1
|
Hall T, Wong JRY, Dirckx M, Rajesparan K, Rashid A. Pre-operative arthritic glenoid assessment: 3D automated planning software versus manual multiplanar measurements of version and inclination. J Orthop 2023; 36:24-28. [PMID: 36582547 PMCID: PMC9793237 DOI: 10.1016/j.jor.2022.12.005] [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: 09/07/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Preoperative CT-based planning is established in shoulder arthroplasty surgery. Automated planning software has become available to assist the surgeon and may increase reliability and efficiency. This study aims to evaluate the reliability of an automated 3-dimensional (3D) planning software package (Blueprint™ v2.1.5, Wright Medical Ltd) in the assessment of the arthritic shoulder against manual multiplanar measurement (MM). Methods 74 CT studies acquired for preoperative shoulder arthroplasty planning were reviewed on two occasions by four different evaluators, taking manual measurement (MM) of glenoid version and inclination adjusted with multiplanar reformation and adhering to modified Freidman and Maurier methods. 15 scans were not processed by Blueprint due to incompatible scanning protocols or severe scapular dysmorphia. 59 Blueprint measures were compared with the manual data. Results Version: Intra-observer reliability of glenoid version MM was excellent (mean ICC 0.92). Inter-observer reliability between all four readers was good (ICC 0.89). A Bland-Altman analysis of Blueprint versus MM for version measurements demonstrated a mean pair difference of -5.77 (95% CI -7.25 to 4.29). Inclination: Intra-rater and inter-rater reliabilities were good (ICC 0.85 and 0.80 respectively). Blueprint and MM values for inclination followed a more convergent pattern than for version. Bland-Altman analysis for inclination did not show substantial bias, with a mean pair difference of 1.4 (95% CI -0.1 to 2.9). Conclusion Manual preoperative planning for shoulder arthroplasty is time consuming and requires experience. Automated 3D planning offers a consistent tool to assist the surgeon, notwithstanding intra-operative anatomical and technical variation, and margin of error. Surgeons should as ever be mindful of the specifics of a given automated program and our data quantified a bias for retroversion which may be important for measures close to the thresholds for augmentation or customised implants.
Collapse
Affiliation(s)
- Tim Hall
- Department of Radiology, University Hospital Lewisham (Lewisham and Greenwich NHS Trust), Lewisham High Street, London, SE13 6LH, United Kingdom
| | | | - Margo Dirckx
- Department of Trauma and Orthopaedic Surgery, Epsom and St Helier University Hospitals NHS Trust, Dorking Rd, Epsom, KT18 7EG, United Kingdom
| | - Kannan Rajesparan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - Abbas Rashid
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, United Kingdom
| |
Collapse
|
2
|
Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients. Diagnostics (Basel) 2022; 12:diagnostics12102507. [PMID: 36292196 PMCID: PMC9600260 DOI: 10.3390/diagnostics12102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient’s age has to be taken into account in shoulder diagnostics and surgery.
Collapse
|
3
|
Rajeswaran G, Basu S, Funk L. Imaging Posterior Instability of the Shoulder. Semin Musculoskelet Radiol 2022; 26:558-565. [DOI: 10.1055/s-0042-1754365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractPosterior instability of the shoulder is much less common than anterior instability with a clinical presentation that is often less obvious, making the diagnosis more challenging and more easily missed. We describe the imaging findings of posterior instability so the radiologist can make the diagnosis and provide a detailed description, enabling the surgeon to make more informed decisions regarding management and surgery.
Collapse
Affiliation(s)
- Gajan Rajeswaran
- Department of Imaging, OneWelbeck Imaging & Diagnostics, London, United Kingdom
| | - Subhasis Basu
- Department of Imaging, Wrightington Hospital, Wigan, Lancashire, United Kingdom
| | - Lennard Funk
- Department of Orthopaedics, Wrightington Hospital, Wigan, Lancashire, United Kingdom
| |
Collapse
|
4
|
Levins J, Passarelli E, Adkins J, Molino J, Henry H, Paxton ES, Green A. Early outcome of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for treatment of advanced glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:1846-1858. [PMID: 35276348 DOI: 10.1016/j.jse.2022.01.152] [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: 10/01/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Long-term outcomes of anatomic total shoulder arthroplasty (aTSA) can be compromised by glenoid loosening and failure. The purpose of this study was to evaluate the short- and midterm outcomes of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for the treatment of advanced glenohumeral osteoarthritis, and to identify associations between preoperative factors and outcomes. METHODS Forty-nine shoulders (mean age 60 ± 7 years) with minimum 2-year follow-up (mean 4.6 ± 1.7) were evaluated. Forty-three (87.8%) were male. Thirteen (26.5%) had previous nonarthroplasty shoulder surgery. There were 19 (38.8%) Walch type A and 30 (61.2%) type B glenoids. Pre- and postoperative shoulder motion, patient-reported outcomes (PROMs), and health-related quality of life (HRQoL) were assessed. Pre- and postoperative plain radiographs were evaluated. Mixed effects models were used to investigate factors associated with outcomes. RESULTS Active forward elevation and active external rotation improved from 111.7° ± 23.8° to 139.2° ± 21.1° and 13.3° ± 20.7° to 38.7° ± 14.7°, respectively (P < .001). The mean American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Simple Shoulder Test (SST), and visual analog scale (VAS) shoulder pain scores at the most recent follow-up were 86.6 ± 19.9, 10.1 ± 14.1, 10.5 ± 2.2, and 1.5 ± 2.3, respectively. The mean changes of PROMs were significant and exceeded the minimal clinically important difference for aTSA. The percentage maximal possible improvement for ASES, DASH, and SST were greater than 75%. Male sex (P < .008) and not having prior shoulder surgery (P < .04) were significantly associated with better absolute and greater change in PROMs. Age, preoperative shoulder motion, and Walch glenoid classification were not associated with PROMs. Five (10.2%, 95% confidence interval [CI] 1.8%-18.6%) patients underwent revision for pain. Three additional patients were dissatisfied at final follow-up without undergoing revision, resulting in 16.7% (95% CI 6.1%-27.2%) of patients being dissatisfied with their outcome after their initial RnR. Mean Short Form-6 Dimensions scores improved from 0.66 ± 0.12 to 0.77 ± 0.13 and mean EuroQol-5 Dimensions scores improved from 0.68 ± 0.20 to 0.85 ± 0.17 (P < .001). Improvement in HRQoL was significantly associated with nondominant arm treatment, increased age, and greater preoperative SST score. Annual medialization of the humeral head center of rotation was 0.56 ± 1.6 mm/yr. No radiographic measure was associated with long-term PROMs. CONCLUSION Ream and Run can provide significant and clinically important improvement in PROMs and HRQoL for a high percentage of patients at short- and midterm follow-up. This procedure is an appropriate alternative to aTSA in select patients.
