1
|
Lannes X, Goetti P, Boubat M, Eghbali P, Becce F, Farron A, Terrier A. Three-dimensional evaluation of the transverse rotator cuff muscle's resultant force angle in relation to scapulohumeral subluxation and glenoid vault morphology in nonpathological shoulders. J Shoulder Elbow Surg 2024; 33:1157-1168. [PMID: 37898420 DOI: 10.1016/j.jse.2023.09.031] [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: 04/16/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling. METHODS Computed tomography scans of 55 trauma patients (age 31 ± 13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3-dimension. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The resultant force vector was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated. RESULTS The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4 ± 4.5°, 54.3 ± 4.8%, -4.1 ± 4.4°, 5.1 ± 10.8°, 3.3 ± 0.6 mm, 20 ± 2 mm, and 33.6 ± 4.6 mm, respectively. The TRFA correlated strongly with SHSI (R = 0.731, P < .001) and GVA (R = 0.716, P < .001) and moderately with GOA (R = 0.663, P < .001). The SHSI was strongly negatively correlated with GVA (R = -0.813, P < .001) and moderately with GOA (R = -0.552, P < .001). The GVA correlated strongly with GOA (R = 0.768, P < .001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius. CONCLUSION Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset.
Collapse
Affiliation(s)
- Xavier Lannes
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Patrick Goetti
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Boubat
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Pezhman Eghbali
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Vegas A, Cannon D, Lewis S, Mekkawy KL, Glener J, Rodriguez HC, Schodlbauer D, Levy JC. Functional and radiographic results of anatomic total shoulder arthroplasty in the setting of subscapularis dysfunction: 5-year outcomes analysis. J Shoulder Elbow Surg 2024; 33:e79-e87. [PMID: 37473908 DOI: 10.1016/j.jse.2023.06.015] [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: 01/15/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Subscapularis management is a critical component to the success of anatomic total shoulder arthroplasty (TSA). Failure to heal the subscapularis can result in pain, weakness, loss of function, and revision. However, not all patients have poor outcomes. The purpose of this study is to compare patients with normal and dysfunctional subscapularis function following TSA in regard to (1) patient-reported outcome measures (PROMs); (2) range of motion (ROM) and strength; (3) achievement of minimal clinically important differences (MCIDs); and (4) specific functional internal rotation tasks. METHODS A retrospective review of patients treated with TSA for osteoarthritis with a minimum 2-year follow-up was performed to identify patients with subscapularis dysfunction. Subscapularis dysfunction was diagnosed when any degree of weakness in internal rotation was detected on physical examination (positive belly press sign). These patients were case controlled matched on a 1:3 ratio to patients with normal subscapularis function based on age and sex. PROMs, measured active motion, revision rates, patient satisfaction, and postoperative radiographic findings were compared. Population-specific institutional anchor-based MCID values were used to compare the improvement in PROM. RESULTS Of the 668 patients included, 34 patients (5.1%) demonstrated evidence of subscapularis dysfunction. Mean follow-up for the normal subscapularis function cohort was 63.4 ± 29.7 and 58.7 ± 26.8 for the dysfunctional subscapularis cohort. Patients with subscapularis dysfunction demonstrated significantly worse postoperative Simple Shoulder Test, Single Assessment Numerical Evaluation, visual analog scale (VAS) function, VAS pain, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores with higher rates of unsatisfactory results when compared to patients with normal subscapularis function. Abduction, elevation, internal rotation ROM, along with supraspinatus and external rotation strength were also significantly worse in the dysfunctional group. Similarly, these patients were more likely to have decreased ability to perform functional internal rotation tasks, with only 47% of the patients being able to reach the small of their back compared to 85% with normal subscapularis function. Radiographically, the dysfunctional cohort demonstrated higher rates of anterior subluxation (56% vs. 7%; P < .001) and glenoid loosening (24% vs. 5%; P = .004). Similarly, revision rates were significantly higher for patients with subscapularis dysfunction (8 patients, 23.5%). Nonetheless, the dysfunctional subscapularis cohort demonstrated improvements in VAS pain (4.0 ± 3.7) and ASES (46.4 ± 35.9) scores that exceeded MCID thresholds. CONCLUSION Patients who develop subscapularis dysfunction after TSA have significantly worse PROMs, ROM, functional tasks of internal rotation, and radiographic outcomes, as well as increased rates of revision. Although patients show worse outcomes and high revision rates compared with their normal-functioning counterparts, these patients maintained improvement above MCID thresholds for pain and function at a mean 5-year follow-up.
Collapse
Affiliation(s)
- Austin Vegas
- Department of Orthopedic Surgery, Larkin Community Hospital, South Miami, FL, USA
| | - Dylan Cannon
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Steven Lewis
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | - Julie Glener
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Hugo C Rodriguez
- Department of Orthopedic Surgery, Larkin Community Hospital, South Miami, FL, USA
| | - Daniel Schodlbauer
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA
| | - Jonathan C Levy
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA.
| |
Collapse
|
3
|
Moroder P, Lacheta L, Minkus M, Gebauer H, Paksoy A, Thiele K, Akgün D. SECEC Didier Patte Prize 2023: the ABC classification of posterior shoulder instability. J Shoulder Elbow Surg 2024:S1058-2746(24)00020-X. [PMID: 38218406 DOI: 10.1016/j.jse.2023.11.019] [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: 07/05/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND The ABC classification has recently been proposed as a comprehensive classification system for posterior shoulder instability (PSI). The purpose of this study was to analyze the comprehensiveness as well as inter-rater and intrarater reliability of the ABC classification. METHODS All consecutive patients presenting with unidirectional PSI from June 2019 to June 2021 were included in a prospective study. No patients were excluded, leaving a consecutive series of 100 cases of PSI in 91 patients. All recorded clinical and imaging data were used to create anonymized clinical case vignettes, which were evaluated twice according to the ABC classification at the end of the recruitment period in random sequential order by 4 independent raters (2 experienced shoulder surgeons and 2 orthopedic residents) to analyze the comprehensiveness as well as inter-rater and intrarater reliability of the ABC classification for PSI and to describe differences in characteristics among subtypes. Group A was defined as a first-time singular PSI event <3 months in the past regardless of etiology and is further subdivided into type 1 and type 2 depending on the occurrence of a subluxation (A1) or dislocation (A2). Group B comprises recurrent dynamic PSI regardless of time since onset and is further subdivided by the cause of instability into functional (B1) and structural (B2) dynamic PSI. Group C includes chronic static PSI with posterior humeral decentering that can be either constitutional (C1) or acquired (C2). RESULTS None of the cases was deemed unsuitable to be classified based on the proposed system by the observers. After consensus agreement between the 2 expert raters, 16 cases were attributed to group A (8 type A1 and 8 type A2); 64, to group B (33 type B1 and 31 type B2); and 20, to group C (11 type C1 and 9 type C2). The expert raters agreed on the classification subtypes in 99% and 96% of the cases during the first rating and second rating, respectively (intraclass correlation coefficients [ICCs], 0.998 and 0.99, respectively). The intraobserver reliability was excellent for both raters. The beginners reached the same conclusion as the consensus agreement in 94% of the cases (ICC, 0.99) and 89% of the cases (ICC, 0.97) during the first round and 94% each (ICC, 0.97) during the second round. The intraobserver reliability was excellent for both beginners. Overall, discrepancies between raters were found between groups B1 and B2 (n = 14), groups B2 and C2 (n = 4), groups B1 and C1 (n = 1), and groups A1 and B2 (n = 1). In general, each subtype showed distinctive clinical and imaging characteristics that facilitated the diagnosis. CONCLUSION The presented ABC classification for PSI is a comprehensive classification with a high reliability and reproducibility. However, a gradual transition and potential progression between the subtypes of PSI must be considered. The reliable distinction between different subtypes of PSI based on etiology and pathomechanism provides a standardized basis for future investigations on treatment recommendations.
Collapse
Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Lucca Lacheta
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Marvin Minkus
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Henry Gebauer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alp Paksoy
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
| |
Collapse
|
4
|
Gauci MO, Ceccarelli R, Lavoue V, Chelli M, van der Meijden OAJ, Gonzalez JF, Boileau P. Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum? J Shoulder Elbow Surg 2024:S1058-2746(23)00894-7. [PMID: 38182028 DOI: 10.1016/j.jse.2023.11.010] [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: 06/15/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively. MATERIAL We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence. RESULTS The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05). CONCLUSION Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance.
Collapse
Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
| | - Romain Ceccarelli
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Vincent Lavoue
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Mikael Chelli
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | | | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| |
Collapse
|
5
|
Rutledge JC, Dey Hazra RO, Geissbuhler AR, Yamaura K, Dey Hazra ME, Hanson JA, Rupp MC, Millett PJ. Does glenoid version and its correction affect outcomes in anatomic shoulder arthroplasty? A systematic review. J Shoulder Elbow Surg 2023:S1058-2746(23)00858-3. [PMID: 38122888 DOI: 10.1016/j.jse.2023.10.031] [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: 06/02/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Correction of glenoid retroversion is commonly performed in anatomic total shoulder arthroplasty (TSA) to increase component contact area and decrease eccentric loading of the glenoid component. Despite demonstrated biomechanical advantages, limited information exists on the clinical benefit of correcting glenoid retroversion. The purpose of this systematic review is to critically evaluate the existing literature on the effect of preoperative and postoperative glenoid retroversion on clinical functional and radiologic outcomes in patients who underwent anatomic TSA. METHODS A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using PubMed, Embase, and Cochrane Library evaluating the impact of glenoid retroversion on clinical and radiologic outcomes of TSA. English-language studies of level I through IV evidence were included. Blinded reviewers conducted multiple screens and methodological quality was appraised using the Modified Coleman Methodology Score. RESULTS Sixteen studies, including 3 level III and 13 level IV studies (1211 shoulders), satisfied all inclusion criteria. To address glenoid retroversion, 9 studies used corrective reaming techniques, and 4 studies used posteriorly augmented glenoids. Two studies used noncorrective reaming techniques. Mean preoperative retroversion ranged from 12.7° to 24° across studies. Eleven studies analyzed the effect of glenoid retroversion on clinical outcomes, including patient-reported outcome scores (PROs), range of motion (ROM), or clinical failure or revision rates. Most studies (8 of 11) did not report any significant association of pre- or postoperative glenoid retroversion on any clinical outcome. Of the 3 studies that reported significant effects, 1 study reported a negative association between preoperative glenoid retroversion and PROs, 1 study reported inferior postoperative abduction in patients with postoperative glenoid retroversion greater than 15°, and 1 study found an increased clinical failure rate in patients with higher postoperative retroversion. Ten studies reported radiographic results (medial calcar resorption, Central Peg Lucency [CPL] grade, Lazarus lucency grade) at follow-up. Only 1 study reported a significant effect of pre- and postoperative retroversion greater than 15° on CPL grade. CONCLUSION There is currently insufficient evidence that pre- or postoperative glenoid version influences postoperative outcomes independent of other morphologic factors such as joint line medialization. Given that noncorrective reaming demonstrated favorable postoperative outcomes, and postoperative glenoid version was not significantly and consistently found to impact outcomes, there is inconclusive evidence that correcting glenoid retroversion is routinely required.
