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Werthel JD, Dufrenot M, Schoch BS, Walch A, Morvan Y, Urvoy M, Walch G, Gauci MO. Are glenoid retroversion, humeral subluxation, and Walch classification associated with a muscle imbalance? J Shoulder Elbow Surg 2024:S1058-2746(24)00028-4. [PMID: 38242526 DOI: 10.1016/j.jse.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior-to-posterior rotator cuff and deltoid muscle volume as a function of humeral subluxation and glenoid morphology when analyzed as a continuous variable in arthritic shoulders. METHODS In total, 333 computed tomography scans of shoulders (273 arthritic shoulders and 60 healthy controls) were included in this study and were segmented automatically. For each muscle, the volume of muscle fibers without intramuscular fat was measured. The ratio between the volume of the subscapularis and the volume of the infraspinatus plus teres minor (AP ratio) and the ratio between the anterior and posterior deltoids (APdeltoid) were calculated. Statistical analyses were performed to determine whether a correlation could be found between these ratios and glenoid version, humeral subluxation, and/or glenoid type per the Walch classification. RESULTS Within the arthritic cohort, no statistically significant difference in the AP ratio was found between type A glenoids (1.09 ± 0.22) and type B glenoids (1.03 ± 0.16, P = .09), type D glenoids (1.12 ± 0.27, P = .77), or type C glenoids (1.10 ± 0.19, P > .999). No correlation was found between the AP ratio and glenoid version (ρ = -0.0360, P = .55) or humeral subluxation (ρ = 0.076, P = .21). The APdeltoid ratio of type A glenoids (0.48 ± 0.15) was significantly greater than that of type B glenoids (0.35 ± 0.16, P < .01) and type C glenoids (0.21 ± 0.10, P < .01) but was not significantly different from that of type D glenoids (0.64 ± 0.34, P > .999). When evaluating both healthy control and arthritic shoulders, moderate correlations were found between the APdeltoid ratio and both glenoid version (ρ = 0.55, P < .01) and humeral subluxation (ρ = -0.61, P < .01). CONCLUSION This in vitro study supports the use of software for fully automated 3-dimensional reconstruction of the 4 rotator cuff muscles and the deltoid. Compared with previous 2-dimensional computed tomography scan studies, our study did not find any correlation between the anteroposterior muscle volume ratio and glenoid parameters in arthritic shoulders. However, once deformity occurred, the observed APdeltoid ratio was lower with type B and C glenoids. These findings suggest that rotator cuff muscle imbalance may not be the precipitating etiology for the posterior humeral subluxation and secondary posterior glenoid erosion characteristic of Walch type B glenoids.
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Affiliation(s)
| | | | | | | | | | | | - Gilles Walch
- Ramsay Générale de Santé, Centre Orthopédique Santy, Jean Mermoz Private Hospital, Lyon, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport - Centre Hospitalier Universitaire (IULS-CHU) de Nice, Nice, France
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Yiannakopoulos C, Vlastos I, Koutserimpas C, Gianzina E, Dellis S, Kalinterakis G. Comparison of Glenoid Dimensions Between 3D Computed Tomography and 3D Printing. Cureus 2024; 16:e53133. [PMID: 38420064 PMCID: PMC10899810 DOI: 10.7759/cureus.53133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Glenoid dimensions can be measured in vivo with various imaging methods including two-dimensional (2D) and three-dimensional computed tomography (CT) and magnetic resonance imaging scans. Printing of three-dimensional (3D) models of the glenoid using imaging data is feasible and can be used to better understand skeletal trauma and complex skeletal deformations such as glenoid bone loss in patients with shoulder instability. The purpose of this study was to compare measurements of glenoid dimensions on 3D CT scan reconstructed models and 3D printed models of the glenoid. METHODS CT scans from 62 young, male adults acquired for non-trauma-related causes were evaluated. Following volume rendering, a stereolithography model of each scapula was constructed and a 3D model was printed. Additionally, 3D CT models of each glenoid were reconstructed using dedicated software. Measurements of the maximum glenoid height and width were performed on both the 3D printed and the 3D reconstructed models. To assess intra- and interrater reliability, measurements of 15 glenoids were repeated by two observers after three weeks. The measurements of the 3D printed and 3D reconstructed models were compared. RESULTS Inter- and intra-rater reliability was excellent or perfect. Analysis of height and width values demonstrated a strong correlation of 0.91 and 0.89 respectively (p<0.001) for both the 3D printed models and the 3D reconstructed models. There was a strong correlation between the height and width, but no significant difference between the glenoid width and height in both models. There was no statistical significance between height and width when measurements on the two models were examined (p=0.12 and 0.23 respectively). CONCLUSION 3D printed glenoid models can be used to evaluate the glenoid dimensions, width, and height, as they provide similar accuracy with 3D reconstructed models as provided from CT scan data.