Collapse
Affiliation(s)
- James Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily Passarelli
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob Adkins
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Janine Molino
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - E Scott Paxton
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
5
|
Zhou J, Zhong B, Qu R, Qian L, Li Z, Liu C, Xiao Z, Xu G, Liang H, Wei K, Ouyang J, Dai J. Anatomic measurement of osseous parameters of the glenoid. Sci Rep 2022; 12:13424. [PMID: 35927571 PMCID: PMC9352768 DOI: 10.1038/s41598-022-17783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
The angle and position of the scapular glenoid are important in shoulder mechanics, the interpretation of diseases, and planning shoulder replacement surgery. In total shoulder replacement, understanding the bony parameters of the glenoid is also of considerable guiding significance for designing implant size and improving material adaptability. To compare glenoid parameters measured from skeletal scapula specimens with those measured by 3D modeling of CT scanning images, analyze correlations between these data, and draw conclusions to guide clinical treatment of shoulder joint injury and total shoulder joint replacement. The data of manual and CT measurements from the same Chinese dry glenoid was compared. Three-dimensional measurement data were collected from the Japanese population and compared with the Chinese population data generated in this study. There were no significant differences between manual measurement and CT measurement in the inclination angle, glenopolar angle, anteroposterior transverse diameter, upper to lower vertical diameter, and depth of the glenoid (P = 0.288, 0.524, 0.111, 0.194, and 0.055, respectively). Further, there were no significant differences between Japanese and Chinese glenoid bones in the upper and lower vertical diameters or anteroposterior transverse diameters (P > 0.05). There were no significant differences between CT and manual measurements, suggesting that the CT method may provide measurements very close to the actual specimen size. This result, however, indicated that the measurer should be careful when measuring the depth of the glenoid.
Collapse
Affiliation(s)
- Jing Zhou
- Department of Anatomy, Youjiang Medical University for Nationalities, Baishe, 533000, China
| | - Bin Zhong
- Department of Anatomy, Youjiang Medical University for Nationalities, Baishe, 533000, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Lei Qian
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Guangwei Xu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Kuanhai Wei
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Guangdong Provincial Key Laboratory of Bone and Cartilage Regeneration Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
| |
Collapse
|
6
|
Smith GCS. A prospective observational case control study investigating the coronal plane scapular morphological differences in full-thickness posterosuperior cuff tears and primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:e223-e233. [PMID: 34875366 DOI: 10.1016/j.jse.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The critical shoulder angle (CSA) is a surrogate marker of the coronal plane morphology of the scapula. CSA differences between scapulae could be due to differences in glenoid inclination (GI) or the location of the most lateral part of the acromion relative to the inferior glenoid, or both. An understanding of the hierarchy of the scapular morphological changes associated with glenohumeral osteoarthritis (GHOA) and rotator cuff (RC) tears would allow accurate biomechanical modeling. METHODS A prospective observational case control study was undertaken in which the GI, "nonglenoid"-CSA, acromial vertical offset index, acromial horizontal offset index, acromial horizontal-vertical offset index, and coronal plane angulation of the acromion (CPAA-m) were measured on high-quality radiographs to compare coronal plane scapular anatomy in: (1) patients with asymptomatic atraumatic full-thickness RC tears, (2) patients with symptomatic primary GHOA, and (3) a control group with no RC tear or GHOA treated for glenohumeral instability or symptomatic labral pathology. Intraobserver reliability of the measurements was performed. RESULTS In the GHOA group, the GI was lower (less superiorly inclined) than the RC tear group (difference between the means: -4.8°, 95% confidence interval [CI] [-8.8°, -0.9°], P = .014) and the control group (difference between the means: -7.9°, 95% CI [-11.8°, -3.9°], P = .000); there was no difference in the acromial measurements. In the RC tear group, the nonglenoid-CSA was higher (difference between the means: 7.7°, 95% CI [3.0°, 12.3°], P = .001), the acromial vertical offset index was lower (difference between the means: -0.13, 95% CI [-0.24, -0.01], P = .026), and the acromial horizontal-vertical offset index was higher (difference between the means: 0.15, 95% CI [0.01, 0.28], P = .030) than the control group; there was no difference in the acromial horizontal offset index or the GI. The CPAA-m was lower (greater coronal plane downslope of the acromion) in both GHOA (difference between the means: -9.6°, 95% CI [-18.6°, -0.5°], P = .036) and RC tears (difference between the means: -9.9°, 95% CI [-19.0°, -0.9°], P = .029) compared with the control group. The intraclass correlation coefficients for intraobserver reliability demonstrated excellent reliability for the measurements (all >0.900). DISCUSSION Scapulae associated with GHOA have lower GI, but no spatial differences in the location of the lateral acromion compared with a normal population. Scapulae associated with RC tears have a lower vertical offset of the lateral acromion, but no difference in horizontal offset or GI compared with a normal population. The downslope of the acromion in the coronal plane is greater (lower CPAA-m) in both RC tears and GHOA than the normal population.
Collapse
Affiliation(s)
- Geoffrey C S Smith
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Orthopaedics, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Centre for Orthopaedic Research, Sydney, NSW, Australia.
| |
Collapse
|
7
|
Berhouet J, Jacquot A, Walch G, Deransart P, Favard L, Gauci MO. Preoperative planning of baseplate position in reverse shoulder arthroplasty: Still no consensus on lateralization, version and inclination. Orthop Traumatol Surg Res 2022; 108:103115. [PMID: 34653644 DOI: 10.1016/j.otsr.2021.103115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In the context of reverse shoulder arthroplasty, some parameters of glenoid baseplate placement follow established golden rules, while other parameters still have no consensus. The assessment of glenoid wear in the future location of the glenoid baseplate varies among surgeons. The objective of this study was to analyze the inter-observer reproducibility of glenoid baseplate 3D positioning during virtual pre-operative planning. METHOD Four shoulder surgeons planned the glenoid baseplate position of a reverse arthroplasty in the CT scans of 30 degenerative shoulders. The position of the glenoid guide pin entry point and the glenoid baseplate center was compared between surgeons. The baseplate's version and inclination were also analyzed. RESULTS The 3D positioning of the pin entry point was achieved within ± 4 mm for nearly 100% of the shoulders. The superoinferior, anteroposterior and mediolateral positions of the baseplate center were achieved within ± 2 mm for 77.2%, 67.8% and 39.4% of the plans, respectively. The 3D orientation of the glenoid baseplate within ± 10° was inconsistent between the four surgeons (weak agreement, K=0.31, p=0.17). DISCUSSION The placement of the glenoid guide pin was very consistent between surgeons. Conversely, there was little agreement on the lateralization, version and inclination criteria for positioning the glenoid baseplate between surgeons. These parameters need to be studied further in clinical practice to establish golden rules. Three-dimensional information from pre-operative planning is beneficial for assessing the glenoid deformity and for limiting its impact on the baseplate position achieved by different surgeons. LEVEL OF EVIDENCE III. Case control study.
Collapse
Affiliation(s)
- Julien Berhouet
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France; Université de Tours-Ecole d'Ingénieurs Polytechnique Universitaire de Tours-Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Equipe Reconnaissance de Forme et Analyse de l'Image, 64 Avenue Portalis, 37200 Tours, France.
| | - Adrien Jacquot
- Chirurgie des Articulations et du Sport, Centre ARTICS, 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Gilles Walch
- Centre Orthopédique Santy, Unité Epaule, 24 Avenue Paul Santy, 69008 Lyon, France
| | | | - Luc Favard
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
| |
Collapse
|
8
|
Dekker TJ, Grantham WJ, Lacheta L, Goldenberg BT, Hazra ROD, Rakowski DR, Dornan GJ, Horan MP, Millett PJ. Glenoid Retroversion Does Not Impact Clinical Outcomes or Implant Survivorship Following Total Shoulder Arthroplasty with Minimal, Non-Corrective Reaming. JSES Int 2022; 6:596-603. [PMID: 35813138 PMCID: PMC9264025 DOI: 10.1016/j.jseint.2022.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hypothesis Methods Results Conclusion
Collapse
|
9
|
Poddar R, Dutta M. Sub-acromion impingement syndrome: Scapular morphometric analysis: A study on dry bones among Eastern Indian population. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_143_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
Levins JG, Kukreja M, Paxton ES, Green A. Computer-Assisted Preoperative Planning and Patient-Specific Instrumentation for Glenoid Implants in Shoulder Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00006. [PMID: 35417437 DOI: 10.2106/jbjs.rvw.20.00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Glenoid component positioning affects implant survival after total shoulder arthroplasty, and accurate glenoid-component positioning is an important technical aspect. » The use of virtual planning and patient-specific instrumentation has been shown to produce reliable implant placement in the laboratory and in some clinical studies. » Currently available preoperative planning software programs employ different techniques to generate 3-dimensional models and produce anatomic measurements potentially affecting clinical decisions. » There are no published data, to our knowledge, on the effect of preoperative computer planning and patient-specific instrumentation on long-term clinical outcomes.