Collapse
Affiliation(s)
| | - Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, CO, USA; Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | | | - Kohei Yamaura
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | - Jared A Hanson
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, CO, USA; Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
| |
Collapse
|
6
|
Fischer CS, Ittermann T, Gonser CE, Floß M, Bülow R, Schmidt CO, Haralambiev L, Histing T, Lange J. Reference values and influencing factors of the glenohumeral subluxation index: a study on 3004 participants. J Shoulder Elbow Surg 2023; 32:2533-2540. [PMID: 37290636 DOI: 10.1016/j.jse.2023.04.032] [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: 12/01/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The primary objective of this study was to examine the glenohumeral subluxation index (GHSI) in a large general population cohort and to define reference values. Glenohumeral subluxation is important in the development and prediction of pathological states of the shoulder joint and in total shoulder arthroplasty. Therefore, another objective was to examine the influence of age, sex, body mass index, and body height and weight on GHSI. METHODS GHSI according to Walch was measured on bilateral magnetic resonance imaging of 3004 participants of the Study of Health in Pomerania (SHIP, aged 21-90 years). SHIP drew a sample of the adult general population of Pomerania (Northeastern Germany). Reference values for GHSI were assessed by quantile regression models. Associations of sex, age, and anthropometric markers with the GHSI were calculated by linear regression models. RESULTS A reference range between 42% and 55% for men with a mean of 49% ± 4% was defined, while the upper reference limit for women was 1% higher (mean, 50% ± 4%). Age was inversely associated with the GHSI in males (P < 0.001), while no significant association in females was observed (P = .625). Body weight and body mass index were positively associated (P < .001) without effect modification by sex. Heavy mechanical oscillations on the upper extremity showed no significant association with GHSI (P = .268). CONCLUSION The reference values for GHSI were expanded to a range of 42%-57% on magnetic resonance imaging. Several associations between GHSI and anthropometric properties are present. According to these associations, adjusted formulas are provided to enable individual, patient-specific diagnostics and therapy. Nevertheless, the clinical picture cannot be neglected.
Collapse
Affiliation(s)
- Cornelius Sebastian Fischer
- BG Unfallklinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christoph Emanuel Gonser
- BG Unfallklinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Matthias Floß
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | | | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Tina Histing
- BG Unfallklinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jörn Lange
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
7
|
Muhammed AR, Aburas L, Yusuf K, Masood Q, Dutta A, Flood C, Bakti N, Singh B. Cemented or uncemented humerus fixation in shoulder arthroplasty? - A narrative review of the current literature. J Orthop 2023; 41:84-89. [PMID: 37426944 PMCID: PMC10329092 DOI: 10.1016/j.jor.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 07/11/2023] Open
|
8
|
Gerber C, Sigrist B, Hochreiter B. Correction of Static Posterior Shoulder Subluxation by Restoring Normal Scapular Anatomy Using Acromion and Glenoid Osteotomies: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00030. [PMID: 37172119 DOI: 10.2106/jbjs.cc.23.00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE A 40-year-old man presented with progressive shoulder pain, associated with static posterior subluxation and mild eccentric glenohumeral osteoarthritis. Compared with a mean statistical shape model of a normal shoulder, the patient's acromion was abnormally high and horizontal, and the glenoid abnormally inclined inferiorly and minimally retroverted. Restoration of normal scapular anatomy using 3-dimensional planned acromial and glenoid osteotomies led to recentering of the joint and full shoulder function up to 24 months postoperatively. CONCLUSION The correction of associated acromial and glenoid malformation can revert early static posterior subluxation of the shoulder. Whether successful recentering prevents progression of osteoarthritis remains to be established.
Collapse
Affiliation(s)
- Christian Gerber
- Department of Orthopaedics University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
| | - Bastian Sigrist
- Department of Orthopaedics, Laboratory for Research in Orthopaedic Computer Science (ROCS), University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Bettina Hochreiter
- Department of Orthopaedics University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
| |
Collapse
|
9
|
Villefort C, Stern C, Gerber C, Wyss S, Ernstbrunner L, Wieser K. Mid-term to long-term results of open posterior bone block grafting in recurrent posterior shoulder instability: a clinical and CT-based analysis. JSES Int 2023; 7:211-217. [PMID: 36911764 PMCID: PMC9998725 DOI: 10.1016/j.jseint.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background There is little consensus on the best treatment after failed conservative management of recurrent posterior shoulder instability. The purpose of this study was to analyze our clinical and radiological mid-term to long-term results of an open, posterior bone block procedure for the treatment of recurrent posterior shoulder instability. Methods From 1999 to 2015, 14 patients were included in the study and available for clinical and radiographic follow-up (FU). FU included a standardized physical examination, assessment of the Constant-Murley-Score, subjective shoulder value, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability Index. Conventional radiographs and a computed tomography (CT)-scan were performed preoperatively and at latest FU. Glenohumeral arthropathy was classified as per Samilson and Prieto. The CT scans were used to evaluate the structure of the graft (resorption, union), graft positioning, glenoid version, centering of the humeral head, and glenoid erosion and morphology. Results The median age at the time of surgery was 26 years (range 16-41 years) and the median FU period was 9 years (range 4-20 years). The rate of reported dynamic postoperative subluxation and instability was 46% (n = 6) and the rate of dynamic posterior instability during clinical testing at FU was 31% (n = 4). The tested instability rate in the traumatic group was 14% (n = 1) compared to the atraumatic group with 50% (n = 3) during clinical FU. The mean Constant-Murley-Score increased from preoperatively (77 ± 11 points) to postoperatively (83 ± 14 points, P = .158). The last FU showed an American Shoulder and Elbow Surgeons score of 85 ± 12; the Western Ontario Shoulder Instability Index score was 715 ± 475 points. The mean subjective shoulder value increased from 58% ± 19 preoperatively to 73% ± 17 at final FU (P = .005). Degenerative changes increased by at least one grade in 67% of the patients. Mean preoperative glenoid retroversion (CT) was 7.5° ± 6°. The position of the graft was optimal in 86% (n = 12). In 62% of the cases, a major resorption of the graft (Zhu grade II) was observed. Conclusion The rate of tested recurrent instability at last FU was as high as 31% (n = 4, atraumatic [n = 3] vs. traumatic [n = 1]) after a median FU of 9 years. Given the moderate improvement of clinical outcome scores, shoulder stability and the increase of degenerative joint changes by at least one grade (Samilson/Prieto) in 67% of patients, a posterior bone block procedure is not a uniformly satisfying treatment option for recurrent posterior shoulder subluxation, especially in cases of atraumatic posterior instability.
Collapse
Affiliation(s)
- Christina Villefort
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sabine Wyss
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Sudah SY, Menendez ME, Moverman MA, Puzzitiello RN, Little D, Nicholson AD, Garrigues GE. The role of the anterior shoulder joint capsule in primary glenohumeral osteoarthritis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:21-27. [PMID: 37588061 PMCID: PMC10426523 DOI: 10.1016/j.xrrt.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The pathogenesis of primary glenohumeral arthritis (GHOA) is mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. Recently, there has been growing interest in characterizing the association between the anterior shoulder joint capsule and primary GHOA because of the potential for targeted treatment interventions. Emerging evidence has shown substantial synovitis, fibrosis, and mixed inflammatory cell infiltrate in the anterior capsule of osteoarthritic shoulders. In addition, increased thickening of the anterior shoulder joint capsule has been associated with greater posterior glenoid wear and humeral head subluxation. While these findings suggest that anterior capsular disease may play a causative role in the etiology and progression of eccentric GHOA, further studies are needed to support this association. The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research.
Collapse
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
| | | | - Michael A. Moverman
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University, Boston, MA, USA
| | - Richard N. Puzzitiello
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University, Boston, MA, USA
| | - Dianne Little
- Department of Basic Medical Sciences and the Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | | | | |
Collapse
|
11
|
Hinse S, Pastor T, Hasler A, Ernstbrunner L, Wieser K, Gerber C. Mid- to Long-term Clinical and Radiological Results of Anatomic Total Shoulder Arthroplasty in patients with B2 Glenoids. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
|
12
|
Verhaegen F, Meynen A, Pitocchi J, Debeer P, Scheys L. Quantitative statistical shape model-based analysis of humeral head migration, Part 2: Shoulder osteoarthritis. J Orthop Res 2023; 41:21-31. [PMID: 35343599 DOI: 10.1002/jor.25335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
We wanted to investigate the quantitative characteristics of humeral head migration (HHM) in shoulder osteoarthritis (OA) and their possible associations with scapular morphology. We quantified CT-scan-based-HHM in 122 patients with a combination of automated 3D scapulohumeral migration (=HHM with respect to the scapula) and glenohumeral migration (=HHM with respect to the glenoid) measurements. We divided OA patients in Group 1 (without HHM), Group 2a (anterior HHM) and Group 2b (posterior HHM). We reconstructed and measured the prearthropathy scapular anatomy with a statistical shape model technique. HHM primarily occurs in the axial plane in shoulder OA. We found "not-perfect" correlation between subluxation distance AP and scapulohumeral migration values (rs = 0.8, p < 0.001). Group 2b patients had a more expressed prearthropathy glenoid retroversion (13° vs. 7°, p < 0.001) and posterior glenoid translation (4 mm vs. 6 mm, p = 0.003) in comparison to Group 1. Binary logistic regression analysis indicated prearthropathy glenoid version as a significant predictor of HHM (χ² = 27, p < 0.001). Multivariate regression analysis showed that the pathologic version could explain 56% of subluxation distance-AP variance and 75% of the scapulohumeral migration variance (all p < 0.001). Herewith, every degree increase in pathologic glenoid retroversion was associated with an increase of 1% subluxation distance-AP, and scapulohumeral migration. The occurrence of posterior HHM is associated with prearthropathy glenoid retroversion and more posterior glenoid translation. The reported regression values of HHM in the function of the pathologic glenoid version could form a basis toward a more patient-specific correction of HHM.
