anteroposterior radiographs. The RPHA was measured with the so-called circle method described by Youderian et al. We measured deviation from the premorbid center of rotation (COR), and more than 3 mm was considered as minimal clinically important difference. Additionally, pre- and postoperative humeral head diameter (HHD), head-neck angle (HNA), and humeral head height (HHH) were measured to assess additional geometrical risk factors for poor RPHA. RESULTS The mean distance from of the premorbid to the implanted head COR was 4.3 ± 3.1 mm. Thirty-five shoulders (35%) showed a deviation of less than 3 mm (mean 1.9 ±1.1) and 65 shoulders (65%) a deviation of ≥3 mm (mean 8.0 ± 3.7). Overstuffing was the main reason for poor RPHA (88%). The level of the humeral head cut was responsible for overstuffing in 46 of the 57 overstuffed cases. The preoperative HHD, HHH, and HNA were significantly larger, higher, and more in valgus angulation in the group with accurate RPHA compared with the group with poor RPHA (HHD of 61.1 mm ± 4.4 vs. 55.9 ± 6.6, P < .001; HHH 8.6±2.2 vs. 7.6±2.6, P = .026; and varus angulation of 134.7° ±6.4° vs. 131.0° ±7.91, P = .010). CONCLUSION Restoration of proximal humeral anatomy after stemless TSA using computed tomography (CT)-based 3D planning was not precise. A poorly performed humeral head cut was the main reason for overstuffing, which was seen in 88% of the cases with inaccurate RPHA. Preoperative small HHD, low HHH, and varus-angulated HNA are risk factors for poor RPHA after stemless TSA.
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Koch M, Frankewycz B, Voss A, Kaeaeb M, Herrmann S, Alt V, Greiner S. 3D-Analysis of the Proximal Humeral Anatomy Before and After Stemless Shoulder Arthroplasty-A Prospective Case Series Study. J Clin Med 2021; 10:jcm10020259. [PMID: 33445617 PMCID: PMC7826806 DOI: 10.3390/jcm10020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stemless shoulder arthroplasty (SSA) is used to anatomically reconstruct proximal humerus geometry and preserve proximal humerus bone stock. The current literature lacks 3D-analysis of pre- and postoperative proximal humeral anatomy after SSA. The aim of this study was to prospectively analyze the humeral head anatomy using a computer-assisted topography mapping technique after SSA in relation to the preoperative status and the contralateral (not affected) side. METHODS Twenty-nine patients (mean age: 63.5 ± 11.7 years) affected by primary shoulder osteoarthritis and treated with SSA were included. Preoperative and postoperative CT scans of the affected and contralateral sites were analyzed regarding joint geometry. Clinical outcome was assessed by Constant and Disabilities of the Arm, Shoulder and Hand (DASH) score shortly before and one year after surgery. RESULTS Clinical outcome improved significantly. No correlation between clinical outcome and the evaluated anatomical parameters was found. There was a significant decrease of the humeral head height (p < 0.01) and radius (p = 0.03) in the preoperative versus the postoperative joint geometry. The comparison to the contralateral site showed also a significant decrease of the humeral head height (p < 0.01). All other parameters showed no significant differences. CONCLUSION Proximal humeral anatomy can be almost anatomically reconstructed by SSA. Solely the humeral head height differs significantly to the preoperative as well as contralateral morphology.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Borys Frankewycz
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
| | - Max Kaeaeb
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
| | | | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Stefan Greiner
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
- Correspondence:
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Cox RM, Sholder D, Stoll L, Abboud JA, Williams GR, Ramsey ML, Lazarus MD, Horneff JG. Radiographic humeral head restoration after total shoulder arthroplasty: does the stem make a difference? J Shoulder Elbow Surg 2021; 30:51-56. [PMID: 32713669 DOI: 10.1016/j.jse.2020.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral stem designs for total shoulder arthroplasty have varied over the years, with a recent trend toward shorter stems. The purpose of this study was to examine the impact of humeral component stem length on the ability to restore the native humeral head anatomy. METHODS We performed a retrospective review including patients who underwent total shoulder arthroplasty for primary osteoarthritis between 2007 and 2017 with complete operative reports and adequate radiographs. Surgical data including stem design were collected. Preoperative and postoperative radiographic measurements of the center of rotation (COR), humeral head height (HH), and neck-shaft angle were performed. Restoration of the native humeral anatomy was deemed "acceptable" based on postoperative differences in the COR ≤ 3 mm, HH ≤ 5 mm, and neck-shaft angle > 130°. Deviations between preoperative and postoperative measurements were compared across stem types. All available 2-year stemless implant radiographs were also analyzed. RESULTS In total, 261 patients were included, with 31 stemless, 43 short-stem, and 187 standard-stem implants. There was no significant difference in COR restoration in the x-axis direction (P = .060) or y-axis direction (P = .579). There was no significant difference in restoration of acceptable HH by stem type (P = .339). Stemless arthroplasty implants were more likely to be placed in varus (22.6%) compared with short-stem (7.0%) and standard-stem (3.7%) designs (P < .001). CONCLUSION Restoration of humeral anatomic parameters occurred significantly less with stemless implants than with short- and standard-stem implants. The stem of a shoulder arthroplasty implant aids surgeons in accurately restoring patient-specific anatomy.