Collapse
Affiliation(s)
- James G Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Brown University Warren Alpert School of Medicine, Providence, Rhode Island
| | | | | | | |
Collapse
|
11
|
Sharifi A, Siebert MJ, Chhabra A. How to Measure Glenoid Bone Stock and Version and Why It Is Important: A Practical Guide. Radiographics 2021; 40:1671-1683. [PMID: 33001780 DOI: 10.1148/rg.2020200008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Shoulder osteoarthritis (OA) is a common and debilitating condition and a source of high morbidity and medical expenditures across the world among individuals older than 60 years. Shoulder OA results in the gradual destruction of articular cartilage of the humeral head and glenoid component, causing inflammation, pain, and a restricted range of motion. Most patients are diagnosed with shoulder OA after experiencing shoulder pain and stiffness, and the diagnosis is often made after medical and physical histories are obtained and physical and imaging examinations are performed. Use of various surgical techniques such as total anatomic or reverse shoulder arthroplasty and hemiarthroplasty has increased in recent years, resulting in reduced morbidity and improved functional status of patients. However, the rate of surgical complications such as premature loosening of components is significant, reducing the effectiveness of such procedures. Data in the literature indicate that high-grade fatty infiltration of the rotator cuff muscle before surgery is associated with postoperative glenoid component loosening. High-grade rotator cuff fatty infiltration and atrophy have been found to be associated with more severe Walch classification-based glenoid morphology subtypes, increased joint line medialization, glenoid bone loss, and increased pathologic glenoid version. The authors describe how advanced imaging techniques are used for preoperative evaluation of the shoulder and discuss how to measure glenoid version and bone stock and classify glenoid morphology types on the basis of Walch classification, as these parameters are commonly used in surgical planning. Methods involving the use of Friedman and paleoglenoid lines for respective measurements are illustrated by using three-dimensional CT and MRI case examples. ©RSNA, 2020.
Collapse
Affiliation(s)
- Arghavan Sharifi
- From the School of Medicine (A.S., M.J.S.) and Department of Radiology and Orthopedic Surgery (A.C.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Matthew J Siebert
- From the School of Medicine (A.S., M.J.S.) and Department of Radiology and Orthopedic Surgery (A.C.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Avneesh Chhabra
- From the School of Medicine (A.S., M.J.S.) and Department of Radiology and Orthopedic Surgery (A.C.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| |
Collapse
|
12
|
Mahendraraj KA, Shields MV, Grubhofer F, Golenbock SW, Jawa A. Reassessing glenoid inclination in reverse total shoulder arthroplasty with glenosphere lateralization. Bone Joint J 2021; 103-B:360-365. [PMID: 33517737 DOI: 10.1302/0301-620x.103b2.bjj-2020-0843.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS Existing literature indicates that inferiorly inclined glenoid baseplates following reverse total shoulder arthroplasty (RSA) produce better outcomes compared to superiorly inclined baseplates. We aim to compare clinical outcomes for RSAs with superiorly and neutrally/inferiorly inclined lateralized glenospheres. METHODS We retrospectively reviewed 154 consecutive patients undergoing RSA between July 2015 and July 2017 by one single-fellowship trained surgeon (AJ). Two raters (KAM and MVS) independently measured glenoid inclination in preoperative and minimum two year follow-up radiographs (anteroposterior/Grashey) using the RSA angle. Inclination was then compared to patient-reported outcomes, range of motion (ROM), and independently assessed degree of scapular notching and staging of heterotopic ossification at two year follow-up. RESULTS Median postoperative inclination for each group was found to be -3.6° (interquartile range (IQR) -2.1 to -6.9) and 6.0° (3.2° to 10.1°) for the neutrally/inferiorly and superiorly inclined cohorts, respectively. Preoperative inclination was highly associated with postoperative inclination (p = 0.004). When comparing superiorly and neutrally/inferiorly inclined glenospheres, there were no differences in heterotopic ossification (p = 0.606), scapular notching (p = 0.367), American Shoulder and Elbow Surgeons score (p = 0.419), Single Assessment Numeric Evaluation (p = 0.417), Visual Analogue Scale (VAS) pain score (p = 0.290), forward elevation (p = 0.161), external rotation (p = 0.537), or internal rotation (p = 0.656). CONCLUSION Compared to neutral and inferior inclination, up to 6° ± 3° of superior glenoid baseplate inclination on a lateralized RSA design produces no differences in postoperative ROM or patient-reported outcomes, and produces similar levels of scapular notching and heterotopic ossification. Additionally, the degree of preoperative inclination represents an important factor in surgical decision-making as it is strongly associated with postoperative inclination. It is important to note that the findings of this study are only reflective of lateralized RSA prostheses. Cite this article: Bone Joint J 2021;103-B(2):360-365.
Collapse
Affiliation(s)
- Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA.,Boston Sports and Shoulder Center, Waltham, Massachusetts, USA
| | | | - Florian Grubhofer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samuel W Golenbock
- Department of Orthopaedic Research, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA.,Boston Sports and Shoulder Center, Waltham, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
13
|
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
|
14
|
Glenoid Retroversion Associates With Asymmetric Rotator Cuff Muscle Atrophy in Those With Walch B-type Glenohumeral Osteoarthritis. J Am Acad Orthop Surg 2020; 28:547-555. [PMID: 31517880 PMCID: PMC7064422 DOI: 10.5435/jaaos-d-18-00830] [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] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our purpose was to determine whether glenoid retroversion associates with asymmetric rotator cuff muscle atrophy in eccentric glenohumeral osteoarthritis (GHOA) and if this asymmetry is worsening of GHOA-related atrophy. METHODS Two groups of shoulder magnetic resonance images were studied: patients older than 50 years without a rotator cuff tear or GHOA (control group) and patients preoperative to anatomic total shoulder arthroplasty (GHOA group). Retroversion and rotator cuff muscle cross-sectional areas were measured using reliable and accurate techniques. Proportional muscle areas were created by dividing by total cuff area to correct for differences in overall patient size. Walch grades were assigned via consensus. RESULTS The control group consisted of 102 patients and the GHOA cohort consisted of 141 patients. Within the eccentric GHOA group, retroversion associated with relative increasing supraspinatus (r = 0.268, P = 0.035), increasing infraspinatus (r = 0.273, P = 0.032), and decreasing subscapularis areas (r = -0.343, P = 0.006). However, the combined GHOA group had a significantly higher relative subscapularis area than the control group (P = 0.026). CONCLUSION In the eccentric GHOA, increasing retroversion is associated with increasing volume of the posterior cuff relative to the anterior cuff muscles, which is a reversal of the asymmetric increasing volume of the anterior cuff relative to the posterior cuff muscles seen with concentric GHOA. LEVEL OF EVIDENCE Diagnostic, level III.
Collapse
|
15
|
Wechselberger J, Neumann J, Wörtler K. Bildgebende Diagnostik bei glenohumeralen Knorpelschäden und Schulter-Früharthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Abstract
Preoperative assessment of the glenoid in the setting of shoulder arthroplasty is critical to account for variations in glenoid morphology, wear, version, inclination, and glenohumeral subluxation. Three-dimensional computed tomography (3D CT) scan assessment of the morphology of glenoid erosion allows for a more accurate surgical decision-making process to correct deformity and restore the joint line. Newer technology has brought forth computer-assisted software for glenoid planning in shoulder arthroplasty and patient-specific instrumentation. There have been promising early findings, although further evaluation is needed to determine how this technology impacts implant survivorship, function, and patient-reported outcomes.