Collapse
Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Alexander Meynen
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Philippe Debeer
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Creighton RA, Burrus MT, Werner BC, Gobezie R, Lederman E, Denard PJ. Short-term clinical and radiographic outcomes of a hybrid all-polyethylene glenoid based on preoperative glenoid morphology. J Shoulder Elbow Surg 2022; 31:2554-2561. [PMID: 35750156 DOI: 10.1016/j.jse.2022.05.016] [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: 03/16/2022] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary purpose of this study was to compare 2-year anatomic total shoulder arthroplasty (TSA) functional and radiographic outcomes between Walch type A and B glenoids treated with an all-polyethylene glenoid designed for hybrid fixation with peripheral cement and central osseous integration. The secondary purpose was to evaluate outcomes based on central peg technique. The hypotheses were that there would be no difference in short-term radiographic or functional outcome scores based on preoperative glenoid morphology or central peg technique. METHODS We performed a multicenter retrospective review of patients who underwent TSA with the same hybrid all-polyethylene glenoid and had minimum 2-year follow-up. Patient-reported outcomes and radiographic outcomes were analyzed based on preoperative Walch morphology and central peg technique. Radiographic analysis included preoperative glenoid morphology; preoperative and postoperative glenoid version, glenoid inclination, and posterior humeral head subluxation; and postoperative glenoid radiolucencies according to the Wirth and Lazarus classifications. RESULTS A total of 266 patients with a mean age of 64.9 ± 8.2 years were evaluated at a mean of 28 months postoperatively. Postoperatively, there were significant improvements in all functional outcome measures (P < .001), range-of-motion measures (forward elevation, external rotation at 0°, external rotation at 90°, internal rotation by spinal level, and internal rotation at 90°; P < .001), and strength measures (Constant, external rotation, and modified belly press; P < .001). There were no clinically meaningful differences in functional outcomes or statistically significant differences in radiographic appearance between Walch type A and B glenoids. Subgroup analysis revealed that glenoids with a cemented central peg had the worst radiographic outcomes based on Lazarus scoring. CONCLUSION Patients undergoing TSA with a hybrid in-line pegged glenoid have excellent clinical outcomes at short-term follow-up regardless of preoperative glenoid morphology. Different central peg techniques do not appear to play a significant role in the risk of glenoid component lucencies at 2 years postoperatively.
Collapse
|
14
|
Cuff DJ, Simon P, Patel JS, Munassi SD. Anatomic shoulder arthroplasty with high side reaming versus reverse shoulder arthroplasty for eccentric glenoid wear patterns with an intact rotator cuff: comparing early versus midterm outcomes with minimum 7 years of follow-up. J Shoulder Elbow Surg 2022; 32:972-979. [PMID: 36400340 DOI: 10.1016/j.jse.2022.10.017] [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: 08/01/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Eccentric glenoid bone loss patterns (B- and C-type glenoid) pose a difficult challenge when performing shoulder arthroplasty. Anatomic total shoulder arthroplasty with preferential high-side reaming (ATSA + HSR) has been an accepted method to treat this problem. Reverse shoulder arthroplasty (RSA) has become an alternative method to manage these cases with eccentric glenoid wear. The purpose of this study was to compare the early 2-year outcomes with the midterm outcomes for patients who underwent ATSA + HSR vs. RSA for eccentric glenoid wear patterns with an intact rotator cuff. MATERIALS AND METHODS From 2008 to 2014 there were 242 shoulder arthroplasties performed in the setting of eccentric glenoid wear patterns. Of that initial cohort 101 ATSA + HSR and 93 RSA had both 2-year and final follow-up with a minimum of 7 years from surgery. American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST), range of motion, patient satisfaction, and radiographs were evaluated for each cohort and contrasted at the 2-year follow-up point and last follow-up time point. RESULTS The average follow-up in the ATSA + HSR cohort was 8.3 years compared with 7.8 years in the RSA cohort. At the 2-year follow-up point, the ATSA + HSR group had better average ASES scores (85 vs. 80 [P < .001]), SST scores (10 vs. 9.6 [P < .001]), forward elevation (162° vs. 151° [P < .001]), external rotation (47° vs. 42° [P < .001]), and internal rotation (IR) (80% full IR vs. 55% full IR [P < .001]). At the 2-year follow-up, 95% of the ATSA + HSR cohort were satisfied compared with 93% in the RSA cohort. At the final follow-up, the RSA group had better average ASES scores (80 vs. 77 [P < .001]) and SST scores (9.4 vs. 8 [P < .001]) and a similar forward elevation (152° vs. 149° [P = .025]). The ATSA + HSR had better external rotation (45° vs. 41° [P < .001]) and IR (74% full IR vs. 54% full IR [P = .005]). Patient satisfaction at the final follow-up had decreased to 82% in the ATSA + HSR group, compared with 95% satisfied in the RSA group. Of the initial ATSA + HSR cohort, 8% of patients had undergone revision compared with 2% in the RSA cohort. CONCLUSION ATSA with HSR had better outcome scores and range of motion with a similar patient satisfaction rating to RSA at the 2-year point. Over time, the ATSA + HSR results deteriorated, and at the final midterm follow-up, the RSA group had more durable results with better outcome scores, a higher patient satisfaction rating, and a lower revision rate.
Collapse
Affiliation(s)
- Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Shoulder Service, Venice, FL, USA.
| | - Peter Simon
- Foundation for Orthopaedic Research and Education (FORE), Translational Research, Tampa, FL, USA; Department of Medical Engineering, University of South Florida College of Engineering and Morsani College of Medicine, Tampa, FL, USA
| | - Jay S Patel
- Foundation for Orthopaedic Research and Education (FORE), Translational Research, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steven D Munassi
- Foundation for Orthopaedic Research and Education (FORE), Translational Research, Tampa, FL, USA
| |
Collapse
|
15
|
Moroder P, Gebauer H, Paksoy A, Siegert P, Festbaum C, Rüttershoff K, Lacheta L, Thiele K, Akgün D. Arthroscopic Posterior Articular Coverage and Shift (PACS) Procedure for Treatment of Preosteoarthritic Constitutional Static Posterior Shoulder Instability (Type C1). Am J Sports Med 2022; 50:3617-3624. [PMID: 36178161 PMCID: PMC9630853 DOI: 10.1177/03635465221124851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Different joint-preserving techniques for treatment of preosteoarthritic, constitutional static (type C1) posterior shoulder instability (PSI) have been proposed, including posterior glenoid open wedge osteotomy and bone graft augmentation. However, the techniques are demanding, the reported complication and reoperation rates are high, and posterior decentering cannot reliably be reversed. PURPOSE To assess the clinical and radiological longitudinal outcomes of patients with type C1 PSI after arthroscopic posterior articular coverage and shift (PACS) surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We performed a retrospective analysis of a prospective database with longitudinal follow-up including 14 shoulders in 13 patients who underwent an arthroscopic PACS procedure for symptomatic preosteoarthritic constitutional static posterior instability (type C1) with previous failed nonoperative treatment. Patients were clinically evaluated before surgery and at 3, 6, 12, and 24 months postoperatively in terms of satisfaction and pain levels as well as standardized physical examination, Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI) score, Constant score, and Rowe score. Preoperative, postoperative, and follow-up magnetic resonance imaging scans were obtained in all patients. A paired 2-sample t test was used to compare changes in continuous variable parameters over time. Correlation analyses were performed using the Pearson correlation coefficient. RESULTS All outcome scores and the pain level improved significantly from preoperatively to postoperatively, and the improvement was sustained over the follow-up period of 2 years (pain level, 6.4 preoperatively vs 3.3 at 2 years, P < .001; SSV, 40 vs 70, P = .001; WOSI, 33 vs 56, P = .001; Constant, 70 vs 79, P = .049; Rowe, 52 vs 76, P < .001). The mean glenohumeral and scapulohumeral subluxation indices were significantly lower in the early postoperative period compared with preoperative measurements (glenohumeral, 52% ± 6% vs 58% ± 10%, P = .02; scapulohumeral, 70% ± 8%; vs 77% ± 9%, P = .002, respectively); however, they returned to baseline values at follow-up (57% ± 7% vs 58% ± 10%, P = .7; 75% ± 6% vs 77% ± 9%, P = .4, respectively). A high scapulohumeral subluxation index, excessive glenoid retroversion, and increased posterior positioning of the humeral head in relation to scapular blade axis and older age were correlated with worse clinical outcomes. CONCLUSION Over the follow-up period of 2 years, the PACS procedure significantly improved outcome scores in patients who had preosteoarthritic constitutional static posterior shoulder instability, especially in younger patients with less severe glenoid retroversion and posterior decentering of the humeral head. However, similar to other techniques, the PACS procedure needs to be considered a symptomatic therapy that does not reverse the underlying cause or stop the progressive pathology.
Collapse
Affiliation(s)
- Philipp Moroder
- Department of Shoulder and Elbow
Surgery, Schulthess Clinic, Zurich, Switzerland,Philipp Moroder, MD, Department of Shoulder and Elbow Surgery,
Schulthess Clinic Zurich, Lengghalde 2, 8008 Zurich, Switzerland (
)
| | - Henry Gebauer
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alp Paksoy
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Paul Siegert
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Festbaum
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Katja Rüttershoff
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Lucca Lacheta
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Kathi Thiele
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Doruk Akgün
- Department of Shoulder and Elbow
Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| |
Collapse
|
16
|
Considerations for Shoulder Arthroplasty Implant Selection in Primary Glenohumeral Arthritis With Posterior Glenoid Deformity. J Am Acad Orthop Surg 2022; 30:e1240-e1248. [PMID: 36027046 DOI: 10.5435/jaaos-d-21-01219] [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: 12/17/2021] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
Glenoid deformity has an important effect on outcomes and complication rates after shoulder arthroplasty for primary glenohumeral arthritis. The B2/B3 glenoid has particularly been associated with a poorer outcome with shoulder arthroplasty compared with other glenoid types. One of the primary challenges is striking a balance between deformity correction and joint line preservation. Recently, there has been a proliferation of both anatomic and reverse implants that may be used to address glenoid deformity. The purpose of this review was to provide an evidence-based approach for addressing glenoid deformity associated with primary glenohumeral arthritis.
Collapse
|
17
|
The association between anterior shoulder joint capsule thickening and glenoid deformity in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:e413-e417. [PMID: 35331857 DOI: 10.1016/j.jse.2022.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior shoulder joint capsule thickening is typically present in osteoarthritic shoulders, but its association with specific patterns of glenoid wear is incompletely understood. We sought to determine the relationship between anterior capsular thickening and glenoid deformity in primary glenohumeral osteoarthritis. METHODS We retrospectively identified 134 consecutive osteoarthritic shoulders with magnetic resonance imaging and computed tomography scans performed. Axial fat-suppressed magnetic resonance imaging slices were used to quantify the anterior capsular thickness in millimeters, measured at its thickest point below the subscapularis muscle. Computed tomography scans were used to classify glenoid deformity according to the Walch classification, and an automated 3-dimensional software program provided values for glenoid retroversion and humeral head subluxation. Multinomial and linear regression models were used to characterize the association of anterior capsular thickening with Walch glenoid type, glenoid retroversion, and posterior humeral head subluxation while controlling for patient age and sex. RESULTS The anterior capsule was thickest in glenoid types B2 (5.5 mm, 95% confidence interval [CI]: 5.0-6.0) and B3 (6.1 mm, 95% CI: 5.6-6.6) and thinnest in A1 (3.7 mm, 95% CI: 3.3-4.2; P < .001). Adjusted for age and sex, glenoid types B2 (odds ratio: 4.4, 95% CI: 2.3-8.4, P < .001) and B3 (odds ratio: 5.4, 95% CI: 2.8-10.4, P < .001) showed the strongest association with increased anterior capsule thickness, compared to glenoid type A1. Increased capsular thickness correlated with greater glenoid retroversion (r = 0.57; P < .001) and posterior humeral head subluxation (r = 0.50; P < .001). In multivariable analysis, for every 1-mm increase in anterior capsular thickening, there was an adjusted mean increase of 3.2° (95% CI: 2.4-4.1) in glenoid retroversion and a 3.8% (95% CI: 2.7-5.0) increase in posterior humeral head subluxation. CONCLUSIONS Increased thickening of the anterior shoulder capsule is associated with greater posterior glenoid wear and humeral head subluxation. Additional research should determine whether anterior capsular disease plays a causative role in the etiology or progression of eccentric glenohumeral osteoarthritis.