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Affiliation(s)
- Ryan M Cox
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Sholder
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura Stoll
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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Geervliet PC, Willems JH, Sierevelt IN, Visser CPJ, van Noort A. Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure. J Orthop Surg Res 2019; 14:474. [PMID: 31888675 PMCID: PMC6936124 DOI: 10.1186/s13018-019-1522-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure. METHODS Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients. RESULTS The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19-3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure. CONCLUSION The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm. TRIAL REGISTRATION Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.
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Affiliation(s)
- Pieter C. Geervliet
- NoordWest Clinics, Department of Orthopedic Surgery, Shoulder Unit, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | - Jore H. Willems
- NoordWest Clinics, Department of Orthopedic Surgery, Shoulder Unit, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | | | | | - Arthur van Noort
- Spaarne Hospital, Spaarnepoort 1, 2134 TM Hoofddorp, the Netherlands
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Normal and Pathoanatomy of the Arthritic Shoulder: Considerations for Shoulder Arthroplasty. J Am Acad Orthop Surg 2019; 27:e1068-e1076. [PMID: 31206438 DOI: 10.5435/jaaos-d-18-00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The glenohumeral joint is a highly mobile, complex articulation that relies not only on the bony support between the humeral head and glenoid but also on appropriate balance and tension of the surrounding soft-tissue structures. Recreating the normal anatomic relationships is a basic premise in joint arthroplasty, which can be challenging in shoulder arthroplasty, as the normal glenohumeral anatomy has considerable variation from patient to patient. Also, as the anatomy of the glenohumeral joint becomes distorted with advanced shoulder pathology, it becomes a challenge to return the shoulder to its premorbid anatomic state. Failure to restore normal anatomic parameters after shoulder arthroplasty has been shown to have deleterious effects on postoperative function and implant survival. As the recognition of this has grown, shoulder prostheses have evolved to allow for considerable more variation in an attempt to recreate patient-specific anatomy. However, understanding the progression of shoulder pathology to better predict the patient's premorbid anatomy remains limited. A thorough understanding of the premorbid and pathologic anatomy of the glenohumeral joint will aid in preoperative planning and intraoperative execution and lead to a more predictable reconstruction of the shoulder, which is critical for a successful outcome after shoulder arthroplasty.
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Dekker TJ, Steele JR, Vinson EV, Garrigues GE. Current peri-operative imaging concepts surrounding shoulder arthroplasty. Skeletal Radiol 2019; 48:1485-1497. [PMID: 30798396 DOI: 10.1007/s00256-019-03183-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 01/21/2019] [Accepted: 02/06/2019] [Indexed: 02/02/2023]
Abstract
Glenohumeral osteoarthritis is a prevalent degenerative disease that can lead to excruciating pain and debility. End-stage osteoarthritis can be treated by both conservative and surgical interventions. Along with a comprehensive history and physical exam, pre-operative imaging with plain radiographs, computerized tomography, and magnetic resonance imaging plays an essential role in the decision-making process guiding whether the patient undergoes a shoulder hemiarthroplasty, anatomic total shoulder arthroplasty, or a reverse total shoulder arthroplasty. The most important pre-operative imaging factors are the integrity of the rotator cuff and presence of significant glenoid erosion. Imaging is also critical postoperatively, as signs of prosthetic loosening, rotator cuff failure (especially involving the subscapularis), periprosthetic fracture, and stress fractures are important entities to recognize. This article will review pertinent imaging findings related to the pre- and post-operative management of patients with glenohumeral osteoarthritis.