Cite this article: EFORT Open Rev 2020;5:126-137. DOI: 10.1302/2058-5241.5.190011
Collapse
Affiliation(s)
- Stephen Gates
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brain Sager
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
17
|
Shukla DR, McLaughlin RJ, Lee J, Nguyen NTV, Sanchez-Sotelo J. Automated three-dimensional measurements of version, inclination, and subluxation. Shoulder Elbow 2020; 12:31-37. [PMID: 32010231 PMCID: PMC6974883 DOI: 10.1177/1758573218825480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/03/2018] [Accepted: 12/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preoperative planning software has been developed to measure glenoid version, glenoid inclination, and humeral head subluxation on computed tomography (CT) for shoulder arthroplasty. However, most studies analyzing the effect of glenoid positioning on outcome were done prior to the introduction of planning software. Thus, measurements obtained from the software can only be extrapolated to predict failure provided they are similar to classic measurements. The purpose of this study was to compare measurements obtained using classic manual measuring techniques and measurements generated from automated image analysis software. METHODS Ninety-five two-dimensional computed tomography scans of shoulders with primary glenohumeral osteoarthritis were measured for version according to Friedman method, inclination according to Maurer method, and subluxation according to Walch method. DICOM files were loaded into an image analysis software (Blueprint, Wright Medical) and the output was compared with values obtained manually using a paired sample t-test. RESULTS Average manual measurements included 13.8° version, 13.2° inclination, and 56.2% subluxation. Average image analysis software values included 17.4° version (3.5° difference, p < 0.0001), 9.2° inclination (3.9° difference, p < 0.001), and 74.2% for subluxation (18% difference, p < 0.0001). CONCLUSIONS Glenoid version and inclination values from the software and manual measurement on two-dimensional computed tomography were relatively similar, within approximately 4°. However, subluxation measurements differed by approximately 20%.
Collapse
Affiliation(s)
| | | | | | | | - Joaquin Sanchez-Sotelo
- Joaquin Sanchez-Sotelo, Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| |
Collapse
|
18
|
Agyeman KD, DeVito P, McNeely E, Malarkey A, Bercik MJ, Levy JC. Comparing the Use of Axillary Radiographs and Axial Computed Tomography Scans to Predict Concentric Glenoid Wear. JB JS Open Access 2020; 5:e0049. [PMID: 32309759 PMCID: PMC7147633 DOI: 10.2106/jbjs.oa.19.00049] [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] [Indexed: 11/14/2022] Open
Abstract
Background: Axillary radiographs traditionally have been considered sufficient to identify concentric glenoid wear in osteoarthritic shoulders; however, with variable glenoid wear patterns, assessment with use of computed tomography (CT) has been recommended. The purpose of the present study was to compare the use of axillary radiographs and mid-glenoid axial CT scans to identify glenoid wear. Methods: Preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty were reviewed. Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric. The morphologies determined with use of axillary radiographs and CT scans were assessed for correlation, and both intraobserver and interobserver consistency were calculated. Results: Concentric wear identified with use of radiographs was confirmed with use of CT scans in an average of 61% of cases (range, 53% to 76%). Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001). The most senior observer identified the highest proportion of concentric wear on radiographs (p < 0.001), showed the greatest consistency between attempts when using CT (p < 0.001), and had the greatest agreement of radiographs and CT evaluating glenoid morphology (p < 0.001). Conclusions: For the experienced shoulder surgeon, concentric glenoid wear identified on axillary radiographs will appear concentric on 2-dimensional CT in approximately 75% of cases. Obtaining a CT scan to confirm glenoid wear patterns most greatly benefits less-experienced surgeons. Across all levels of experience, axillary radiographs and single-slice, mid-glenoid CT scans appear insufficient for consistently predicting wear patterns. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Kofi D Agyeman
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Paul DeVito
- Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
| | - Emmanuel McNeely
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Andy Malarkey
- Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
| | | | | |
Collapse
|
19
|
Normal and Pathoanatomy of the Arthritic Shoulder: Considerations for Shoulder Arthroplasty. J Am Acad Orthop Surg 2019; 27:e1068-e1076. [PMID: 31206438 DOI: 10.5435/jaaos-d-18-00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The glenohumeral joint is a highly mobile, complex articulation that relies not only on the bony support between the humeral head and glenoid but also on appropriate balance and tension of the surrounding soft-tissue structures. Recreating the normal anatomic relationships is a basic premise in joint arthroplasty, which can be challenging in shoulder arthroplasty, as the normal glenohumeral anatomy has considerable variation from patient to patient. Also, as the anatomy of the glenohumeral joint becomes distorted with advanced shoulder pathology, it becomes a challenge to return the shoulder to its premorbid anatomic state. Failure to restore normal anatomic parameters after shoulder arthroplasty has been shown to have deleterious effects on postoperative function and implant survival. As the recognition of this has grown, shoulder prostheses have evolved to allow for considerable more variation in an attempt to recreate patient-specific anatomy. However, understanding the progression of shoulder pathology to better predict the patient's premorbid anatomy remains limited. A thorough understanding of the premorbid and pathologic anatomy of the glenohumeral joint will aid in preoperative planning and intraoperative execution and lead to a more predictable reconstruction of the shoulder, which is critical for a successful outcome after shoulder arthroplasty.
Collapse
|
20
|
Nashikkar PS, Scholes CJ, Haber MD. Computer navigation re-creates planned glenoid placement and reduces correction variability in total shoulder arthroplasty: an in vivo case-control study. J Shoulder Elbow Surg 2019; 28:e398-e409. [PMID: 31353300 DOI: 10.1016/j.jse.2019.04.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/03/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate glenoid component placement is important to prevent glenoid component failure in total shoulder arthroplasty (TSA). Navigation may reduce the variability of glenoid component version and inclination; therefore, the aims of this study were to determine, in patients undergoing TSA, whether computer navigation improved the ability to achieve neutral postoperative version and inclination, as well as achieve the individualized preoperative plan. METHODS Patients undergoing TSA using navigation (computer-assisted surgery [CAS], n = 33) or the conventional technique (n = 27) from January 2014 to July 2017 were recruited and compared. Preoperative and postoperative version and inclination, as well as postoperative inferior overhang, were measured using computed tomography scans. RESULTS The CAS group had more than twice as many augmented glenoid components as the conventional group (45.5% vs. 19.2%). CAS significantly reduced the between-patient variability in postoperative version and led to a greater proportion of components positioned in "neutral" alignment for both inclination and version (P < .015). The incidence of neutral inclination or version postoperatively was significantly higher in the CAS group, and the glenoid was implanted within 5° of the surgical plan in more than 70% of cases, with more than 40% displaying no detectable difference. CONCLUSION An integrated system of 3-dimensional surgical planning, augmented glenoid components, and intraoperative navigation may reduce the risk of glenoid placement outside of a neutral position in patients undergoing TSA compared with conventional methods. This study demonstrated the capacity for CAS to replicate the surgical plan in a majority of cases.