Collapse
|
18
|
Kleim BD, Hinz M, Geyer S, Scheiderer B, Imhoff AB, Siebenlist S. A 3-Dimensional Classification for Degenerative Glenohumeral Arthritis Based on Humeroscapular Alignment. Orthop J Sports Med 2022; 10:23259671221110512. [PMID: 35982830 PMCID: PMC9380229 DOI: 10.1177/23259671221110512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity. Purpose/Hypothesis The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently. Study Design Cross-sectional study; Level of evidence, 3. Methods The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3. Results Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation >60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified. Conclusion There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
Collapse
Affiliation(s)
- Benjamin D. Kleim
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Maximillian Hinz
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| |
Collapse
|
19
|
Scarcella MJ, Yalcin S, Ginesin E, Patel R, Miniaci A. Treatment options for complex shoulder osteoarthritis with posterior humeral head subluxation and glenoid bone loss (Walch B): A systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:285-296. [PMID: 37588863 PMCID: PMC10426496 DOI: 10.1016/j.xrrt.2022.04.007] [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
Background Shoulder osteoarthritis (OA) with eccentric (B) glenoids has generally been associated with poor patient-reported outcomes and increased complications. The purpose of this study was to outline all the described treatment options and their outcomes and complications in order to better guide treatment. Methods This systematic review was performed according to the Preferred Reporting Items for Systematic review and Meta-analysis guidelines. Searches were performed up to December 19, 2019, using Medline, EMBASE, Scopus, and Cochrane databases. Inclusion criteria included studies for glenohumeral OA reporting posterior humeral head subluxation and/or posterior glenoid erosion. Studies were excluded if they were review papers, abstracts, or conference papers; had heterogeneity of included Walch types; or were not written in English. Results Twenty-one studies met inclusion criteria. The mean follow-up duration was 47.5 months (range, 14-300), and the mean patient age 62 years (38-88). Six different discernible techniques were identified: asymmetric reaming with onlay glenoid (AROG) in 267 shoulders, posterior glenoid bone grafting (PGBG) with onlay glenoid in 79 shoulders, augmented glenoid (AG) in 160 shoulders, reverse shoulder arthroplasty (RSA) with or without bone grafting in 118 shoulders, hemiarthroplasty with concentric reaming (HACR) in 57 shoulders, and humeral head arthroplasty with inlay glenoid (HAIG) in 36 shoulders. All techniques reported improved patient outcomes and range of motion. Short-term (<5 years) studies reported glenoid loosening leading to revisions in 3% of AROG, 2.7% PGBG, 0.8% AG, 1.4% RSA, and 0% HAIG shoulders. HACR had a high revision rate (12.3%) due to persistent pain and stiffness. Midterm (>5 years) studies demonstrated increased rates of glenoid loosening with AROG (14.5%), PGBG (21% loose, 23.8% "at risk"), and AG (18.9% "at risk"), as well as increased rates of subluxation or revision due to instability. HAIG did not demonstrate loosening, subluxation, or revision at 55.2 months. Conclusion Various techniques exist to manage complex primary glenohumeral OA with posterior subluxation and posterior glenoid erosion. Glenoid component survival is a concern with ASOG, PGBG, and AG. HACR has the highest early revision rate. RSA offers promising short-term and midterm results likely due to the advantage of more secure fixation as well as a constrained design to prevent posterior subluxation. HAIG has the lowest complication and revision rates although further long-term studies are needed.
Collapse
Affiliation(s)
| | - Sercan Yalcin
- Cleveland Clinic Orthopaedic and Rheumatology Institute, Avon, OH, USA
| | | | | | - Anthony Miniaci
- Cleveland Clinic Orthopaedic and Rheumatology Institute, Avon, OH, USA
| |
Collapse
|
20
|
Vocelle AR, Weidig G, Bush TR. Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies. J Hand Ther 2022; 35:377-387. [PMID: 35918274 DOI: 10.1016/j.jht.2022.06.008] [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: 01/30/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Invited review. BACKGROUND Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.
Collapse
Affiliation(s)
- Amber R Vocelle
- Physical Medicine and Rehabilitation Department, E.W. Sparrow Hospital, Lansing, MI, USA; Physical Medicine and Rehabilitation Department, Michigan State University, East Lansing, MI, USA
| | - Garrett Weidig
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA
| | - Tamara R Bush
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA.
| |
Collapse
|
21
|
Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders. J Clin Med 2022; 11:jcm11020351. [PMID: 35054045 PMCID: PMC8779855 DOI: 10.3390/jcm11020351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R2 = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R2 = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae.
Collapse
|
22
|
Waltenspül M, Häller T, Ernstbrunner L, Wyss S, Wieser K, Gerber C. Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion. J Shoulder Elbow Surg 2022; 31:81-89. [PMID: 34216782 DOI: 10.1016/j.jse.2021.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of posterior shoulder instability (PSI) associated with excessive glenoid retroversion is a rare, challenging problem in shoulder surgery. One proposed technique is posterior open wedge glenoid osteotomy to correct excessive glenoid retroversion as described by Scott. However, this operation is rarely performed, and limited long-term outcomes using this approach are available. The goal of this study was to analyze the long-term outcomes of posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion. METHODS Six consecutive patients (7 shoulders) with a mean age of 24 years (range 19-34) were treated with posterior open wedge glenoid osteotomy for PSI associated with a glenoid retroversion greater than 15° and followed up clinically and radiographically at a mean age of 15 years (range 10-19). RESULTS Recurrent, symptomatic PSI was observed in 6 of 7 shoulders (86%). One necessitated revision with a posterior (iliac crest) bone block procedure and was rated as a failure and excluded from functional analysis. One patient rated his result as excellent, 3 as good, 1 as fair, and 1 as unsatisfactory. Mean relative Constant Score (CS%) was unchanged from preoperation to final follow-up (CS% = 72%) and pain did not significantly decrease (Constant Score = 7-10 points; P = .969). The mean Subjective Shoulder Value (SSV) improved postoperatively, but with 6 patients the improvement did not reach statistical significance (SSV = 42%-67%, P = .053) and the total Western Ontario Shoulder Instability Index averaged 30% at the final follow-up. Mean glenoid retroversion of all 7 shoulders was corrected from 20° (range 16°-26°) to 3° (range -3° to +8°) (P = .018). In the 5 shoulders with preoperative static posterior subluxation of the humeral head, the humeral head was not recentered. All 7 shoulders showed progression of glenoid arthritic changes. CONCLUSIONS Posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion neither reliably restored shoulder stability nor recentered the joint or prevent progression of osteoarthritis. Alternative treatments for PSI associated with excessive glenoid retroversion have to be developed and evaluated.
Collapse
Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Thomas Häller
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sabine Wyss
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
23
|
Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde LF, Pouliart N. Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries. Expert Rev Med Devices 2021; 18:1189-1201. [PMID: 34903126 DOI: 10.1080/17434440.2021.2014318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.
Collapse
Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Orthopaedic Surgery and Traumatology, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Taco Gosens
- Department of Orthopaedic Surgery and Traumatology, Elisabeth Tweesteden Hospital, Tilburg/Waalwijk, The Netherlands
| | - Sara De Boey
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nicole Pouliart
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| |
Collapse
|
24
|
Jo YH, Kim DH, Lee BG. When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis? Clin Shoulder Elb 2021; 24:272-278. [PMID: 34875733 PMCID: PMC8651594 DOI: 10.5397/cise.2021.00633] [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: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.
Collapse
Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Heifner JJ, Kumar AD, Wagner ER. Glenohumeral osteoarthritis with intact rotator cuff treated with reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2021; 30:2895-2903. [PMID: 34293419 DOI: 10.1016/j.jse.2021.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although reverse shoulder arthroplasty (RSA) has shown satisfactory outcomes in rotator cuff-deficient shoulders, its performance in shoulders with an intact rotator cuff has not been fully elucidated. Shoulder osteoarthritis can present with alterations in glenoid morphology, which have contributed to inconsistent outcomes in anatomic shoulder replacement. The glenoid component is responsible for a predominance of these arthroplasty complications. Given these glenoid-related difficulties, RSA may provide a more favorable option. We aimed to summarize the current literature on rotator cuff intact osteoarthritis treated with primary RSA and to determine whether morphologic changes in the glenoid led to inferior outcomes. METHODS A literature search was performed using an inclusion criterion of primary RSA for osteoarthritis with an intact rotator cuff. The Modified Coleman Methodology Score was calculated to analyze reporting quality. Following appropriate exclusions, of the 1002 studies identified by the databases, 13 were selected. RESULTS Postoperative improvement in weighted means for Constant scores reached statistical significance (P = .02). The mean rate of major complications was 3.8%. A subset of 8 studies was created that detailed the following descriptions of altered glenoid morphology: "static posterior instability," "severe posterior subluxation," "posterior glenoid wear >20°," "significant posterior glenoid bone loss," "biconcave glenoid," "B2 glenoid," and "B/C glenoid." Within this subset, the mean complication rate was 4.7%, with 4 of the 7 studies having a rate ≤ 3%, and improvements in the Constant score (P = .002) and external rotation (P = .02) reached statistical significance. DISCUSSION RSA as treatment for osteoarthritis with an intact rotator cuff provides optimal outcomes with low complication rates across a short term of follow up. Preoperative considerations for using reverse arthroplasty in the treatment of osteoarthritis with an intact rotator cuff include glenoid retroversion, posterior humeral subluxation, and glenoid bone loss. The attributes of reverse arthroplasty that contribute to favorable outcomes in arthritic shoulders include its semiconstrained design and robust glenoid fixation. Soft-tissue imbalances as a consequence of pathologic glenoid morphology and chronic humeral subluxation can be mitigated with the RSA semiconstrained design. Glenoid bone loss can be effectively managed with RSA's robust glenoid fixation, with and without the use of bone graft. The capability to lateralize the joint center of rotation may be valuable when faced with a medialized glenoid wear pattern. The current findings suggest that reverse arthroplasty can achieve highly favorable outcomes for glenohumeral osteoarthritis with an intact rotator cuff.
Collapse
Affiliation(s)
| | - Anjali D Kumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric R Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Upper Extremity Surgery Research, Emory University, Atlanta, GA, USA
| |
Collapse
|
26
|
Schoch BS, King JJ, Zuckerman J, Wright TW, Roche C, Flurin PH. Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison. Shoulder Elbow 2021; 13:518-526. [PMID: 34659485 PMCID: PMC8512971 DOI: 10.1177/1758573220921150] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. METHODS Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. RESULTS At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). DISCUSSION At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.