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Affiliation(s)
- Christos Yiannakopoulos
- Orthopaedics, IASO General Hospital, Athens, GRC
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, Athens, GRC
| | - Iakovos Vlastos
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, Athens, GRC
| | | | - Elina Gianzina
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, Athens, GRC
| | - Spilios Dellis
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, Athens, GRC
| | - Georgios Kalinterakis
- School of Physical Education & Sports Science, National & Kapodistrian University of Athens, Athens, GRC
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Contreras ES, Kingery MT, Zuckerman JD, Virk MS. Treatment of Glenoid Wear with the Use of Augmented Glenoid Components in Total Shoulder Arthroplasty: A Scoping Review. JBJS Rev 2023; 11:01874474-202310000-00008. [PMID: 38096492 DOI: 10.2106/jbjs.rvw.23.00063] [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: 12/18/2023]
Abstract
» Treatment of glenoid bone loss continues to be a challenge in total shoulder arthroplasty (TSA). Although correcting glenoid wear to patient's native anatomy is desirable in TSA, there is lack of consensus regarding how much glenoid wear correction is acceptable and necessary in both anatomic and reverse TSA.» Use of augmented glenoid components is a relatively new treatment strategy for addressing moderate-to-severe glenoid wear in TSA. Augmented glenoid components allow for predictable and easy correction of glenoid wear in the coronal and/or axial planes while at the same time maximizing implant seating, improving rotator cuff biomechanics, and preserving glenoid bone stock because of off-axis glenoid reaming.» Augmented glenoid components have distinct advantages over glenoid bone grafting. Glenoid bone grafting is technically demanding, adds to the surgical time, and carries a risk of nonunion and graft resorption with subsequent failure of the glenoid component.» The use of augmented glenoid components in TSA is steadily increasing with easy availability of computed tomography-based preoperative planning software and guidance technology (patient-specific instrumentation and computer navigation).» Although different augment designs (full wedge, half wedge, and step cut) are available and a particular design may provide advantages in specific glenoid wear patterns to minimize bone removal (i.e. a half wedge in B2 glenoids), there is no evidence to demonstrate the superiority of 1 design over others.
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Boekel P, Rikard-Bell M, Grant A, Brandon B, Doma K, O’Callaghan WB, Wilkinson M, Morse L. Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial. JSES Int 2023; 7:614-622. [PMID: 37426909 PMCID: PMC10328789 DOI: 10.1016/j.jseint.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Hypothesis Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. Methods All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Results Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. Conclusion IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Matthew Rikard-Bell
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| | - Benjamin Brandon
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - William B. O’Callaghan
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
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3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence. Skeletal Radiol 2022; 51:2281-2289. [PMID: 35737085 DOI: 10.1007/s00256-022-04086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. METHODS 3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. RESULTS The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). CONCLUSIONS 3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.
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Lawrence RL, Roseni K, Bey MJ. Correspondence between scapular anatomical coordinate systems and the 3D axis of motion: A new perspective on an old challenge. J Biomech 2022; 145:111385. [PMID: 36403529 PMCID: PMC10321460 DOI: 10.1016/j.jbiomech.2022.111385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Several scapular anatomical coordinate systems have been reported in the literature to describe shoulder kinematics. Unfortunately, the use of different conventions hinders comparison across studies. Further, inconsistencies between a coordinate system and the scapula's 3D axis of motion means that scapular motion will be incorrectly attributed to axes about which it did not rotate. The objectives of this study were to: 1) determine the extent to which the axes of four common scapular coordinate system conventions correspond to the 3D axis of scapular motion (i.e., instantaneous helical axis, IHA), and 2) report the prevalence of scapulothoracic gimbal lock for each convention. Shoulder kinematics were tracked during scapular plane abduction in 45 participants using biplane videoradiography. Scapulothoracic kinematics were described using the original convention proposed by van der Helm, the convention recommended by the International Society of Biomechanics (ISB), a glenoid-based coordinate system, and a glenoid-oriented coordinate system. The 3D angle was calculated between the IHA and each axis of the four conventions (IHA-axis angular deviations). A repeated measures ANOVA was used to compare IHA-axis angular deviations between conventions. The glenoid-oriented and ISB conventions resulted in the smallest and largest IHA-axis angular deviations, respectively (21.7°±3.6° vs. 30.5°±5.2°, p < 0.01). Gimbal lock was approached in 17.8% of participants when using the original convention, 2.2% when using the ISB convention, and 0% when using the glenoid-based or -oriented conventions. These findings suggest the glenoid-oriented coordinate system may be worthy of further consideration when investigating shoulder kinematics during scapular plane abduction.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA; Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Kevin Roseni
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
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Jacquot A, Gauci MO, Urvoy M, de Casson FB, Berhouet J, Letissier H. Anatomical plane and transverse axis of the scapula: Reliability of manual positioning of the anatomical landmarks. Shoulder Elbow 2022; 14:491-499. [PMID: 36199507 PMCID: PMC9527481 DOI: 10.1177/17585732211001756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Background The aim of our study was to evaluate the accuracy of manual determination of the three key points defining the anatomical plane of the scapula, which conditions the reliability of planning software programs based on manual method. Method We included 82 scapula computed tomography scans (56 pathologic and 26 normal glenoid), excluding truncation and major three-dimensional artifact. Four observers independently picked the three key points for each case. Inter- and intra-observer agreement was calculated for each point, using the intraclass correlation method. The mean error (mm) between the observers was calculated as the diameter of the smallest sphere including the four chosen positions. Results Lower inter-observer agreement was found for the trigonum superoinferior position and for the glenoid center anteroposterior position. The mean positioning error between the four observers was 6.9 mm for the trigonum point, and error greater than 10 mm was recorded in 25% of the cases. The mean positioning error was 3.5 mm for the glenoid center in altered glenoid, compared to 1.8 mm for normal glenoid. Discussion Manual determination of an anatomical plane of the scapula suffers from inaccuracy especially due to the variability in trigonum picking, and in a lesser extent, to the variability of glenoid center picking in altered glenoid.