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Affiliation(s)
- Travis J Dekker
- Department of Orthopaedics, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - J R Steele
- Department of Orthopaedics, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
| | - E V Vinson
- Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
| | - G E Garrigues
- Department of Orthopaedics, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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Baranek ES, Trofa DP, Levine WN, Goldberg SS. Accuracy of Humeral Implant Positioning Using a Canal-Sparing Total Shoulder Arthroplasty System. J Shoulder Elb Arthroplast 2019. [DOI: 10.1177/2471549219844837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.
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Affiliation(s)
- Eric S Baranek
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York
| | - David P Trofa
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York
| | - William N Levine
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York
| | - Steven S Goldberg
- Division of Orthopedic Surgery, Physicians Regional Medical Center – Pine Ridge, Naples, Florida
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Gallacher S, Williams HLM, King A, Kitson J, Smith CD, Thomas WJ. Clinical and radiologic outcomes following total shoulder arthroplasty using Arthrex Eclipse stemless humeral component with minimum 2 years' follow-up. J Shoulder Elbow Surg 2018; 27:2191-2197. [PMID: 30093232 DOI: 10.1016/j.jse.2018.05.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless humeral components benefit from less morbidity, better reproduction of the humeral anatomy, ease of revision, and fewer stem-related complications. Encouraging results are available up to 9 years after surgery from the designer's series. This is an independent study of 100 consecutive Eclipse stemless prostheses for osteoarthritis with a minimum 2-year follow-up (range, 2-6 years). METHODS We included only total shoulder arthroplasties performed for osteoarthritis. The primary outcome was the Oxford Shoulder Score (OSS) after 2 years. Secondary outcome measures were change in shoulder range of movement and radiographic analysis of prosthesis size and position. RESULTS The mean OSS at 2 years was 38 of 48, with a mean improvement of +19 points (range, +17 to +22 points; P < .001). There was no significant deterioration in OSS after 3 or 4 years' follow-up. Statistically significant improvement was seen in arm elevation and external rotation (P < .001). There were 5 reoperations-1 for impingement of the biceps stump and 4 revisions to reverse arthroplasty for cuff failure. Of the prostheses, 92% were sized within 2 mm of the anatomic head size, and in 76% of prostheses, the center of rotation was within 3 mm of the native anatomy. An incomplete radiolucent line was present in zone B (around the cage screw) in a single patient at 2 years following surgery. There were no cases of loosening or infection. CONCLUSION The functional and radiographic outcomes of Eclipse total shoulder replacement are excellent. We were able to accurately reproduce the native anatomy in the majority of cases, with no implant loosening, at 2 to 6 years' follow-up.
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Affiliation(s)
- Sian Gallacher
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Huw L M Williams
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew King
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Jeff Kitson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Chris D Smith
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - William J Thomas
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK.
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Sandau N, Brorson S, Olsen BS, Sørensen AK, Jensen SL, Schantz K, Ovesen J, Rasmussen JV. Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs. J Orthop Surg Res 2018; 13:299. [PMID: 30482217 PMCID: PMC6258391 DOI: 10.1186/s13018-018-1008-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/19/2018] [Indexed: 02/14/2023] Open
Abstract
Background In a clinical setting, a visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after resurfacing hemiarthroplasty and is a part of the decision-making process, in combination with other parameters, when evaluating patients with inferior clinical results. However, the reliability of this method of visual evaluation has not been reported. The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs. Methods Six experienced shoulder surgeons independently classified implant inclination, size of the implant and if the joint seemed overstuffed, in 219 cases of post-implant radiographs. All cases were classified twice 3 weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen’s kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement. Results The overall inter-observer agreement for implant size (kappa, 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa, 0.46 and 0.44), but only a fair agreement was found concerning the evaluation for stuffing of the joint (kappa, 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial. Conclusions Our results indicate that a visual evaluation of plain radiographs may be inadequate to evaluate overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs. Future studies may contribute to elucidate whether reliability increases if consensus on clear definitions and standardized methods of evaluation is made.