Collapse
Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo
Clinic, Jacksonville, FL, USA,Bradley S Schoch, Department of Orthopedic
Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Joseph J King
- Department of Orthopaedic Surgery and
Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph Zuckerman
- New York University Langone Orthopedic
Hospital, New York, NY, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and
Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | |
Collapse
|
27
|
Three-dimensional measures of posterior bone loss and retroversion in Walch B2 glenoids predict the need for an augmented anatomic glenoid component. J Shoulder Elbow Surg 2021; 30:2386-2392. [PMID: 33753274 DOI: 10.1016/j.jse.2021.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/14/2021] [Accepted: 02/21/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study is to evaluate whether the amount of measured posterior bone loss on 2- and 3-dimensional (2D and 3D) imaging of Walch B2 glenoids can reliably predict the plan for an augmented anatomic glenoid component. METHODS Patients with Walch B2 glenoids and preoperative computed tomography (CT) scans were retrospectively identified. 2D axial CT scans were reviewed and posterior bone loss was measured by 3 independent reviewers. Images were then formatted into BluePrint (Wright Medical) preoperative planning software. The same 3 reviewers again measured posterior bone loss on 3D imaging. Additionally, all cases were planned with BluePrint software. An augment was used when the following criteria were unable to be satisfied with standard implants: <10° retroversion, <10° superior inclination, ≥90% backside contact, <2 mm medial reaming, and ≤1 peg perforation. RESULTS Forty-two patients were included in the final analysis with a mean age of 63.1 ± 6.3 years. As measured by BluePrint, the mean retroversion was 23° ± 7° (range = 9°-40°), the mean superior inclination was 5° ± 6° (range = -9° to 22°), and the mean posterior subluxation was 80% ± 17% (range = 41%-95%). The mean 2D bone loss measurements (3.5 ± 1.6 mm) were significantly lower than the mean 3D bone loss (4.0 ± 1.8 mm) measurements (P = .03). There was substantial agreement between reviewers on both 2D and 3D measurements with an interclass correlation of 0.815 (95% confidence interval [CI] 0.714-0.889, P < .001) and an interclass correlation of 0.802 (95% CI 0.683-0.884, P < .001), respectively. Augments were used in 73.8%, 63.4%, and 63.4% of cases by reviewers 1, 2, and 3, respectively, with moderate agreement with a Fleiss kappa of 0.592 (95% CI 0.416-0.769, P < .001). Augment size was moderately, positively correlated with the amount of bone loss on 3D imaging but not with 2D imaging. After multivariate logistic regression, both 3D bone loss and retroversion were found to be predictive for a plan to use an augment. CONCLUSION Planning for a posterior augment in Walch B2 glenoids is better predicted with 3D imaging than with 2D imaging, as 2D imaging may underestimate posterior bone loss. Additionally, use of a larger augment size is moderately correlated with posterior bone loss on 3D imaging but not 2D imaging. Standard 2D imaging may be limited in cases of posterior bone loss, and 3D imaging may be beneficial for preoperative planning in Walch B2 glenoids.
Collapse
|
28
|
Abstract
» The term "subluxation" means partial separation of the joint surfaces. In the arthritic shoulder, "arthritic glenohumeral subluxation" refers to displacement of the humeral head on the surface of the glenoid. » The degree of arthritic glenohumeral subluxation can be measured using radiography with standardized axillary views or computed tomography (CT). » Shoulders with a type-B1 or B2 glenoid may show more posterior subluxation on an axillary radiograph that is made with the arm in an elevated position than on a CT scan that is made with the arm at the side. » The degree of arthritic glenohumeral subluxation is not closely related to glenoid retroversion. » The position of the humeral head with respect to the plane of the scapula is related to glenoid retroversion and is not a measure of glenohumeral subluxation. » Studies measuring glenohumeral subluxation before and after arthroplasty should clarify its importance to the clinical outcomes of shoulder reconstruction.
Collapse
|
29
|
Ricchetti ET, Jun BJ, Jin Y, Ho JC, Patterson TE, Dalton JE, Derwin KA, Iannotti JP. Relationship Between Glenoid Component Shift and Osteolysis After Anatomic Total Shoulder Arthroplasty: Three-Dimensional Computed Tomography Analysis. J Bone Joint Surg Am 2021; 103:1417-1430. [PMID: 33835109 PMCID: PMC8360268 DOI: 10.2106/jbjs.20.00833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis. METHODS In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic TSA with a polyethylene glenoid component, sequential 3D CT analysis was performed preoperatively (CT1), early postoperatively (CT2), and at a minimum 2-year follow-up (CT3). Glenoid component shift was defined as a change in component version or inclination of ≥3° from CT2 to CT3. Glenoid component central anchor peg osteolysis (CPO) was assessed at CT3. Factors associated with glenoid component shift and CPO were evaluated. RESULTS Glenoid component shift occurred from CT2 to CT3 in 78 (51%) of the 152 patients. CPO was seen at CT3 in 19 (13%) of the 152 patients, including 15 (19%) of the 78 with component shift. Walch B2 glenoids with a standard component and glenoids with higher preoperative retroversion were associated with a higher rate of shift, but not of CPO. B3 glenoids with an augmented component and glenoids with greater preoperative joint-line medialization were associated with CPO, but not with shift. More glenoid component joint-line medialization from CT2 to CT3 was associated with higher rates of shift and CPO. A greater absolute change in glenoid component inclination from CT2 to CT3 and a combined absolute glenoid component version and inclination change from CT2 to CT3 were associated with CPO. Neither glenoid component shift nor CPO was associated with worse clinical outcomes. CONCLUSIONS Postoperative 3D CT analysis demonstrated that glenoid component shift commonly occurs following anatomic TSA, with increased inclination the most common direction. Most (81%) of the patients with glenoid component shift did not develop CPO. Longer follow-up is needed to determine the relationships of glenoid component shift and CPO with loosening over time. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Bong-Jae Jun
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Yuxuan Jin
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Thomas E. Patterson
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Jarrod E. Dalton
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Kathleen A. Derwin
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| |
Collapse
|
30
|
Yalcin S, Scarcella M, Everhart J, Samuel L, Miniaci A. Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty With a Nonspherical Humeral Head and Inlay Glenoid in Elite Weight Lifters: A Prospective Case Series. Orthop J Sports Med 2021; 9:23259671211021055. [PMID: 34377719 PMCID: PMC8330482 DOI: 10.1177/23259671211021055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Weight lifting after total shoulder arthroplasty (TSA) can place significant stresses on implants that could lead to instability, loosening, and increased wear. A TSA system with nonspherical humeral head resurfacing and inlay glenoid—which improves the biomechanics and thus reduces instability, wear, and potential loosening—may be able to tolerate repetitive loads from weight lifting. Purpose: To determine clinical and radiographic outcomes after TSA in weight lifters. Study Design: Case series; Level of evidence, 4. Methods: We prospectively enrolled 16 weight lifters (mean ± SD age, 57.2 ± 7.8 years; 15 male) undergoing primary anatomic TSA (n = 17 shoulders, 1 staged bilateral) with nonspherical humeral head resurfacing and inlay glenoid replacement for glenohumeral osteoarthritis between February 2015 and February 2019. Exclusion criteria were rotator cuff deficiency, revision TSA, post-traumatic arthritis, and inflammatory arthritis. Outcome measures included the rate of return to weight lifting, results of patient-reported outcome measures (Penn Shoulder Score, Kerlan-Jobe Orthopaedic Clinic, and 12-Item Veterans RAND Health Survey), radiographic outcomes, and complication rate. Results: Follow-up was obtained on all patients at a mean of 38 months (range, 14-63 months). All patients returned to competitive weight lifting at 15.6 ± 6.9 weeks. Compared to the preoperative weight lifting level, at last follow-up patients reported performance at the following level: lighter weight, 1 (6%); same weight, 8 (50%); heavier weight, 7 (44%). Preoperative eccentric posterior glenoid wear was common (71% Walch B2 classification; 12/17), but posterior humeral subluxation improved at follow-up according to the Walch index (mean, 55.5% preoperative vs 48.5% postoperative; P < .001) and contact point ratio (mean, 63.9% preoperative vs 50.1% postoperative; P < .001). Pre- to postoperative improvements were seen in Penn Shoulder Score (44.3 vs 82.6; P < .001), Kerlan-Jobe Orthopaedic Clinic (50.6 vs 91.1; P < .001), and 12-Item Veterans RAND Health Survey physical component score but not mental component score. No signs of radiographic loosening were detected in follow-up images, nor were there any postoperative instability episodes or revision surgeries. Conclusion: There were substantial improvements in shoulder function and a high rate of return to weight lifting after TSA with a nonspherical humeral head resurfacing and inlay glenoid component. Radiographically, the humeral head centralized on the glenoid after surgery, and there was no evidence of component loosening at a mean 38-month follow-up.
Collapse
Affiliation(s)
- Sercan Yalcin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Scarcella
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Everhart
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Linsen Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
31
|
The Evolution of the Walch Classification for Primary Glenohumeral Arthritis. J Am Acad Orthop Surg 2021; 29:e635-e645. [PMID: 33973964 DOI: 10.5435/jaaos-d-20-00880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/10/2021] [Indexed: 02/01/2023] Open
Abstract
Our understanding of the pathology of and treatment for glenohumeral arthritis (GHA) has grown dramatically in the past few decades. Original observations regarding patterns of glenoid erosion, glenoid retroversion, and posterior humeral head subluxation in patients with primary GHA were documented in the 1980s and early 1990s. In the late 1990s, Walch et al proposed what is now the most widely used classification system to describe the characteristic pathology of GHA. Improved understanding of both premorbid and pathologic anatomies, along with advancements in imaging, have steered modifications in this classification system. These changes have improved its reliability and helped to further guide management decisions. The purpose of this article is to review the evolution of the Walch classification, understand the rationale behind the modifications, and discuss potential future developments.