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Affiliation(s)
- Adrien Jacquot
- ARTICS, Center of Joint and Sports Surgery, Nancy, France
- Clinique Louis Pasteur, Orthopaedic Surgery Unit, Essey-Les-Nancy, France
| | - Marc-Olivier Gauci
- Orthopedic Surgery, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, Nice, France
| | | | | | - Julien Berhouet
- Faculté de Médecine de Tours – Université de Tours – CHRU Trousseau Service d’Orthopédie Traumatologie, Chambray-Les-Tours, France
- Equipe Reconnaissance de Forme et Analyse de l’Image – École d’Ingénieurs Polytechnique Universitaire de Tours – Laboratoire d’Informatique Fondamentale et Appliquée de Tours EA6300 – Université de Tours, Tours, France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, Brest, France
- LaTIM, INSERM, Technopôle Brest-Iroise, Brest, France
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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.
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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.
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Gauci MO, Athwal GS, Sanchez-Sotelo J, Chaoui J, Urvoy M, Boileau P, Walch G. Identification of threshold pathoanatomic metrics in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2021; 30:2270-2282. [PMID: 33813011 DOI: 10.1016/j.jse.2021.03.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An assessment of the pathoanatomic parameters of the arthritic glenohumeral joint (GHJ) has the potential to identify discriminating metrics to differentiate glenoid types in shoulders with primary glenohumeral osteoarthritis (PGHOA). The aim was to identify the morphometric differences and threshold values between glenoid types including normal and arthritic glenoids with the various types in the Walch classification. We hypothesized that there would be clear morphometric discriminators between the various glenoid types and that specific numeric threshold values would allow identification of each glenoid type. METHODS The computed tomography scans of 707 shoulders were analyzed: 585 obtained from shoulders with PGHOA and 122 from shoulders without glenohumeral pathology. Glenoid morphology was classified according to the Walch classification. All computed tomography scans were imported in a dedicated automatic 3D-software program that referenced measurements to the scapular body plane. Glenoid and humeral modeling was performed using the best-fit sphere method, and the root-mean-square error was calculated. The direction and orientation of the glenoid and humerus described glenohumeral relationships. RESULTS Among shoulders with PGHOA, 90% of the glenoids and 85% of the humeral heads were directed posteriorly in reference to the scapular body plane. Several discriminatory pathoanatomic parameters were identified: GHJ narrowing < 3 mm was a discriminatory metric for type A glenoids. Posterior humeral subluxation > 70% discriminated type B1 from normal GHJs. The root-mean-square error was a discriminatory metric to distinguish type B2 from type A, type B3, and normal GHJs. Type B3 glenoids differed from type A2 by greater retroversion (>13°) and subluxation (>71%). The type C glenoid retroversion inferior limit was 21°, whereas normal glenoids never presented with retroversion > 16°. CONCLUSION Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with PGHOA.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean Mermoz-Generale De Santé (GDS) Ramsay, Lyon, France
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Park KM, Marcellin-Little DJ, Garcia TC. Evaluation of computer-aided design software methods for assessment of the three-dimensional geometry of the canine radius. Am J Vet Res 2021; 82:435-448. [PMID: 34032484 DOI: 10.2460/ajvr.82.6.435] [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: 11/20/2022]
Abstract
OBJECTIVE To describe methods to measure the 3-D orientation of the proximal, diaphyseal, and distal segments of the canine radius by use of computer-aided design software (CADS) and to compare the repeatability and reliability of measurements derived by those methods. SAMPLE 31 canine radii with biapical deformities and 24 clinically normal (control) canine radii. PROCEDURES Select CT scans of radii were imported into a CADS program. Cartesian coordinate systems for the humerus and proximal, diaphyseal, and distal radial segments were developed. The orientation of each radial segment in the frontal, sagittal, and transverse planes was measured in triplicate by 3 methods. The repeatability and reliability of those measurements were calculated and compared among the 3 measurement methods. RESULTS The mean ± SD within-subject repeatability of radial angular measurements for all 3 methods was 1.40 ± 0.67° in the frontal plane, 3.17 ± 2.21° in the sagittal plane, and 3.01 ± 1.11° in the transverse plane for control radii and 2.56 ± 1.95° in the frontal plane, 3.59 ± 2.39° in the sagittal plane, and 3.47 ± 1.19° in the transverse plane for abnormal radii. Mean ± SD bias between radial measurement methods was 1.88 ± 2.07° in the frontal plane, 6.44 ± 6.80° in the sagittal plane, and 2.27 ± 2.81° in the transverse plane. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that use of CADS to assess the 3-D orientation of the proximal, diaphyseal, and distal segments of normal and abnormal canine radii yielded highly repeatable and reliable measurements.
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Gauci MO, Deransart P, Chaoui J, Urvoy M, Athwal GS, Sanchez-Sotelo J, Boileau P, Walch G. Three-dimensional geometry of the normal shoulder: a software analysis. J Shoulder Elbow Surg 2020; 29:e468-e477. [PMID: 32807728 DOI: 10.1016/j.jse.2020.03.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-dimensional (3D) geometry of the normal glenohumeral bone anatomy and relations is poorly documented. Our aims were (1) to determine the 3D geometry of the normal glenohumeral joint (GHJ) with reference to the scapular body plane and (2) to identify spatial correlations between the orientation and direction of the humeral head and the glenoid. METHODS Computed tomographies (CTs) of the normal, noninjured GHJ were collected from patients who had undergone CTs in the setting of (1) polytrauma, (2) traumatic head injury, (3) chronic acromioclavicular joint dislocations, and (4) unilateral trauma with a contralateral normal shoulder. We performed 3D segmentation and measurements with a fully automatic software (Glenosys; Imascap). Measurements were made in reference to the scapular body plane and its transverse axis. Geometric measurements included version, inclination, direction, orientation, best-fit sphere radius (BFSR), humeral subluxation, critical shoulder angle, reverse shoulder angle, glenoid area, and glenohumeral distance. Statistical correlations were sought between glenoid and humeral 3D measurements (Pearson correlation). RESULTS A total of 122 normal GHJs (64 men, 58 women, age: 52 ± 17 years) were studied. The glenoid BFSR was always larger than the humerus BFSR (constant factor of 1.5, standard deviation = 0.2). The mean glenoid version and inclination were -6° ± 4° and 7° ± 5°, respectively. Men and women were found to have significantly different values for inclination (6° vs. 9°, P = .02), but not for version. Humeral subluxation was 59% ± 7%, with a linear correlation with glenoid retroversion (r = -0.70, P < .001) regardless of age. There was a significant and linear correlation between glenoid and humeral orientation and direction (r = 0.72 and r = 0.70, P < .001). CONCLUSION The 3D geometry of the glenoid and humeral head present distinct limits in normal shoulders that can be set as references in daily practice: version and inclination are -6° and 7°, respectively, and humeral posterior subluxation is 59%; interindividual variations, regardless of the size, are relative to the scapular plane. There exists a strong correlation between the position of the humeral head and the glenoid orientation and direction.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, UR2CA, Côte d'Azur University, CHU de Nice, Nice, France.
| | | | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, UR2CA, Côte d'Azur University, CHU de Nice, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz-GDS Ramsay, Lyon, France
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12
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Choi CH, Kim HC, Kang D, Kim JY. Comparative study of glenoid version and inclination using two-dimensional images from computed tomography and three-dimensional reconstructed bone models. Clin Shoulder Elb 2020; 23:119-124. [PMID: 33330245 PMCID: PMC7714290 DOI: 10.5397/cise.2020.00220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background This study was performed to compare glenoid version and inclination measured using two-dimensional (2D) images from computed tomography (CT) scans or three-dimensional (3D) reconstructed bone models. Methods Thirty patients who had undergone conventional CT scans were included. Two orthopedic surgeons measured glenoid version and inclination three times on 2D images from CT scans (2D measurement), and two other orthopedic surgeons performed the same measurements using 3D reconstructed bone models (3D measurement). The 3D-reconstructed bone models were acquired and measured with Mimics and 3-Matics (Materialise). Results Mean glenoid version and inclination in 2D measurements were -1.705º and 9.08º, respectively, while those in 3D measurements were 2.635º and 7.23º. The intra-observer reliability in 2D measurements was 0.605 and 0.698, respectively, while that in 3D measurements was 0.883 and 0.892. The inter-observer reliability in 2D measurements was 0.456 and 0.374, respectively, while that in 3D measurements was 0.853 and 0.845. Conclusions The difference between 2D and 3D measurements is not due to differences in image data but to the use of different tools. However, more consistent results were obtained in 3D measurement. Therefore, 3D measurement can be a good alternative for measuring glenoid version and inclination.
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Affiliation(s)
- Chang-Hyuk Choi
- Department of Orthopedic Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Hee-Chan Kim
- Department of Orthopedic Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Daewon Kang
- Department of Orthopedic Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Jun-Young Kim
- Department of Orthopedic Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
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13
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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%.
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Affiliation(s)
| | | | | | | | - Joaquin Sanchez-Sotelo
- Joaquin Sanchez-Sotelo, Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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14
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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.
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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
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15
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Normal and Pathoanatomy of the Arthritic Shoulder: Considerations for Shoulder Arthroplasty. J Am Acad Orthop Surg 2019; 27:e1068-e1076. [PMID: 31206438 DOI: 10.5435/jaaos-d-18-00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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.
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16
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Matsuki K, Sugaya H, Hoshika S, Ueda Y, Takahashi N, Tokai M, Banks SA. Three-dimensional measurement of glenoid dimensions and orientations. J Orthop Sci 2019; 24:624-630. [PMID: 30579647 DOI: 10.1016/j.jos.2018.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asians generally have smaller stature than Europeans and Americans, and currently available implants used in reverse shoulder arthroplasty might not fit smaller bony anatomies. However, few articles have reported glenoid geometry in the Asian population. The purpose of this study was to measure the dimensions and orientations of the glenoid from three-dimensional computed tomography reconstructions of elderly Japanese subjects. METHODS This study included 100 shoulders (50 males and 50 females with >50 years of age). The mean age was 67 ± 7 years for both sexes, and the mean height was 167 ± 7 cm for males and 154 ± 6 cm for females. Three-dimensional scapular models were created from computed tomographic images, and the glenoid height, glenoid width, glenoid version, glenoid inclination, vault depth, and vault width were measured. RESULTS The mean glenoid height and width were 38.6 and 29.4 mm for males and 33.1 and 24.4 mm for females, respectively. Both retroversion and superior inclination were approximately 3° in both sexes. The glenoid vault was deeper in the posterior region with the maximum depth of 26.1 and 23.6 mm in males and females. The vault width was narrower in the anterior region with the anterior width of 2.5 mm at 15 mm medial from the glenoid face in females. CONCLUSION Glenoids of Japanese females are small compared to currently available baseplates for reverse shoulder arthroplasty. These results may be helpful to aid design in smaller baseplates that better fit the anatomic geometry of the Asian glenoid.
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Affiliation(s)
- Keisuke Matsuki
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan; Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.
| | - Hiroyuki Sugaya
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Shota Hoshika
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Yusuke Ueda
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Norimasa Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Morihito Tokai
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA
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17
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Castagna A, Garofalo R. Journey of the glenoid in anatomic total shoulder replacement. Shoulder Elbow 2019; 11:140-148. [PMID: 30936954 PMCID: PMC6434953 DOI: 10.1177/1758573218790119] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
Anatomic total shoulder arthroplasty (TSR) has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. Many studies have reported that the glenoid component loosening and failure remain the most common long-term complication of total shoulder arthroplasty. The approach to glenoid component is critical because a surgeon should consider patient-specific anatomy, preserving bone stock and joint line restoration, for a good and durable shoulder function. Over the years, different glenoid design and materials have been tried in various configurations. These include cemented polyethylene, uncemented metal-backed and hybrid implants. Although advances in biomechanics, design and tribology have improved our understanding of the glenoid, the journey of the glenoid component in anatomic total shoulder arthroplasty has not yet reached its final destination. This article attempts to describe the evolution of the glenoid component in anatomic TSR and current practice.