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Affiliation(s)
- Nicolai Sandau
- Department of Orthopedic Surgery, Herlev & Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Stig Brorson
- Department of Orthopedic Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Bo S Olsen
- Department of Orthopedic Surgery, Herlev & Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Anne Kathrine Sørensen
- Department of Orthopedic Surgery, Herlev & Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Steen L Jensen
- Department of Orthopedic Surgery, Aalborg University Hospital, Højgårdsvej 11, 9640, Farsø, Denmark
| | - Kim Schantz
- Department of Orthopedic Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Janne Ovesen
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8000, Aarhus, Denmark
| | - Jeppe V Rasmussen
- Department of Orthopedic Surgery, Herlev & Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
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Total shoulder prosthesis with humeral resurfacing: Impact on lateral offset and short-term clinical consequences. Orthop Traumatol Surg Res 2018; 104:787-791. [PMID: 29555560 DOI: 10.1016/j.otsr.2018.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reports of early glenoid wear after humeral resurfacing hemiarthroplasty have prompted the use, in combination with this procedure, of newly developed glenoid implants. This combination can increase global humeral offset. The objectives of this study were to assess changes in overall lateral offset and their potential short-term clinical consequences after combined humeral resurfacing and glenoid replacement. HYPOTHESIS Combined humeral resurfacing and glenoid replacement induces a large increase in overall lateral offset, resulting in short-term clinical consequences. MATERIAL AND METHODS A single-centre prospective study was started in November 2011. Consecutive patients scheduled for total shoulder arthroplasty with humeral resurfacing were included. The primary outcome measure was the change in lateral offset between radiographs obtained pre-operatively and 3 months post-operatively. The functional outcome assessed using the Constant score was compared between the groups with a lateral offset change <10mm vs. ≥10mm. RESULTS From November 2011 to November 2014, 35 total shoulder arthroplasties with humeral resurfacing were performed in 32 patients with a mean age of 72.1 years (range, 55-86 years). Mean follow-up was 20±6 months (range, 12-31 months). Overall lateral offset was significantly greater post-operatively than pre-operatively (14±6mm vs. 5±7mm, p<0.0001), the mean difference being 8mm (range, 2-20mm). Post-operative range of motion was better in the group with an overall lateral offset ≥10mm (p=0.0016). DISCUSSION Combined humeral resurfacing and glenoid replacement markedly increases overall lateral offset. This increase is not associated with adverse effects on short-term function and may improve post-operative motion range. However, greater lateral offset elevates the loads on the glenoid implant, which may increase the risk of glenoid implant loosening and rotator cuff tearing. Close radiological monitoring is therefore imperative. LEVEL OF EVIDENCE IV, prospective cohort study.
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Chalmers PN, Granger EK, Orvets ND, Patterson BM, Chamberlain AM, Keener JD, Tashjian RZ. Does prosthetic humeral articular surface positioning associate with outcome after total shoulder arthroplasty? J Shoulder Elbow Surg 2018; 27:863-870. [PMID: 29289492 DOI: 10.1016/j.jse.2017.10.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the effect of humeral articular component positioning on changes in patient-reported outcomes after anatomic total shoulder arthroplasty. METHODS This was a retrospective series of consecutive patients at 2 high-volume referral centers. The study included patients with (1) a preoperative and postoperative radiograph demonstrating a perfect or nearly perfect profile of the humerus and implant and (2) Simple Shoulder Test, visual analog scale for pain, and American Society of Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment scores preoperatively and at greater than 2 years postoperatively. Head height, head diameter, tuberosity-to-head height distance, inclination, and medial offset of the center of rotation (COR) were measured preoperatively and postoperatively. Distance and direction from the ideal COR to the reconstructed center of rotation was measured. Measurements were correlated with improvement in functional outcomes. RESULTS The study included 95 patients, aged 66 ± 9 years, with a mean follow-up of 4.3 ± 1.7 years. An a priori power analysis suggested that a sample size of 95 patients provided 80% power to detect correlations of R2 = 0.07. The COR shift was >2 mm in 62% of patients and >4 mm 15%. Thirty-two percent had a change of ASES of <21 points. On multivariate analysis, there were no significant associations between any change in measured prosthetic radiographic parameters and changes in the visual analog scale, Simple Shoulder Test, or ASES scores (P > .05). CONCLUSION In this retrospective analysis of total shoulder arthroplasty in which most components were well positioned, humeral component positioning did not associate with change in postoperative outcomes. These findings should be prospectively confirmed.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Erin K Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan D Orvets
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Brendan M Patterson
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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