Collapse
|
32
|
Polisetty TS, Colley R, Levy JC. Value Analysis of Anatomic and Reverse Shoulder Arthroplasty for Glenohumeral Osteoarthritis with an Intact Rotator Cuff. J Bone Joint Surg Am 2021; 103:913-920. [PMID: 33983149 DOI: 10.2106/jbjs.19.01398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While anatomic total shoulder arthroplasty (TSA) has historically been considered the ideal treatment for end-stage glenohumeral osteoarthritis, reverse shoulder arthroplasty (RSA) has recently gained popularity. With substantial differences in implant design and cost between TSA and RSA, further investigation of outcomes and value is needed to support recent trends. The purpose of this study was to use the average and incremental cost-effectiveness ratio (ACER and ICER) and the procedure value index (PVI) to examine differences in outcomes and value between TSA and RSA for treatment of glenohumeral osteoarthritis with an intact rotator cuff. METHODS We performed a retrospective matched-cohort study of patients treated with primary shoulder arthroplasty for osteoarthritis with an intact rotator cuff who had a minimum 2-year follow-up. Outcome measures analyzed included the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) questionnaire, visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), and overall satisfaction. Patients treated with TSA were matched 4:1 to those treated with RSA based on sex, age, and preoperative SST score. Value differences between TSA and RSA were calculated. Radiographs were analyzed for preoperative glenoid classification and postoperative radiolucent lines and gross loosening. RESULTS Two hundred and fifty-two TSA-treated patients were matched to 63 RSA-treated patients with no significant differences in sex, age, or preoperative SST score. Total hospitalization costs, charges, and reimbursements along with outcome improvements in units of minimal clinically important differences (MCIDs) and patient satisfaction did not differ between the groups. For RSA, the implant cost was significantly higher than that for TSA, but the operating room, anesthesia, and cement costs were lower. The TSA group had a 3.2% rate of gross glenoid loosening and a 2.4% revision rate. There was no loosening or revision in the RSA group. None of the value analytics differed between groups even after inclusion of the outcomes and costs of early TSA revisions. CONCLUSIONS TSA and RSA demonstrated similar outcomes and value when used to manage glenohumeral osteoarthritis with an intact rotator cuff. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
33
|
Schiffman CJ, Prabhakar P, Hsu JE, Shaffer ML, Miljacic L, Matsen FA. Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:761-770. [PMID: 33587515 DOI: 10.2106/jbjs.20.01853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Publications regarding anatomic total shoulder arthroplasty (TSA) have consistently reported that they provide significant improvement for patients with glenohumeral arthritis. New TSA technologies that have been introduced with the goal of further improving these outcomes include preoperative computed tomography (CT) scans, 3-dimensional preoperative planning, patient-specific instrumentation, stemless and short-stemmed humeral components, as well as metal-backed, hybrid, and augmented glenoid components. The benefit of these new technologies in terms of patient-reported outcomes is unknown. METHODS We reviewed 114 articles presenting preoperative and postoperative values for commonly used patient-reported metrics. The results were analyzed to determine whether patient outcomes have improved over the 20 years during which new technologies became available. RESULTS The analysis did not identify evidence that the results of TSA were statistically or clinically improved over the 2 decades of study or that any of the individual technologies were associated with significant improvement in patient outcomes. CONCLUSIONS Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Pooja Prabhakar
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Ljubomir Miljacic
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
34
|
Lo L, Koenig S, Leong NL, Shiu BB, Hasan SA, Gilotra MN, Wang KC. Glenoid bony morphology of osteoarthritis prior to shoulder arthroplasty: what the surgeon wants to know and why. Skeletal Radiol 2021; 50:881-894. [PMID: 33095290 DOI: 10.1007/s00256-020-03647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Abstract
Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon.
Collapse
Affiliation(s)
- Lawrence Lo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 110 S. Paca Street, 6th Floor, Baltimore, MD, 21201, USA
| | - Brian B Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 2200 Kernan Drive, Suite 1154, Baltimore, MD, 21207, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 100 Penn Street, Room 540D, Baltimore, MD, 21201, USA
| | - Kenneth C Wang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA. .,Imaging Service, Baltimore VA Medical Center, 10 N. Greene St, Rm. C1-24, Baltimore, MD, 21201, USA.
| |
Collapse
|
35
|
Akgün D, Siegert P, Danzinger V, Plachel F, Minkus M, Thiele K, Moroder P. Glenoid vault and humeral head alignment in relation to the scapular blade axis in young patients with pre-osteoarthritic static posterior subluxation of the humeral head. J Shoulder Elbow Surg 2021; 30:756-762. [PMID: 32853792 DOI: 10.1016/j.jse.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Static posterior subluxation of the humeral head is a pre-osteoarthritic deformity preceding posterior erosion in young patients. Its etiology remains unknown. The aim of this study was to analyze the differences in scapular morphology between young patients with pre-osteoarthritic static posterior subluxation of the humeral head and healthy controls with a centered humeral head. METHODS We performed a retrospective analysis of all patients with pre-osteoarthritic static posterior subluxation of the humeral head who were treated in our institution between January 2018 and November 2019. Fourteen shoulders in 12 patients were included in this study and then matched according their age, sex, and affected side with controls. Computed tomography images of both groups were compared in the standardized axial imaging plane for differences in scapular morphology. The following parameters were measured: glenoid version relative to the Friedman line and scapular blade axis, scapulohumeral and glenohumeral subluxation index, and neck angle, as well as glenoid and humeral offset. RESULTS The patients in the subluxation group showed significantly higher scapulohumeral and glenohumeral subluxation indexes than controls (0.76 vs. 0.55 [P < .0001] and 0.58 vs. 0.51 [P = .016], respectively). The mean measurements of glenoid version according to the Friedman line and relative to the scapular blade axis were significantly higher in the subluxation group than in controls (19° vs. 4° [P < .0001]and 14° vs. 2° [P = .0002], respectively). The glenoid vault was significantly more anteriorly positioned with respect to the scapular blade axis in the subluxation group than in controls (neck angle, 166° vs. 173° [P = .0003]; glenoid offset, 9.2 mm vs. 4.6 mm [P = .0005]). The midpoint of the humeral head showed a posterior offset with respect to the scapular blade axis in the subluxation group, whereas controls had an anteriorly placed midpoint of the humeral head (-2 mm vs. 3.1 mm, P = .01). A higher scapulohumeral subluxation index showed significant correlations with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.493, P = .008 and decreased neck angle: r = -0.554, P = .002), a posterior humeral offset (r = -0.775, P < .0001), and excessive glenoid retroversion measured by both methods (Friedman line: r = 0.852, P < .0001; scapular blade axis: r = 0.803, P < .0001). A higher glenohumeral subluxation index also correlated significantly with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.403, P = .034; decreased neck angle: r = -0.406, P = .032) and posterior humeral offset (r = -0.502, P = .006). CONCLUSION Young patients with pre-osteoarthritic static posterior subluxation of the humeral head have significant constitutional differences in scapular morphology in terms of an increased anterior glenoid offset, excessive glenoid retroversion, and increased posterior humeral offset in relation to the scapular blade compared with healthy matched controls.
Collapse
Affiliation(s)
- Doruk Akgün
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany.
| | - Paul Siegert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Victor Danzinger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Fabian Plachel
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Marvin Minkus
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Kathi Thiele
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Philipp Moroder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany
| |
Collapse
|
36
|
Matache BA, Alnusif N, Chaoui J, Walch G, Athwal GS. Humeral head subluxation in Walch type B shoulders varies across imaging modalities. JSES Int 2021; 5:98-101. [PMID: 33554173 PMCID: PMC7846694 DOI: 10.1016/j.jseint.2020.08.016] [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: 11/26/2022] Open
Abstract
Background The Walch type B pattern of glenohumeral osteoarthritis is characterized by posterior humeral head subluxation (PHHS). At present, it is unknown whether the percentage of subluxation measured on axillary radiographs is consistent with measurements on 2-dimensional (2D) axial or 3-dimensional (3D) volumetric computed tomography (CT). The purpose of this study was to evaluate PHHS across imaging modalities (radiographs, 2D CT, and 3D CT). Methods A cohort of 30 patients with Walch type B shoulders underwent radiography and standardized CT scans. The cohort comprised 10 type B1, 10 type B2, and 10 type B3 glenoids. PHHS was measured using the scapulohumeral subluxation method on axillary radiographs and 2D CT. On 3D CT, PHHS was measured volumetrically. PHHS was statistically compared between imaging modalities, with P ≤ .05 considered significant. Results The mean PHHS value for the entire group was 69% ± 24% on radiographs, 65% ± 23% with 2D CT, and 74% ± 24% with 3D volumetric CT. PHHS as measured on complete axillary radiographs was not significantly different than that measured on 2D CT (P = .941). Additionally, PHHS on 3D volumetric CT was 9.5% greater than that on 2D CT (P < .001). There were no significant differences in PHHS between the type B1, B2, and B3 groups with 2D or 3D CT measurement techniques (P > .102). Conclusion Significant differences in PHHS were found between measurement techniques (P < .035). A 9.5% difference in PHHS between 2D and 3D CT can be mostly accounted for by the linear (2D) vs. volumetric (3D) measurement techniques (a linear 80% PHHS value is mathematically equivalent to a volumetric PHHS value of 89.6%). Surgeons should be aware that subluxation values and therefore thresholds vary across different imaging modalities and measurement techniques.
Collapse
Affiliation(s)
| | - Naser Alnusif
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
| | | | | | - George S Athwal
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
| |
Collapse
|
37
|
Ernstbrunner L, Jessen M, Wieser K. Anatomic healing after non-operative treatment of a large, displaced anterior glenoid rim fracture after primary traumatic anterior shoulder dislocation – a case report. BMC Musculoskelet Disord 2020; 21:361. [PMID: 32517721 PMCID: PMC7285733 DOI: 10.1186/s12891-020-03384-1] [Citation(s) in RCA: 1] [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: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Large, displaced anterior glenoid rim fractures after primary traumatic anterior shoulder dislocation are usually managed by surgical stabilization. Although there is little evidence supporting surgical management, it is often preferred over non-operative treatment. This case report describes non-operative management of such large, displaced anterior glenoid rim fracture with CT- and MRI-based documentation of anatomical healing of the fracture fragment, a finding that has not been described previously. Case presentation This case report describes a 49-year-old male, right-hand dominant, carpenter, who had a left-sided primary anterior shoulder dislocation after a fall while skiing. Initial plain radiographs showed a reduced glenohumeral joint with a large, displaced anterior glenoid rim fracture. CT-evaluation showed a centered humeral head, and as per our institutional protocol, non-operative management was initiated. Longitudinal radiographic assessment at 2 weeks, 4.5 months and 12 months showed reduction of the initially severely displaced fracture fragment. MRI- and CT-evaluation after 12 months confirmed anatomical healing of the fragment. At final follow-up, the patient was highly satisfied, although the healing process was complicated by posttraumatic frozen shoulder, which has had almost fully resolved after 12 months. Conclusions Given that the glenohumeral joint is concentrically reduced, large (displaced) anterior glenoid rim fractures after traumatic primary shoulder dislocation can be successfully treated non-operatively, with the potential of anatomical fracture fragment healing. Therefore, it remains subject to conservative treatment at our institution and surgical stabilization is reserved for patients with a decentered humeral head or persistent glenohumeral instability.
Collapse
|
38
|
The Characteristics of the Favard E4 Glenoid Morphology in Cuff Tear Arthropathy: A CT Study. J Clin Med 2020; 9:jcm9113704. [PMID: 33218196 PMCID: PMC7699291 DOI: 10.3390/jcm9113704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Cuff tear arthropathy (CTA) is characterized by superior migration of the humeral head with superior erosion of the glenoid. Rarely, humeral head migration can be anteroinferior with associated anterior erosion of the glenoid, a pattern described by Favard as the type E4 glenoid. The purpose of this retrospective imaging study was to analyze the 2D and 3D characteristics of the E4 glenoid. Methods: A shoulder arthroplasty database of 258 cuff tear arthropathies was examined to identify patients with an E4 type deformity. This resulted in a study cohort of 15 females and 2 males with an average age of 75 years. All patients had radiographs and CT scans available for analysis. CT-scan DICOM (Digital Imaging and Communications in Medicine) data were uploaded to a validated three-dimensional (3D) imaging software. Muscle fatty infiltration, glenoid measurements (anteversion, inclination), and humeral head subluxation according to the scapular plane were determined. Results: The mean anteversion and inclination of the E4 cohort were 32° ± 14° and −5° ± 2, respectively. The mean anterior subluxation was 19% ± 16%. All cases had severe grade 3 or 4 fatty infiltration of the infraspinatus, whereas only 65% had grade 3 or 4 subscapularis fatty infiltration. A significant correlation existed between glenoid anteversion and humeral head subluxation (p < 0.001), but no correlation was found with muscle fatty infiltration. The CT analysis demonstrated an acquired erosive biconcave morphology in 11 patients (65%) and monoconcavity in 6 patients (35%). Conclusion: The E4 type glenoid deformity in cuff tear arthropathy is characterized by an anterior erosion and anteversion associated with anterior subluxation of the humeral head.