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Affiliation(s)
| | - Raffaele Garofalo
- Raffaele Garofalo, Shoulder and Elbow Unit,
IRCCS Humanitas Institute, Milan, Italy.
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18
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One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers. INTERNATIONAL ORTHOPAEDICS 2018; 43:367-378. [DOI: 10.1007/s00264-018-4213-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
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19
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Sowa B, Bochenek M, Braun S, Kretzer JP, Zeifang F, Bruckner T, Walch G, Raiss P. The subchondral bone layer and glenoid implant design are relevant for primary stability in glenoid arthroplasty. Arch Orthop Trauma Surg 2018; 138:1487-1494. [PMID: 29974217 DOI: 10.1007/s00402-018-2990-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical studies suggest that reaming of the subchondral bone layer to achieve good implant seating is a risk factor for glenoid loosening. This study aims to evaluate (1) the importance of the subchondral bone layer and (2) the influence of the design of the glenoid component. METHODS Different techniques for preparation of an A1 glenoid were compared: (1) preserving the subchondral bone layer; (2) removal of the subchondral bone layer; (3) implantation of a glenoid component that does not adapt to the native anatomy. Artificial glenoid bones (n = 5 each) were used with a highly standardized preparation and implantation protocol. Biomechanical testing was performed during simulated physiological shoulder motion. Using a high-resolution optical system, the micromotions between implant and bone were measured up to 10,000 motion cycles. RESULTS At the 10,000 cycle measuring point, significantly more micromotions were found in the subchondral layer removed group than in the subchondral layer preserved group (p = 0.0427). The number of micromotions in the nonadapted group was significantly higher than in the subchondral layer preserved group (p = 0.0003) or the subchondral layer removed group (p = 0.0207). CONCLUSION Conservative reaming proved important to diminish the micromotions of the glenoid component. Implantation of a glenoid component that matches with the bony underlying glenoid can help to preserve the subchondral bone layer without sacrificing proper implant seating.
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Affiliation(s)
- Boris Sowa
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Martin Bochenek
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Steffen Braun
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Felix Zeifang
- Ethianum Clinic Heidelberg, Voßstraße 6, 69115, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz -GDS Ramsay, 24, Avenue Paul Santy, 69008, Lyon, France
| | - Patric Raiss
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.,OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
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20
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Tashjian RZ, Chalmers PN. Future Frontiers in Shoulder Arthroplasty and the Management of Shoulder Osteoarthritis. Clin Sports Med 2018; 37:609-630. [DOI: 10.1016/j.csm.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Terrier A, Obrist R, Malfroy Camine V, Becce F, Farron A. Biomechanical comparison of glenoid implants with adaptable and fixed backside curvatures in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:1656-1663. [PMID: 29709415 DOI: 10.1016/j.jse.2018.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We evaluated the biomechanical effects and potential advantages of glenoid implants with adaptable backside curvature radii and compared them with standard implants having fixed backside curvatures in anatomic total shoulder arthroplasty (aTSA) for primary glenohumeral osteoarthritis with uniconcave glenoids. METHODS A glenoid implant with adaptable backside curvatures (Aequalis PerFORM, Tornier SAS, Montbonnot, France) was compared with its previous model having a fixed curvature radius. Virtual aTSAs were performed in 24 patients from preoperative shoulder computed tomography data sets, using both implants in each patient. For all 48 simulated aTSAs, we first measured the glenoid bone reaming depth, subchondral bone quality after reaming, and implant backside surface and then the predicted cement stress, bone-cement interfacial stress, and bone strain at 60° of arm abduction. These biomechanical quantities were tested for differences between adaptable and fixed implants and for correlations between preoperative measurements and postoperative predictions. RESULTS Adaptable glenoid implants induced a significant decrease in cement stress (P = .008), bone-cement interfacial stress (P = .045), and bone strain (P = .039), particularly for glenoids with curvature radii larger than 40 mm. However, these biomechanical effects were not significantly correlated with an increase in subchondral glenoid bone quality. CONCLUSIONS Our study confirms the presumed biomechanical advantages of adaptable glenoid implants, even though the effects were not directly due to the adaptation of the backside curvature radius. Benefits were more pronounced for glenoids with large curvature radii. Our initial biomechanical findings should now be corroborated with large-scale clinical studies.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Raphaël Obrist
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Valérie Malfroy Camine
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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Paul R, Knowles N, Chaoui J, Gauci MO, Ferreira L, Walch G, Athwal GS. Characterization of the dysplastic Walch type C glenoid. Bone Joint J 2018; 100-B:1074-1079. [DOI: 10.1302/0301-620x.100b8.bjj-2018-0116.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The Walch Type C dysplastic glenoid is characterized by excessive retroversion. This anatomical study describes its morphology. Patients and Methods A total of 29 shoulders with a dysplastic glenoid were analyzed. CT was used to measure retroversion, inclination, height, width, radius-of-curvature, surface area, depth, subluxation of the humeral head and the Goutallier classification of fatty infiltration. The severity of dysplasia and deficiency of the posterior rim of the glenoid were recorded. Results A type C glenoid occurred in 1.8% of shoulders referred to our tertiary centres. The mean retroversion, inclination, height, width, radius-of-curvature, surface area, and depth of the glenoid were 37°, 3°, 46 mm, 30 mm, 37°, 1284 mm3, and 16 mm, respectively. The mean posterior subluxation was 90%. The Goutallier class was < 2 in 25 shoulders (86%). Glenoid dysplasia was mild in four, moderate in 14, and severe in 11 shoulders. The typical appearance of the posterior glenoid rim had a rounded or ‘lazy J’ morphology. The glenoid neck was deficient in 18 shoulders (62%). Conclusion A dysplastic Type C glenoid characteristically has a uniconcave retroverted morphology, a deficient posteroinferior rim and scapular neck, and a reduced depth. These findings help to define the unique anatomical variations and may aid the planning of surgery and the development of components for these patients. Cite this article: Bone Joint J 2018;100-B:1074–9.