Collapse
Affiliation(s)
| | | | - Mark D Haber
- Southern Orthopaedics, Wollongong, NSW, Australia.
| |
Collapse
|
21
|
Boileau P, Gauci MO, Wagner ER, Clowez G, Chaoui J, Chelli M, Walch G. The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1281-1290. [PMID: 30935825 DOI: 10.1016/j.jse.2018.11.074] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Avoiding superior inclination of the glenoid component in reverse shoulder arthroplasty (RSA) is crucial. We hypothesized that superior inclination was underestimated in RSA. Our purpose was to describe and assess a new measurement of inclination for the inferior portion of the glenoid (where the baseplate rests). METHODS The study included 47 shoulders with rotator cuff tear arthropathy (mean age, 76 years). The reverse shoulder arthroplasty angle (RSA angle), defined as the angle between the inferior part of the glenoid fossa and the perpendicular to the floor of the supraspinatus, was compared with the global glenoid inclination (β angle or total shoulder arthroplasty [TSA] angle). Measurements were made on plain anteroposterior radiographs and reformatted 2-dimensional (2D) computed tomography (CT) scans by 3 independent observers and compared with 3-dimensional (3D) software (Glenosys) measurements. RESULTS The mean RSA angle was 25° ± 8° on plain radiographs, 20° ± 6° on reformatted 2D CT scans, and 21° ± 5° via 3D reconstruction software. The mean TSA angle was on average 10° ± 5° lower than the mean RSA angle (P < .001); this difference was observed regardless of the method of measurement (radiographs, 2D CT, or 3D CT) and type of glenoid erosion according to Favard. In Favard type E1 glenoids with central concentric erosion, the difference between the 2 angles was 12° ± 4° (P < .001). CONCLUSION The same angle cannot be used to measure glenoid inclination in anatomic and reverse prostheses. The TSA (or β) angle underestimates the superior orientation of the reverse baseplate in RSA. The RSA angle (20° ± 5°) needs to be corrected to achieve neutral inclination of the baseplate (RSA angle = 0°). Surgeons should be aware that E1 glenoids (with central erosion) are at risk for baseplate superior tilt if the RSA angle is not corrected.
Collapse
Affiliation(s)
- Pascal Boileau
- University Institute of Locomotion & Sport (iULS), Pasteur 2 Hospital, University of Nice-Sophia Antipolis, Nice, France.
| | - Marc-Olivier Gauci
- University Institute of Locomotion & Sport (iULS), Pasteur 2 Hospital, University of Nice-Sophia Antipolis, Nice, France
| | - Eric R Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Gilles Clowez
- University Institute of Locomotion & Sport (iULS), Pasteur 2 Hospital, University of Nice-Sophia Antipolis, Nice, France
| | | | - Mikaël Chelli
- University Institute of Locomotion & Sport (iULS), Pasteur 2 Hospital, University of Nice-Sophia Antipolis, Nice, France
| | | |
Collapse
|
22
|
Chalmers PN, Suter T, Jacxsens M, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. Influence of Radiographic Viewing Perspective on Glenoid Inclination Measurement. J Shoulder Elb Arthroplast 2019; 3. [PMID: 33437911 PMCID: PMC7799437 DOI: 10.1177/2471549218824986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction The purposes of this study were to determine (1) whether glenoid inclination
(GI) could be accurately measured on plain radiographs as compared to a
gold-standard 3-dimensional (3D) measure and (2) whether GI could be
reliably measured on plain radiographs. Materials and Methods Digitally reconstructed radiographs (DRRs) were made from 3D computed
tomography reconstructions of 68 normal cadaver scapulae. DRRs were made in
a variety of viewing angles. Inclination was measured on these DRRs. These
measurements were also made using a gold-standard 3D method. Measurements
were made by 2 orthopedic surgeons and 1 surgeon twice, to calculate
interrater and intrarater intraclass correlation coefficients (ICCs). Results The gold-standard 3D β was 83 ± 5° (72°–98°). On neutral plain radiographs,
the mean ± standard deviation 2D β angle was 80 ± 6° (range, 66°–99°). With
regard to accuracy, the 2D β angle was significantly different from the 3D β
angle, with the 2D β underestimating the 3D β by 5° (95% confidence
intervals −1 to 12). With regard to reliability, interrater ICCs for 2D β
with a neutral viewing angle was 0.79. Two-dimensional β varied widely with
viewing angle from 0.24 to 0.88. Interrater ICCs for the 3D method was 0.83
(0.60–0.92). Intrarater ICCs for all 3 techniques were high (>0.91). Conclusions Two-dimensional radiographic GI measurement is not accurate, as it
underestimates the 3D value by an average of 5° when compared to the
gold-standard 3D measurement. GI 2D measurement reliability varies with
viewing angle on plain radiographs and thus to accurately and reliably
measure inclination 3D imaging is necessary.
Collapse
Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Thomas Suter
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Matthijs Jacxsens
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
23
|
Glenoidrekonstruktion bei Wechseloperationen an der Schulter. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:98-114. [DOI: 10.1007/s00064-019-0594-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
|
24
|
Chalmers PN, Beck L, Granger E, Henninger H, Tashjian RZ. Superior glenoid inclination and rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1444-1450. [PMID: 29576340 DOI: 10.1016/j.jse.2018.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/19/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. METHODS In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. RESULTS (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, -1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P < .001) in the rotator cuff tear group of 192 patients than in the control cohort of 107 patients. CONCLUSIONS Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance.
Collapse
Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lindsay Beck
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Erin Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Heath Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
25
|
Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty? J Shoulder Elbow Surg 2018; 27:1133-1138. [PMID: 29478943 DOI: 10.1016/j.jse.2017.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/13/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The contralateral scapula can be used as a reliable template to determine scapular offset, glenoid inclination, and version of the native scapula in view of reconstructing pathologic scapulae. METHODS Three-dimensional measurements of scapular offset, inclination, and version were performed using data from a set of 50 bilateral computed tomography scans of full scapulae to determine direct side-to-side differences. RESULTS The scapula pairs had a mean bilateral difference of 2 mm in offset, 2° in inclination, and 2° in version. Ninety percent of the scapula pairs showed an offset difference smaller than 3 mm. In 96% and 94% of the scapula pairs, the inclination difference and version difference, respectively, were smaller than 5°. The maximum bilateral difference for offset, inclination, and version was 6 mm, 6°, and 8°, respectively. DISCUSSION AND CONCLUSION The anatomic parameters of scapular offset, glenoid inclination, and version are quite symmetrical and fall into the currently technically feasible accuracy of shoulder arthroplasty implantation. The healthy scapula can be used as a template to guide the reconstruction of the glenoid during shoulder arthroplasty planning in the case of unilateral advanced arthropathy.
Collapse
|
26
|
Jacxsens M, Karns MR, Henninger HB, Drew AJ, Van Tongel A, De Wilde L. Guidelines for humeral subluxation cutoff values: a comparative study between conventional, reoriented, and three-dimensional computed tomography scans of healthy shoulders. J Shoulder Elbow Surg 2018; 27:36-43. [PMID: 28739298 DOI: 10.1016/j.jse.2017.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/30/2017] [Accepted: 06/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The humeral subluxation index (HSI) is frequently assessed on computed tomography (CT) scans in conditions of the shoulder characterized by humeral displacement. An arbitrarily set HSI cutoff value of 45% for anterior subluxation and 55% for posterior subluxation has been widely accepted. We studied whether mean values and thresholds of humeral subluxation, in relation to the glenoid and scapula, were influenced by different imaging modalities. METHODS The HSIs referenced to the scapula (SHSI) and glenoid (GHSI) were compared between conventional CT scans, CT scans reoriented into the corresponding reference plane (ie, scapular plane for the SHSI and glenoid center plane for the GHSI), and 3-dimensional (3D) CT reconstructions of 120 healthy shoulders. The 95% normal range determined the cutoff values of humeral subluxation. RESULTS The SHSI thresholds for conventional, reoriented, and 3D CT scans were 33%-61%, 44%-68%, and 49%-61%, respectively. A different mean SHSI was found for each imaging modality (conventional, 47%; reoriented, 56%; 3D, 55%; P ≤ .014), with the conventional SHSI showing an underestimation in 89% of the cases. GHSI thresholds for conventional, reoriented, and 3D CT scans were 40%-61%, 44%-56%, and 46%-54%, respectively. The mean GHSI did not differ between each imaging modality (conventional, 51%; reoriented, 50%; 3D, 50%; P = .146). CONCLUSIONS The SHSI and GHSI are susceptible to different imaging modalities with consequently different cutoff values. The redefined HSI cutoff values guide physicians in the evaluation of humeral subluxation in conditions characterized by humeral displacement, depending on the available image data.