Collapse
|
39
|
Trivedi NN, Shimberg JL, Sivasundaram L, Mengers S, Salata MJ, Voos JE, Gillespie RJ. Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2020; 102:1825-1835. [PMID: 33086353 DOI: 10.2106/jbjs.19.01294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nikunj N Trivedi
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | | | | | | |
Collapse
|
40
|
Gates S, Cutler H, Khazzam M. Outcomes of Posterior Glenoid Bone-Grafting in Anatomical Total Shoulder Arthroplasty: A Systematic Review. JBJS Rev 2020; 7:e6. [PMID: 31567619 DOI: 10.2106/jbjs.rvw.19.00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Total shoulder arthroplasty offers a reliable means with which to treat glenohumeral joint arthritis. Posterior glenoid bone loss presents a unique challenge with an increased risk of glenoid component failure. The use of posterior bone-grafting is one method to address glenoid bone loss in patients undergoing anatomical total shoulder arthroplasty. The purpose of the present study was to assess the outcome and survival of the glenoid component following the use of bone graft to address posterior glenoid bone loss in patients undergoing anatomical total shoulder arthroplasty. METHODS A systematic review of posterior glenoid bone-grafting in patients undergoing anatomical total shoulder arthroplasty was performed. Studies evaluating patient-reported outcomes, complications, and imaging assessments of the glenoid component as well as of bone graft structural healing and integrity following posterior glenoid bone-grafting were included. Data extracted included demographic characteristics, Walch classification, bone-grafting method, clinical outcomes measures, complications, radiolucency around the glenoid component, graft failure, posterior humeral head subluxation, and time of the latest follow-up. RESULTS Six studies met the inclusion and exclusion criteria. Ninety-four patients from these 6 studies underwent posterior glenoid bone-grafting with anatomical total shoulder arthroplasty. The mean age was 59.7 years, and the mean duration of follow-up was 5.7 years. Overall, 57% of the patients had an excellent postoperative Neer score. At the time of the latest follow-up, 28.7% had evidence of radiolucency and 35% had humeral head subluxation or instability. Thirteen patients (14%) underwent revision of the glenoid component by the time of the latest follow-up. CONCLUSIONS The present study demonstrated a 28.7% complication rate, a 14% revision rate, a 17% graft failure rate, and a 35% rate of recurrence of posterior humeral head subluxation. Posterior glenoid bone-grafting to correct bone loss is associated with a substantial risk of postoperative complications. The treatment of posterior glenoid bone loss remains a challenge in patients undergoing anatomical total shoulder arthroplasty. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Stephen Gates
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | |
Collapse
|
41
|
Grantham WJ, Dekker TJ, Lacheta L, Horan MP, Goldenberg BT, Elrick BP, Millett PJ. Total shoulder arthroplasty outcomes after noncorrective, concentric reaming of B2 glenoids. JSES Int 2020; 4:644-648. [PMID: 32939500 PMCID: PMC7479043 DOI: 10.1016/j.jseint.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Total shoulder arthroplasty (TSA) is an effective procedure for the treatment of glenohumeral osteoarthritis (GHOA) delivering reliable pain relief and improved shoulder function. Abnormal glenoid morphologies are common, and biconcave glenoids are enigmas that have been associated with poor clinical outcomes and implant survivorship. Purpose To assess the clinical outcome scores of patients who underwent noncorrective, concentric reaming for TSA with biconcave glenoids (B2). We hypothesized that patients with B2 glenoids who underwent TSA with glenoid implantation using noncorrective, concentric reaming would have significant improvements in clinical outcome scores and high implant survivorship. Methods All patients who underwent anatomic TSA for GHOA with B2 glenoids, performed by a single surgeon, between July 2006 and December 2015 with minimum 2-year follow-up were reviewed. Walch classification was obtained from preoperative imaging (magnetic resonance imaging or computed tomography). Clinical outcome scores were prospectively collected and included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, 12-Item Short Form Health Survey physical component summary (PCS), and patient satisfaction. Clinical failures (revision TSA surgery or conversion to reverse TSA) and complications were reported. Paired t test and bivariate correlations level of significance was set at P = .05. Survivorship analysis with implant failure as an endpoint was done using Kaplan-Meier survival curves. Results 51 TSA in 49 patients (9 females, 40 males) with primary GHOA with B2 glenoids were performed with a mean age of 64 (range 36-81 years) at the time of surgery. The mean retroversion was 19.1° (range 5.4°-38°), and posterior decentering was 42.0% (range 19.4%-78.5%). At final evaluation, 45/51 anatomic TSAs (88% follow-up) with a mean follow-up of 4.9 years (range 2.0-10.4 years) were assessed. All clinical outcome scores improved significantly pre- to postoperatively: ASES, 52.5 to 79.6 (P < .001); SANE, 52.4 to 74.7 (P < .001); QuickDASH, 39.2 to 19.1 (P = .001); and PCS, 40.9 to 48.9 (P = .001). Median postoperative satisfaction was 9 (range 1-10). There were 2 failures and 4 that required another surgery —subscapularis repair, lysis of adhesions, irrigation and débridement, and one to explore the status of the subscapularis for persistent pain. The implant survivorship rate was 95% at a mean follow-up of 4.9 years. Conclusion Anatomic total shoulder replacement with minimally noncorrective, concentric reaming in patients with B2 glenoids had significant improvement in clinical outcome scores, high patient satisfaction, and high survivorship in this cohort.
Collapse
Affiliation(s)
| | | | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, CO, USA.,Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | | |
Collapse
|
42
|
Ma CB, Xiao W, Salesky M, Cheung E, Zhang AL, Feeley BT, Lansdown DA. Do glenoid retroversion and humeral subluxation affect outcomes following total shoulder arthroplasty? JSES Int 2020; 4:649-656. [PMID: 32939501 PMCID: PMC7479050 DOI: 10.1016/j.jseint.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Glenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). There are limited data to support this suggestion. We investigated whether preoperative glenoid retroversion and humeral head subluxation are associated with inferior outcomes after TSA and whether change of retroversion influences outcomes after TSA. Methods Patients undergoing TSA with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. Retroversion and humeral head subluxation before and after surgery were measured on axillary radiographs. Postoperative radiographs were -evaluated for glenoid component loosening and compared between groups. Spearman correlations were determined between retroversion measurements and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Patients were analyzed in groups based on retroversion and humeral head subluxation. Results There were 113 patients (50% follow-up rate) evaluated at 4.2 years postoperatively. The mean preoperative retroversion (15.3° ± 7.7°) was significantly higher than postoperative retroversion (10.0° ± 6.8°; P < .0001). There was no correlation between postoperative glenoid version or humeral head subluxation and ASES scores. For patients with preoperative retroversion of >15°, there was no difference in outcome scores based on postoperative retroversion. There were no differences in preoperative or postoperative version for patients with or without glenoid lucencies. Discussion We observed no significant relationship between postoperative glenoid retroversion or humeral head subluxation and clinical outcomes in patients following TSA. For patients with preoperative retroversion >15°, change of retroversion during TSA had no impact on their clinical outcomes at short-term follow-up.
Collapse
Affiliation(s)
- C Benjamin Ma
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Weiyuan Xiao
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Madeleine Salesky
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Edward Cheung
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Alan L Zhang
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
43
|
|
44
|
Ode GE, Ling D, Finocchiaro A, Lai EY, Taylor SA, Dines J, Dines D, Warren R, Gulotta L. Clinical characteristics and patient-reported outcomes of total shoulder arthroplasty after anterior stabilization: a retrospective matched control study. J Shoulder Elbow Surg 2020; 29:S59-S66. [PMID: 32643610 DOI: 10.1016/j.jse.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Instability arthropathy is a known cause of glenohumeral osteoarthritis (OA) among patients with and without prior shoulder stabilization. This study aims to compare the clinical, radiographic, and patient-reported outcome measure (PROM) scores among total shoulder arthroplasty (TSA) patients with and without a history of shoulder stabilization. METHODS A case-control study was performed comparing 20 patients with a history of anterior shoulder stabilization (11 open, 9 arthroscopic) who underwent TSA to a matched cohort of 20 TSA patients without a history of shoulder surgery (mean follow-up = 2.8 years). Patients were matched by sex, age, and baseline American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score within 10 points (mean age 59.6 ± 9.6 years). Patient characteristics, operative findings, and preoperative and postoperative radiographic characteristics for both groups were reported. Comparisons were made regarding PROM scores (ASES, 12-Item Short Form Health Survey (SF-12), Shoulder Activity Scale [SAS], numeric rating scale for pain) at baseline, 2 years, and 5 years and patient satisfaction at 2 years. RESULTS Intraoperative findings of subscapularis scarring or attenuation was common among patients with prior anterior stabilization. The instability cohort did have a higher percentage of B2/B3 glenoid types than the OA cohort (45% vs. 15%), but this was not significantly different possibly because of the small sample size. At 2 years, both instability and OA groups reported significant improvement in pain, function, and activity level. There was no difference between groups on any PROMs or patient satisfaction level. At 5 years, instability patients had significantly lower scores on the ASES and the SF-12 PCS than the OA group. CONCLUSION There was notable alterations in both soft tissue and bony morphology among patients with prior anterior stabilization. After TSA, both instability and primary OA groups showed significant improvements at 2 years. However, PROMs for instability patients deteriorated at 5 years compared with the control group. Complex bony and soft tissue imbalances may contribute to more unpredictable long-term PROM scores. Thoughtful preoperative consideration of these factors should influence decision making regarding selection of TSA for management of OA in this complex patient cohort.