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Affiliation(s)
- R. Paul
- The Roth McFarlane Hand and Upper Limb
Center, University of Western Ontario, London, Ontario, Canada
| | - N. Knowles
- Department of Mechanical and Materials
Engineering, University of Western Ontario
| | - J. Chaoui
- IMT Atlantique, and VP Software Strategy,Wright
Medical, Plouzane, France
| | - M-O. Gauci
- Institut Universitaire Locomoteur et du
Sport, Nice, France
| | - L. Ferreira
- Department of Mechanical and Materials
Engineering, University of Western Ontario
| | - G. Walch
- Ramsay Générale de Santé, Hôpital Privé
Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - G. S. Athwal
- St Joseph’s Health Care London, London, Ontario, Canada
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Raiss P, Godenèche A, Wittmann T, Schnetzke M, Bruckner T, Neyton L, Walch G. Short-term radiographic results of a cemented polyethylene keeled glenoid component with varying backside radiuses of curvature. J Shoulder Elbow Surg 2018; 27:839-845. [PMID: 29292036 DOI: 10.1016/j.jse.2017.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study analyzed the radiographic results of a cemented all-polyethylene keeled glenoid component available in different sizes and multiple backside radiuses of curvature. METHODS The study group consisted of 118 cases (114 patients). There were 63 women and 51 men. Mean age at the time of arthroplasty was 68 years (range, 51-85 years). True anterior-posterior radiographs obtained postoperatively and at the final follow-up were analyzed for implant seating and the occurrence of radiolucent lines. Glenoid morphology and fatty infiltration of the rotator cuff muscles were examined using computed tomography scans. Mean follow-up was 38 months (range, 24-70 months). RESULTS The mean radiolucent line score after surgery was 0.54 points (range, 0-3 points), and 90% had no or only 1 radiolucent line. At the final follow-up, the mean score was 1.06 points (range, 0-3 points), and 74% had no or only 1 radiolucent line. The score increased significantly over time (P < .001). No component was at risk for loosening. No correlation was found between patient age, sex, hand dominance, glenoid morphology, or fatty infiltration of the rotator cuff muscles and the occurrence of radiolucent lines. CONCLUSION In the short-term, the glenoid component analyzed in this study showed promising radiographic results, with a low number of radiolucent lines without failure. However, the mean radiolucent line score increased significantly over time, and long-term observations are necessary to confirm a possible advantage compared with older component designs.
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Affiliation(s)
- Patric Raiss
- Department for Shoulder and Elbow Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany.
| | - Arnaud Godenèche
- Department for Shoulder Surgery, Centre Orthopédique Santy, Lyon, France
| | - Thomas Wittmann
- Department for Shoulder and Elbow Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany
| | - Marc Schnetzke
- Department for Shoulder and Elbow Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Lionel Neyton
- Department for Shoulder Surgery, Centre Orthopédique Santy, Lyon, France
| | - Gilles Walch
- Department for Shoulder Surgery, Centre Orthopédique Santy, Lyon, France
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Berhouet J, Rol M, Spiry C, Slimane M, Chevalier C, Favard L. Shoulder patient-specific guide: First experience in 10 patients indicates room for improvement. Orthop Traumatol Surg Res 2018; 104:45-51. [PMID: 29246481 DOI: 10.1016/j.otsr.2017.11.005] [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: 06/02/2017] [Revised: 10/04/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Implantation of the glenoid component of a total shoulder prosthesis can be facilitated by using a patient-specific guide (PSG) designed to ensure replication of the preoperatively planned position. The objective of this study was to assess the reliability and accuracy of a PSG in replicating the planned glenoid component position during total shoulder arthroplasty (TSA). HYPOTHESIS Additional criteria should be used for 3D preoperative planning and PSG design to further improve the accuracy of glenoid component positioning. MATERIAL AND METHODS We studied 10 patients who underwent TSA with use of a PSG to position the glenoid component after preoperative 3D planning. Postoperative glenoid version and tilt were measured and compared to the planned values. We also used new criteria to assess implant rotation and global 3D position, as well as accuracy of the 3D pilot hole for the glenoid guide-pin. RESULTS Mean errors in glenoid position were -1.7°±4.4° for version, -0.4°±4.9° for tilt, and 6.0°±13.5° for rotation. Mean difference in global orientation of the glenoid implant versus the planned value was 4.9°±2.5°. Mean 3D discrepancy in glenoid pilot hole position was 2.9±0.5mm; the discrepancy was greater in the mediolateral direction (1.9±0.9mm) than in the supero-inferior (1.1±1.2mm) and antero-posterior (0.8±1.2mm) directions. DISCUSSION The poor performance of the PSG in controlling rotation and reaming may explain the difference in global glenoid position compared to the planned value. Improvements in PSG design to incorporate these two parameters deserve consideration. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- J Berhouet
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France; Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais-de-Tours, 64, avenue Portalis, 37200 Tours, France.