Collapse
Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Michael R Karns
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alex J Drew
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
27
|
Habermeyer P, Magosch P, Weiß C, Hawi N, Lichtenberg S, Tauber M, Ipach B. Classification of humeral head pathomorphology in primary osteoarthritis: a radiographic and in vivo photographic analysis. J Shoulder Elbow Surg 2017; 26:2193-2199. [PMID: 28943071 DOI: 10.1016/j.jse.2017.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head. METHODS The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads. RESULTS In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%. CONCLUSION It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.
Collapse
Affiliation(s)
| | - Petra Magosch
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Christel Weiß
- Medizinische Fakultät Mannheim, Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Germany
| | - Nael Hawi
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
| | - Sven Lichtenberg
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injury, Paracelsus Medical University, Salzburg, Austria
| | - Bastian Ipach
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
| |
Collapse
|
28
|
Gohlke F, Werner B. Humerale und glenoidale Knochendefekte in der Schulterendoprothetik. DER ORTHOPADE 2017; 46:1008-1014. [DOI: 10.1007/s00132-017-3484-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Labronici PJ, Tavares AK, Canhoto EC, Giordano V, Pires RES, da Silva LHP, Mathias MB, de Miranda Rosa I. Does the position of the scapula in relation to the glenopolar angle change the preferred treatment of extra-articular fractures? Injury 2017; 48 Suppl 4:S21-S26. [PMID: 29145964 DOI: 10.1016/s0020-1383(17)30771-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyse the glenopolar angle (GPA) at different inclinations of the scapula using 3D CT, to test the hypothesis that the result could change the indication from conservative treatment to surgery. MATERIALS AND METHODS Analysis of 30 3D CT images of patients' scapulae, measuring the GPA. The GPA was measured with scapulae at 0° and at 20° and 30° of internal and external rotation. Angles were compared by age, sex and examiner for the different angles of rotation of the scapulae. RESULTS The GPA of scapulae in rotation tended to be smaller than the GPA without rotation, and the larger the degree of rotation, the more the angle was underestimated. Additionally, for the same degree of rotation, internal rotation was associated with greater underestimation of the GPA than external rotation. Two different examiners achieved an excellent level of agreement between angle measurements. The GPA with the scapula at 0° was significantly higher among elderly patients. The variation in GPA with the scapula in rotation (20° and 30°) in relation to the GPA without rotation was significantly greater for female patients. CONCLUSIONS As the rotation of the scapula was displaced from the scapula in the coronal position (GPA 0°), both in internal rotation and in external rotation, the GPA reduced. Therefore, rotational displacement may lead to an error in GPA measurement, resulting in incorrect indication of treatment. It is recommended that whenever possible, GPA measurements should be taken in neutral rotation, with the scapula in a neutral position at 0°.
Collapse
Affiliation(s)
- Pedro José Labronici
- Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis and Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - Augusto Khede Tavares
- Orthopedics and Traumatology at the Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, Rio de Janeiro, Brazil
| | - Erasmo Cavalheiro Canhoto
- Orthopedics and Traumatology at the Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, Rio de Janeiro, Brazil
| | - Vincenzo Giordano
- Nova Monteiro Orthopedics and Traumatology Service, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | | | | | | | | |
Collapse
|
30
|
The influence of three-dimensional planning on decision-making in total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1477-1483. [PMID: 28162884 DOI: 10.1016/j.jse.2017.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term results and complication rates in shoulder arthroplasty are related to implant positioning. Current literature reports increased precision in glenoid component positioning using 3-dimensional (3D) computed tomography (CT) planning tools. This study evaluated the accuracy of glenoid version and inclination measurements using 2D CT scans compared with a validated 3D software program and its influence on decision making on implant selection. METHODS Preoperative CT scans were obtained from 50 patients undergoing total shoulder arthroplasty. Glenoid version and inclination measurements were performed in random order by 3 independent qualified orthopedic surgeons on reformatted 2D CT scans. Indication for anatomic or reverse shoulder arthroplasty was based on glenoid deformity and on rotator cuff conditions. Results were compared with those from a validated 3D computer software program, and the final decision was made according to the 3D planning. RESULTS Mean preoperative glenoid retroversion on reformatted 2D CT scans was 11.9° ± 9.6° and mean superior inclination was 10.7° ± 8.6°. When the 3D software was used, glenoid retroversion averaged 15.1° ± 10.6° and superior inclination averaged 8.9° ± 9.9°. The 2D CT demonstrated good interobserver and intraobserver reliability for glenoid version and inclination. Decision on the choice of implant was adjusted in 7 patients after the 3D planning. CONCLUSIONS Our findings show that measurements of glenoid version and inclination on reformatted 2D CT scans are less accurate compared with 3D measurements. A preoperative 3D planning software allows for improvement of virtual glenoid positioning and influences the decision making process.
Collapse
|
31
|
Poltaretskyi S, Chaoui J, Mayya M, Hamitouche C, Bercik MJ, Boileau P, Walch G. Prediction of the pre-morbid 3D anatomy of the proximal humerus based on statistical shape modelling. Bone Joint J 2017; 99-B:927-933. [DOI: 10.1302/0301-620x.99b7.bjj-2017-0014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/10/2017] [Indexed: 01/02/2023]
Abstract
Aims Restoring the pre-morbid anatomy of the proximal humerus is a goal of anatomical shoulder arthroplasty, but reliance is placed on the surgeon’s experience and on anatomical estimations. The purpose of this study was to present a novel method, ‘Statistical Shape Modelling’, which accurately predicts the pre-morbid proximal humeral anatomy and calculates the 3D geometric parameters needed to restore normal anatomy in patients with severe degenerative osteoarthritis or a fracture of the proximal humerus. Materials and Methods From a database of 57 humeral CT scans 3D humeral reconstructions were manually created. The reconstructions were used to construct a statistical shape model (SSM), which was then tested on a second set of 52 scans. For each humerus in the second set, 3D reconstructions of four diaphyseal segments of varying lengths were created. These reconstructions were chosen to mimic severe osteoarthritis, a fracture of the surgical neck of the humerus and a proximal humeral fracture with diaphyseal extension. The SSM was then applied to the diaphyseal segments to see how well it predicted proximal morphology, using the actual proximal humeral morphology for comparison. Results With the metaphysis included, mimicking osteoarthritis, the errors of prediction for retroversion, inclination, height, radius of curvature and posterior and medial offset of the head of the humerus were 2.9° (± 2.3°), 4.0° (± 3.3°), 1.0 mm (± 0.8 mm), 0.8 mm (± 0.6 mm), 0.7 mm (± 0.5 mm) and 1.0 mm (± 0.7 mm), respectively. With the metaphysis excluded, mimicking a fracture of the surgical neck, the errors of prediction for retroversion, inclination, height, radius of curvature and posterior and medial offset of the head of the humerus were 3.8° (± 2.9°), 3.9° (± 3.4°), 2.4 mm (± 1.9 mm), 1.3 mm (± 0.9 mm), 0.8 mm (± 0.5 mm) and 0.9 mm (± 0.6 mm), respectively. Conclusion This study reports a novel, computerised method that accurately predicts the pre-morbid proximal humeral anatomy even in challenging situations. This information can be used in the surgical planning and operative reconstruction of patients with severe degenerative osteoarthritis or with a fracture of the proximal humerus. Cite this article: Bone Joint J 2017;99-B:927–33.