Collapse
Affiliation(s)
- Gabriella E Ode
- Department of Orthopaedics, Prisma Health-Upstate, Greenville, SC, USA.
| | - Daphne Ling
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Anthony Finocchiaro
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Emily Ying Lai
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua Dines
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David Dines
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Russell Warren
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence Gulotta
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
45
|
Chainani A, Matson A, Chainani M, Marchand Colon AJ, Toth AP, Garrigues GE, Little D. Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis. J Shoulder Elbow Surg 2020; 29:e253-e268. [PMID: 32113865 DOI: 10.1016/j.jse.2019.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND During anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (GHOA), the anterior shoulder joint capsule (ASJC) is characterized grossly by contracture, synovitis, and fibrosis. In tissues that develop fibrosis, there is substantial cross-talk between macrophages, fibroblasts, and myofibroblasts, modulated by calcium signaling and transient receptor potential (TRP) channel signaling. The purpose of this study was to compare and characterize the degree of synovitis, inflammatory infiltrate, and TRP channel expression in ASJC harvested from shoulders with and without primary GHOA. METHODS The ASJC was resected from patients undergoing TSA for primary GHOA or other diagnoses and compared with ASJC from cadaveric donors with no history of shoulder pathology. ASJC was evaluated by immunohistochemistry to characterize synovial lining and capsular inflammatory cell infiltrate and fibrosis, and to evaluate for expression of TRPA1, TRPV1, and TRPV4, known to be involved in fibrosis in other tissues. Blinded sections were evaluated by 3 graders using a semiquantitative scale; then results were compared between diagnosis groups using nonparametric methods. RESULTS Compared with normal control, the ASJC in primary GHOA had significantly increased synovitis, fibrosis, mixed inflammatory cell infiltrate including multiple macrophages subsets, and upregulation of TRP channel expression. CONCLUSION These data support the clinical findings of ASJC and synovial fibrosis in primary GHOA, identify a mixed inflammatory response, and identify dysregulation of TRP channels in the synovium and joint capsule. Further studies will identify the role of synovial and capsular fibrosis early in the development of GHOA.
Collapse
Affiliation(s)
- Abby Chainani
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Andrew Matson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Masoom Chainani
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Dianne Little
- Departments of Basic Medical Sciences and Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| |
Collapse
|
46
|
Reduction of scapulohumeral subluxation with posterior augmented glenoid implants in anatomic total shoulder arthroplasty: Short-term 3D comparison between pre- and post-operative CT. Orthop Traumatol Surg Res 2020; 106:681-686. [PMID: 32284278 DOI: 10.1016/j.otsr.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Failure rates in anatomic total shoulder arthroplasty (aTSA) are higher in case of asymmetric glenoid bone loss secondary to posterior wear, and in persistent static posterior subluxation of the humeral head (PSH). HYPOTHESIS This study aimed to test the hypothesis that the combined use of posterior augmented glenoid (PAG) implants with three-dimensional (3D) surgical planning and patient-specific instrumentation (PSI) guides helps reduce short-term PSH after aTSA in patients with type B2-B3 glenoids. PATIENTS AND METHODS We included nine consecutive patients with primary glenohumeral osteoarthritis and type B2 or B3 glenoids, who underwent aTSA with cemented keeled PAG implants (posterior augments of 15, 25, or 35 degrees). All patients underwent preoperative shoulder computed tomography (CT) scans, with 3D surgical planning coupled to PSI at the time of surgery. Postoperative shoulder CT scans were performed at an average of 14 weeks (range, 10-21 weeks). Scapulohumeral subluxation and glenoid version and inclination were measured in 3D, on both pre- and post-operative CT scans, using the same reliable quantitative method. RESULTS There was a significant decrease in scapulohumeral subluxation from 49±12% preoperatively to 22±17% postoperatively (p=0.0039), with a large effect size (Cohen's d=1.89). Preoperative glenoid version was corrected from -17.3±9.4 degrees to -5.2±7.5 degrees postoperatively. The absolute difference between the postoperative and surgically planned version and inclination was 5.4±3.6 degrees and 3.3±2.0 degrees, respectively. DISCUSSION The combined use of PAG implants with 3D preoperative planning and PSI results in a significant decrease in short-term PSH and glenoid version in patients with asymmetric posterior glenoid wear. We suggest that such implants should not be limited to posterior augmentation, because glenoid deficiency can also be observed in other glenoid sectors. LEVEL OF EVIDENCE IV, Basic science study.
Collapse
|
47
|
Prearthroplasty glenohumeral pathoanatomy and its relationship to patient's sex, age, diagnosis, and self-assessed shoulder comfort and function. J Shoulder Elbow Surg 2019; 28:2290-2300. [PMID: 31311749 DOI: 10.1016/j.jse.2019.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is great current interest in characterizing the prearthroplasty glenohumeral pathoanatomy because of its role in guiding surgical technique and its possible effects on arthroplasty outcome. METHODS We examined 544 patients within 6 weeks before arthroplasty with the goals of characterizing the following: demographic and radiographic characteristics; relationships of the radiographic pathoanatomy to the patient's age, sex, and diagnosis; inter-relationships among glenoid type, glenoid version, and amount of decentering of the humeral head on the glenoid; and relationships of the pathoanatomy to the patient's self-assessed comfort and function. RESULTS Male patients had a higher frequency of B2 glenoids and a lower frequency of A2 glenoids. The arthritic shoulders of men were more retroverted and had greater amounts of posterior decentering. Patients with types A1 and C glenoids were younger than those with other glenoid types. Shoulders with osteoarthritis were more likely to be type B2 and to be retroverted. Types B2 and C had the greatest degree of retroversion, whereas types B1 and B2 had the greatest amounts of posterior decentering. Shoulders with glenoid types B1 and B2 and those with more decentering did not have worse self-assessed shoulder comfort and function. CONCLUSIONS Glenohumeral pathoanatomy was found to have previously unreported relationships to the patient's sex, age, and diagnosis. Contrary to what might have been expected, more advanced glenohumeral pathoanatomy (ie, type B glenoids, greater retroversion, greater decentering) was not associated with worse self-assessed shoulder comfort and function.
Collapse
|
48
|
Luedke C, Kissenberth MJ, Tolan SJ, Hawkins RJ, Tokish JM. Outcomes of Anatomic Total Shoulder Arthroplasty with B2 Glenoids: A Systematic Review. JBJS Rev 2019; 6:e7. [PMID: 29664870 DOI: 10.2106/jbjs.rvw.17.00112] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Total shoulder arthroplasty remains an effective procedure for shoulder pain relief. Despite the negative effect of abnormal glenoid morphology and specifically retroverted and posteriorly subluxated glenoids, there is no consensus for management of B2 glenoids in total shoulder arthroplasty. The purpose of this study was to compare the outcomes and complication rates for B2 glenoid techniques so as to provide a baseline understanding of the current state of treatment of this pathology. METHODS A systematic review evaluating outcomes of total shoulder arthroplasty with biconcave glenoids using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology included searches up to December 31, 2015, of PubMed, Embase, MEDLINE, Cochrane Reviews, and Google Scholar. Nine articles met inclusion and exclusion criteria. RESULTS In this study, 239 total shoulder arthroplasties with B2 glenoids with a mean follow-up of 55.5 months (range, 24 to 91 months) were included. The mean patient age was 63.3 years (range, 55.8 to 68.7 years). Asymmetric reaming was performed in 127 glenoids, posterior bone-grafting was included in 53 glenoids, and 34 received an augmented glenoid component to correct glenoid retroversion and bone loss. Overall, the mean Constant and Neer scores improved from preoperative measures. Fifty-eight percent of patients had no loosening, and 42% had some loosening, although not all of these patients were symptomatic. Despite variation in outcome measures hindering treatment approach comparison, the posteriorly augmented glenoid was generally reported to provide better outcomes with few complications. Although posterior glenoid bone-grafting results in acceptable outcomes, it also represents the highest rate of complications. The revision rate was 15.6% for asymmetric reaming, 9.5% for posterior glenoid bone-grafting, and 0% for posteriorly augmented glenoids. CONCLUSIONS Surgical treatment of the B2 glenoid remains a challenge to the shoulder surgeon, with worse outcomes and higher complication rates. Longer follow-up, consistent outcome measures, and result stratification based on glenoid type may allow for direct comparison in the future. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Colten Luedke
- Steadman Hawkins Clinic of the Carolinas, Greenville Health Systems, Greenville, South Carolina
| | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Greenville Health Systems, Greenville, South Carolina
| | | | - Richard J Hawkins
- Steadman Hawkins Clinic of the Carolinas, Greenville Health Systems, Greenville, South Carolina
| | | |
Collapse
|
49
|
Aleem AW, Chalmers PN, Bechtold D, Khan AZ, Tashjian RZ, Keener JD. Association Between Rotator Cuff Muscle Size and Glenoid Deformity in Primary Glenohumeral Osteoarthritis. J Bone Joint Surg Am 2019; 101:1912-1920. [PMID: 31567672 DOI: 10.2106/jbjs.19.00086] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although glenoid morphology has been associated with fatty infiltration of the rotator cuff in arthritic shoulders, the association of rotator cuff muscle area with specific patterns of glenoid wear has not been studied. The purpose of our study was to assess the associations of glenoid deformity in primary glenohumeral osteoarthritis and rotator cuff muscle area. METHODS A retrospective study of 370 computed tomographic (CT) scans of osteoarthritic shoulders was performed. Glenoid deformity according to the modified Walch classification was determined, and retroversion, inclination, and humeral-head subluxation were calculated using automated 3-dimensional software. Rotator cuff muscle area was measured on sagittal CT scan reconstructions. A ratio of the area of the posterior rotator cuff muscles to the subscapularis was calculated to approximate axial plane potential force imbalance. Univariate and multivariate analyses to determine associations with glenoid bone deformity and rotator cuff measurements were performed. RESULTS Patient age and sex were significantly related to cuff muscle area across glenoid types. Multivariate analysis did not find significant differences in individual rotator cuff cross-sectional areas across glenoid types, with the exception of a larger supraspinatus area in Type-B2 glenoids compared with Type-A glenoids (odds ratio [OR], 1.5; p = 0.04). An increased ratio of the posterior cuff area to the subscapularis area was associated with increased odds of a Type-B2 deformity (OR, 1.3; p = 0.002). Similarly, an increase in this ratio was significantly associated with increased glenoid retroversion (beta = 0.92; p = 0.01) and humeral-head subluxation (beta = 1.48; p = 0.001). Within the Type-B glenoids, only posterior humeral subluxation was related to the ratio of the posterior cuff to the subscapularis (beta = 1.15; p = 0.001). CONCLUSIONS Age and sex are significantly associated with cuff muscle area in arthritic shoulders. Asymmetric glenoid wear and humeral-head subluxation in osteoarthritis are associated with asymmetric atrophy within the rotator cuff transverse plane. Increased posterior rotator cuff muscle area compared with anterior rotator cuff muscle area is associated with greater posterior glenoid wear and subluxation. It is unclear if the results are causative or associative; further research is required to clarify the relationship. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel Bechtold
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Adam Z Khan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
50
|
Alentorn-Geli E, Wanderman NR, Assenmacher AT, Sperling JW, Cofield RH, Sánchez-Sotelo J. Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study. J Orthop Surg (Hong Kong) 2019; 26:2309499018768570. [PMID: 29661111 DOI: 10.1177/2309499018768570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). PATIENTS AND METHODS All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). RESULTS Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively ( p = 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively ( p = 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 ( p = 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. CONCLUSIONS The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.
Collapse
Affiliation(s)
| | - Nathan R Wanderman
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John W Sperling
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert H Cofield
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|