| | - M Rol
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - C Spiry
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - M Slimane
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais-de-Tours, 64, avenue Portalis, 37200 Tours, France
| | - C Chevalier
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - L Favard
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
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Boileau P, Cheval D, Gauci MO, Holzer N, Chaoui J, Walch G. Automated Three-Dimensional Measurement of Glenoid Version and Inclination in Arthritic Shoulders. J Bone Joint Surg Am 2018; 100:57-65. [PMID: 29298261 DOI: 10.2106/jbjs.16.01122] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative computed tomography (CT) measurements of glenoid version and inclination are recommended for planning glenoid implantation in shoulder arthroplasty. However, current manual or semi-automated 2-dimensional (2D) and 3-dimensional (3D) methods are user-dependent and time-consuming. We assessed whether the use of a 3D automated method is accurate and reliable to measure glenoid version and inclination in osteoarthritic shoulders. METHODS CT scans of osteoarthritic shoulders of 60 patients scheduled for shoulder arthroplasty were obtained. Automated, surgeon-operated, image analysis software (Glenosys; Imascap) was developed to measure glenoid version and inclination. The anatomic scapular reference planes were defined as the mean of the peripheral points of the scapular body as well as the plane perpendicular to it, passing along the supraspinatus fossa line. Measurements were compared with those obtained using previously described manual or semi-automated methods, including the Friedman version angle on 2D CTs, Friedman method on 3D multiplanar reconstructions (corrected Friedman method), Ganapathi-Iannotti and Lewis-Armstrong methods on 3D volumetric reconstructions (for glenoid version), and Maurer method (for glenoid inclination).The mean differences (and standard deviation) and the concordance correlation coefficients (CCCs) were calculated. Two orthopaedic surgeons independently examined the images for the interobserver analysis, with one of them measuring them twice more for the intraobserver analysis; interobserver and intraobserver reliability was calculated using the intraclass correlation coefficients (ICCs). RESULTS The mean difference in the Glenosys glenoid version measurement was 2.0° ± 4.5° (CCC = 0.93) compared with the Friedman method, 2.5° ± 3.2° (CCC = 0.95) compared with the corrected Friedman method, 1.5° ± 4.5° (CCC = 0.94) compared with the Ganapathi-Iannotti method, and 1.8° ± 3.8° (CCC = 0.95) compared with the Lewis-Armstrong method. There was a mean difference of 0.2° ± 4.7° (CCC = 0.78) between the inclination measurements made with the Glenosys and Maurer methods. The difference between the overall average 2D and 3D measurements was not significant (p = 0.45). CONCLUSIONS Use of fully automated software for 3D measurement of glenoid version and inclination in arthritic shoulders is reliable and accurate, showing excellent correlation with previously described manual or semi-automated methods. CLINICAL RELEVANCE The use of automated surgeon-operated image analysis software to evaluate 3D glenoid anatomy eliminates interobserver and intraobserver discrepancies, improves the accuracy of preoperative planning for shoulder replacement, and offers a potential gain of time for the surgeon.
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Affiliation(s)
- Pascal Boileau
- iULS (Institut Universitaire Locomoteur & du Sport), Hôpital Pasteur 2, University of Nice Sophia-Antipolis, Nice, France
| | - Damien Cheval
- Department of Orthopaedic Surgery, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France
| | - Marc-Olivier Gauci
- iULS (Institut Universitaire Locomoteur & du Sport), Hôpital Pasteur 2, University of Nice Sophia-Antipolis, Nice, France
| | - Nicolas Holzer
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
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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.
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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
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Mizuno N, Nonaka S, Ozaki R, Yoshida M, Yoneda M, Walch G. Three-dimensional assessment of the normal Japanese glenoid and comparison with the normal French glenoid. Orthop Traumatol Surg Res 2017; 103:1271-1275. [PMID: 28965996 DOI: 10.1016/j.otsr.2017.08.015] [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: 11/18/2016] [Revised: 04/14/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In 2014, reverse total shoulder arthroplasty was approved in Japan. We were concerned that the base plate might be incompatible with Japanese who were generally smaller than Westerners. Therefore, we investigated the dimensions and morphology of the normal Japanese glenoid and compared with the normal French glenoid. MATERIALS AND METHODS One hundred Japanese shoulders without glenoid lesions (50 men and 50 women) were investigated and compared with 100 French shoulders (50 men and 50 women). Computed tomography was performed with 3-dimensional image reconstruction and images were analyzed using Glenosys software. Glenoid parameters (width, height, retroversion and inclination) were compared between Japanese and French subjects. RESULTS In Japanese subjects, the mean glenoid width was 25.5mm, height was 33.3mm, retroversion was 2.3° and inclination was 11.6° superiorly. In French subjects, the mean glenoid width was 26.7mm, height was 35.4mm, retroversion was 6.0° and inclination was 10.4° superiorly. Glenoid width and height were significantly smaller in Japanese subjects than French subjects (P=0.001 and P<0.001), while retroversion was significantly greater in French subjects (P<0.001). There was no significant difference of inclination. CONCLUSIONS These findings will help surgeons to identify suitable patients for RSA and perform the procedure with appropriate preoperative planning. LEVEL OF EVIDENCE IV: retrospective or historical series.