Collapse
Affiliation(s)
- S. Poltaretskyi
- IMASCAP, IMT Atlantique, Laboratory of
Medical Information Processing (LaTIM - INSERM UMR 1101), 65
Place Copernic, 29280, Plouzane, France
| | - J. Chaoui
- IMASCAP, IMT Atlantique, 65
Place Copernic, 29280, Plouzane, France
| | - M. Mayya
- IMASCAP, IMT Atlantique, 65
Place Copernic, 29280, Plouzane, France
| | - C. Hamitouche
- IMT Atlantique, Laboratory of Medical
Information Processing (LaTIM - INSERM UMR 1101), 655
Avenue du Technopôle, 29200 Plouzané, France
| | - M. J. Bercik
- Lancaster Orthopedic Group, 231
Granite Run Drive, Lancaster, PA
17601, USA
| | - P. Boileau
- IULS (Institut Universitaire Locomoteur
et du Sport), Hôpital Pasteur 2, University of Nice Sophia-Antipolis, 30
Avenue de la Voie Romaine, CS 51069 06000, Nice, France
| | - G. Walch
- Hopital Privé Jean Mermoz Ramsay-GDS Centre
Orthopédique Santy, 24 Avenue Paul Santy 69008, Lyon, France
| |
Collapse
|
32
|
Chalmers PN, Salazar D, Chamberlain A, Keener JD. Radiographic characterization of the B2 glenoid: is inclusion of the entirety of the scapula necessary? J Shoulder Elbow Surg 2017; 26:855-860. [PMID: 28131692 DOI: 10.1016/j.jse.2016.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/19/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computed tomography (CT) scans are often obtained before total shoulder arthroplasty to assess glenoid deformity. To allow correction of the slice axis into the plane of the scapula, these scans have typically required inclusion of the entirety of the scapula. The purpose of this study was to determine whether inclusion of the medial border and inferior angle is necessary for accurate measurement of scapular version, inclination, and humeral subluxation. METHODS Fourteen CT scans in preoperative total shoulder arthroplasty patients with Walch B2 type glenoids underwent a standardized measurement protocol. Glenoid version, inclination, depth, and humeral subluxation were measured on 2-dimensional CT images corrected to the plane of the scapula. These measurements were then repeated in randomized, blinded fashion after subtracting 12.5%, 25%, and 50% of the scapula from the medial border and 12.5%, 25%, and 50% of the scapula from the inferior angle. RESULTS Measurement of retroversion did not significantly differ between measurement of the full scapula and measurement of any of the incomplete scapulas, with the exception of the subtraction of 50% of the scapular width, which caused retroversion to be overestimated by 4.7° (P = .006) and led to inaccurate measurement of subluxation and glenoid depth. CONCLUSION If at least 8 cm of scapular width is imaged on a CT scan, accurate glenoid measurements can be made. Even if 50% of scapular height is not imaged, accurate measurements can be made. Failure to include the medial border or inferior angle does not preclude accurate glenoid measurement.
Collapse
Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA.
| | - Dane Salazar
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Aaron Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| |
Collapse
|
33
|
Nyffeler RW, Meyer DC. Acromion and glenoid shape: Why are they important predictive factors for the future of our shoulders? EFORT Open Rev 2017; 2:141-150. [PMID: 28630752 PMCID: PMC5467673 DOI: 10.1302/2058-5241.2.160076] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The shape of the acromion differs between patients with degenerative rotator cuff tears and individuals without rotator cuff pathology.It can be assessed in the sagittal plane (acromion type, acromion slope) and in the coronal plane (lateral acromion angle, acromion index, critical shoulder angle).The inter-observer reliability is better for the measurements in the coronal plane.A large lateral extension (high acromion index or high critical shoulder angle) and a lateral down-sloping of the acromion (low lateral acromion angle) are associated with full-thickness supraspinatus tears.The significance of glenoid inclination for rotator cuff disease is less clear.The postulated patho-mechanism is the compression of the supraspinatus tendon between the humeral head and the acromion. Bursal side tears might be caused by friction and abrasion of the tendon. Articular side tears could be due to impairment of the gliding mechanism between tendon fibrils leading to local stress concentration. Further research is needed to understand the exact pathomechanism of tendon degeneration and tear. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160076. Originally published online at www.efortopenreviews.org.
Collapse
Affiliation(s)
| | - Dominik C. Meyer
- Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| |
Collapse
|
34
|
Radiographic characterization of the B2 glenoid: the effect of computed tomographic axis orientation. J Shoulder Elbow Surg 2017; 26:258-264. [PMID: 27592372 DOI: 10.1016/j.jse.2016.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/18/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid retroversion may accelerate glenoid loosening after total shoulder arthroplasty. Accurate measurement of preoperative glenoid deformity is critical for decision-making and prognostication. The purpose of this study was to determine whether glenoid version, inclination, and depth and humeral subluxation measurements on computed tomography (CT) scan slices oriented in the plane of the body differ from those oriented in the scapular plane and those obtained by automated 3-dimensional reconstruction software in the setting of a biconcave B2-type glenoid. METHODS Thirty-one preoperative CT scans in patients undergoing total shoulder arthroplasty with Walch B2-type glenoids underwent a standardized measurement protocol by 3 observers. Glenoid version, inclination, and depth and humeral subluxation were measured on 2-dimensional CT images in the plane of the body, on 2-dimensional images in the plane of the scapula, and by a validated, automated 3-dimensional software program. RESULTS Correction of CT slice axis into the plane of the scapula decreased measured retroversion by 2.4° to 4.7° (P < .004) and inclination by 21° (P < .001). Whereas uncorrected version measurements do not differ from automated software measurements, corrected measurements do (P < .001). Whereas corrected inclination measurements do not differ from automated measurements, uncorrected measurements do (P < .001). Automated measurements differed from both corrected and uncorrected subluxation (P < .001 in both cases). CONCLUSION If CT images are not reoriented into the plane of the scapula, version and inclination will be significantly overestimated. In the setting of a retroverted, deformed glenoid, automated software may produce similar inclination measurements to corrected 2-dimensional CT, but it produces significantly altered measurements of version and subluxation.
Collapse
|
35
|
Engelhardt C, Farron A, Becce F, Place N, Pioletti DP, Terrier A. Effects of glenoid inclination and acromion index on humeral head translation and glenoid articular cartilage strain. J Shoulder Elbow Surg 2017; 26:157-164. [PMID: 27522337 DOI: 10.1016/j.jse.2016.05.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/17/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous clinical studies have reported associations between glenoid inclination (GI), the acromion index (AI), and the critical shoulder angle (CSA) on the one hand and the occurrence of glenohumeral osteoarthritis and supraspinatus tendon tears on the other hand. The objective of this work was to analyze the correlations and relative importance of these different anatomic parameters. METHODS Using a musculoskeletal shoulder model developed from magnetic resonance imaging scans of 1 healthy volunteer, we varied independently GI from 0° to 15° and AI from 0.5 to 0.8. The corresponding CSA varied from 20.9° to 44.1°. We then evaluated humeral head translation and critical strain volume in the glenoid articular cartilage at 60° of abduction in the scapular plane. These values were correlated with GI, AI, and CSA. RESULTS Humeral head translation was positively correlated with GI (R = 0.828, P < .0001), AI (R = 0.539, P < .0001), and CSA (R = 0.964, P < .0001). Glenoid articular cartilage strain was also positively correlated with GI (R = 0.489, P = .0004) but negatively with AI (R = -0.860, P < .0001) and CSA (R = -0.285, P < .0473). CONCLUSIONS The biomechanical shoulder model is consistent with clinical observations. The prediction strength of CSA is confirmed for humeral head translation and thus presumably for rotator cuff tendon tears, whereas the AI seems more appropriate to evaluate the risk of glenohumeral osteoarthritis caused by excessive articular cartilage strain. As a next step, we should corroborate these theoretical findings with clinical data.
Collapse
Affiliation(s)
- Christoph Engelhardt
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Place
- Institute of Sports Sciences, Faculty of Biology Medicine, University of Lausanne, Lausanne, Switzerland; Department of Physiology, Faculty of Biology Medicine, University of Lausanne, Lausanne, Switzerland
| | - Dominique P Pioletti
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| |
Collapse
|
36
|
Kejriwal R, Ahuja T, Hong T. Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures? Injury 2016; 47:2772-2776. [PMID: 27717542 DOI: 10.1016/j.injury.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/25/2016] [Accepted: 10/02/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Plain radiographs still play a role in management of extraarticular scapular neck fractures. Glenopolar angle (GPA) is one of the radiograph measurements that is used to determine the necessity for surgery. Our aim was to establish reliability of GPA on plain radiograph in patients with extraarticular scapular neck fractures. METHODS We performed a multicentre retrospective study including all patients with extraarticular scapular neck fractures with available imaging between 2006 and 2012. We excluded intra-articular glenoid fractures, scapular blade fractures, acromion fractures, and scapular spine fractures. We compared GPA on plain radiograph with three dimensional computed tomography (3D CT) measurement, as well as contribution of radiograph rotational error, glenoid inclination, and medial shortening of glenoid fragment towards GPA measurement. RESULTS One hundred patients met the inclusion criteria. The mean difference between the GPA measurements on radiographs and 3D CT was 6.1±0.85° (95% confidence interval) as an absolute value. In terms of contribution to GPA values, GPA changed by one degree with ten degrees of radiograph rotational error, three degrees of glenoid inclination, and three millimetres of glenoid fragment medial shortening. CONCLUSION Plain radiograph can provide a clinician with a reasonable estimation of the GPA. Glenoid inclination has a greater influence on GPA compared to medial shortening.
Collapse
Affiliation(s)
- Ritwik Kejriwal
- FRACS, Department of Orthopaedic Surgery, Taranaki Base Hospital, 87 Vivian St., New Plymouth, 4310, New Zealand.
| | - Tarun Ahuja
- MBCHB, Department of Orthopaedic Surgery, Auckland City Hospital, New Zealand
| | - Thin Hong
- FRACS, Department of Orthopaedic Surgery, Waikato Hospital, New Zealand
| |
Collapse
|
37
|
Bercik MJ, Kruse K, Yalizis M, Gauci MO, Chaoui J, Walch G. A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 2016; 25:1601-6. [PMID: 27282738 DOI: 10.1016/j.jse.2016.03.010] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since Walch and colleagues originally classified glenoid morphology in the setting of glenohumeral osteoarthritis, several authors have reported varying levels of interobserver and intraobserver reliability. We propose several modifications to the Walch classification that we hypothesize will increase interobserver and intraobserver reliability. METHODS We propose the addition of the B3 and D glenoids and a more precise definition of the A2 glenoid. The B3 glenoid is monoconcave and worn preferentially in its posterior aspect, leading to pathologic retroversion of at least 15° or subluxation of 70%, or both. The D glenoid is defined by glenoid anteversion or anterior humeral head subluxation. The A2 glenoid has a line connecting the anterior and posterior native glenoid rims that transects the humeral head. Using 3-dimensional computed tomography glenoid reconstructions, 3 evaluators used the original Walch classification and the modified Walch classification to classify 129 nonconsecutive glenoids on 4 separate occasions. Reliabilities were assessed by calculating κ coefficients. RESULTS Interobserver reliabilities improved from an average of 0.391 (indicating fair agreement) using the original classification to an average of 0.703 (substantial agreement) using the modified classification. Intraobserver reliabilities improved from an average of 0.605 (moderate agreement) to an average of 0.882 (nearly perfect agreement). CONCLUSION When 3-dimensional glenoid reconstructions and the modified Walch classification described herein are used, improved interobserver and intraobserver reliabilities are obtained.
Collapse
Affiliation(s)
| | - Kevin Kruse
- Texas Orthopaedic Associates, Dallas, TX, USA
| | - Matthew Yalizis
- Sydney Shoulder and Elbow Specialists, Ramsgate, NSW, Australia
| | - Marc-Olivier Gauci
- Department of Orthopaedic and Sport Surgery, University Institute of Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | | | | |
Collapse
|
38
|
Abstract
Reverse shoulder arthroplasty (RSA) was designed for the treatment of elderly patients with cuff tear arthropathy. Because of its success, the indications for RSA have expanded beyond cuff tear arthropathy to include acute fractures, fracture sequelae, massive rotator cuff tears, inflammatory arthritis, and revision shoulder arthroplasty. Consequently, the number of RSAs performed has increased steadily. Glenoid bone loss is not uncommon in patients undergoing primary or revision RSA. Failure to appreciate and address glenoid bone loss during RSA can lead to improper baseplate positioning and early failure or complications such as dislocation or scapular notching. The authors present a review of the current literature as well as recommended strategies for characterization of glenoid bone loss and preferred surgical techniques for addressing bone loss during RSA.
Collapse
|
39
|
Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF. Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res 2016; 102:559-62. [PMID: 27238292 DOI: 10.1016/j.otsr.2016.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/28/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Associations have been reported linking rotator cuff tears (RCTs) to both greater lateral extension of the acromion and greater inclination of the glenoid cavity. These two factors combined can be assessed using a recently introduced parameter, the critical shoulder angle (CSA). The primary objective of this study was to confirm the association linking a high CSA value to RCTs, and the secondary objective was to assess the reproducibility of CSA measurement using a goniometer. HYPOTHESIS The null hypothesis was that the CSA value in a group of patients with RCTs was not significantly different from that in patients with anterior shoulder instability and a Bankart lesion, taken as the general population for this study. METHODS After a power estimation, we retrospectively included 28 patients with a mean age of 55.5 years who had surgery for RCTs and 27 patients with a mean age of 27.2 years who underwent anterior labral repair. Two surgeons used a goniometer to measure the CSA in each patient. Reproducibility was assessed based on Bland-Altman plots and Pearson's correlation coefficient. RESULTS The mean CSA was significantly higher (P=0.02) in the RCT group (36.4°±4.4°; range: 30°-46°) than in the labral-repair group (33.3°±3.8°; range: 25°-41°). Intra-observer reproducibility was 96.7% and inter-observer reproducibility was 95.5%. CONCLUSION Our results support previously published evidence that the CSA is significantly greater in patients with RCTs. Thus, an anatomical difference seems to exist between patients with RCTs and the general population. The CSA measured on a standard radiograph using a goniometer provides a reproducible assessment of this anatomical difference. LEVEL OF EVIDENCE IV, case-control epidemiological study with a power estimation.
Collapse
Affiliation(s)
- L Cherchi
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France.
| | - J F Ciornohac
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France
| | - J Godet
- Département de santé publique, secteur biostatistiques et méthodologie, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | - P Clavert
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France; Fédération de médecine translationnelle, FMTS, faculté de médecine de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - J-F Kempf
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France; Fédération de médecine translationnelle, FMTS, faculté de médecine de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| |
Collapse
|