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Affiliation(s)
- N Mizuno
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
| | - S Nonaka
- Shinkawa Shindo Orthopaedic Surgery Hospital, Sapporo, Japan
| | - R Ozaki
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - M Yoshida
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - M Yoneda
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - G Walch
- Centre orthopedique Santy, hopital privé J.-Mermoz, Lyon, France
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Service BC, Hsu JE, Somerson JS, Russ SM, Matsen FA. Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty? Clin Orthop Relat Res 2017; 475:2726-2739. [PMID: 28681354 PMCID: PMC5638733 DOI: 10.1007/s11999-017-5433-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND While glenoid retroversion and posterior humeral head decentering are common preoperative features of severely arthritic glenohumeral joints, the relationship of postoperative glenoid component retroversion to the clinical results of total shoulder arthroplasty (TSA) is unclear. Studies have indicated concern for inferior outcomes when glenoid components are inserted in 15° or more retroversion. QUESTIONS/PURPOSES In a population of patients undergoing TSA in whom no specific efforts were made to change the version of the glenoid, we asked whether at 2 years after surgery patients having glenoid components implanted in 15° or greater retroversion had (1) less improvement in the Simple Shoulder Test (SST) score and lower SST scores; (2) higher percentages of central peg lucency, higher Lazarus radiolucency grades, higher mean percentages of posterior decentering, and more frequent central peg perforation; or (3) a greater percentage having revision for glenoid component failure compared with patients with glenoid components implanted in less than 15° retroversion. METHODS Between August 24, 2010 and October 22, 2013, information for 201 TSAs performed using a standard all-polyethylene pegged glenoid component were entered in a longitudinally maintained database. Of these, 171 (85%) patients had SST scores preoperatively and between 18 and 36 months after surgery. Ninety-three of these patients had preoperative radiographs in the database and immediate postoperative radiographs and postoperative radiographs taken in a range of 18 to 30 months after surgery. Twenty-two patients had radiographs that were inadequate for measurement at the preoperative, immediate postoperative, or latest followup time so that they could not be included. These excluded patients did not have substantially different mean age, sex distribution, time of followup, distribution of diagnoses, American Society of Anesthesiologists class, alcohol use, smoking history, BMI, or history of prior surgery from those included in the analysis. Preoperative retroversion measurements were available for 11 (11 shoulders) of the 22 excluded patients. For these 11 shoulders, the mean (± SD) retroversion was 15.8° ± 14.6°, five had less than 15°, and six had more than 15° retroversion. We analyzed the remaining 71 TSAs, comparing the 21 in which the glenoid component was implanted in 15° or greater retroversion (mean ± SD, 20.7° ± 5.3°) with the 50 in which it was implanted in less than 15° retroversion (mean ± SD, 5.7° ± 6.9°). At the 2-year followup (mean ± SD, 2.5 ± 0.6 years; range, 18-36 months), we determined the latest SST scores and preoperative to postoperative improvement in SST scores, the percentage of maximal possible improvement, glenoid component radiolucencies, posterior humeral head decentering, and percentages of shoulders having revision surgery. Radiographic measurements were performed by three orthopaedic surgeons who were not involved in the care of these patients. The primary study endpoint was the preoperative to postoperative improvement in the SST score. RESULTS With the numbers available, the mean (± SD) improvement in the SST (6.7 ± 3.6; from 2.6 ± 2.6 to 9.3 ± 2.9) for the retroverted group was not inferior to that for the nonretroverted group (5.8 ± 3.6; from 3.7 ± 2.5 to 9.4 ± 3.0). The mean difference in improvement between the two groups was 0.9 (95% CI, - 2.5 to 0.7; p = 0.412). The percent of maximal possible improvement (%MPI) for the retroverted glenoids (70% ± 31%) was not inferior to that for the nonretroverted glenoids (67% ± 44%). The mean difference between the two groups was 3% (95% CI, - 18% to 12%; p = 0.857). The 2-year SST scores for the retroverted (9.3 ± 2.9) and the nonretroverted glenoid groups (9.4 ± 3.0) were similar (mean difference, 0.2; 95% CI, - 1.1 to 1.4; p = 0.697). No patient in either group reported symptoms of subluxation or dislocation. With the numbers available, the radiographic results for the retroverted glenoid group were similar to those for the nonretroverted group with respect to central peg lucency (four of 21 [19%] versus six of 50 [12%]; p = 0.436; odds ratio, 1.7; 95% CI, 0.4-6.9), average Lazarus radiolucency scores (0.5 versus 0.7, Mann-Whitney U p value = 0.873; Wilcoxon rank sum test W = 512, p value = 0.836), and the mean percentage of posterior humeral head decentering (3.4% ± 5.5% versus 1.6% ± 6.0%; p = 0.223). With the numbers available, the percentage of patients with retroverted glenoids undergoing revision (0 of 21 [0%]) was not inferior to the percentage of those with nonretroverted glenoids (three of 50; [6%]; p = 0.251). CONCLUSION In this small series of TSAs, postoperative glenoid retroversion was not associated with inferior clinical results at 2 years after surgery. This suggests that it may be possible to effectively manage arthritic glenohumeral joints without specific attempts to modify glenoid version. Larger, longer-term studies will be necessary to further explore the results of this approach. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Benjamin C Service
- Orthopaedic Surgery and Sports Medicine, Orlando Health, Orlando, FL, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Stacy M Russ
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
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Gauci MO, Boileau P, Baba M, Chaoui J, Walch G. Patient-specific glenoid guides provide accuracy and reproducibility in total shoulder arthroplasty. Bone Joint J 2017; 98-B:1080-5. [PMID: 27482021 DOI: 10.1302/0301-620x.98b8.37257] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/08/2016] [Indexed: 11/05/2022]
Abstract
AIMS Patient-specific glenoid guides (PSGs) claim an improvement in accuracy and reproducibility of the positioning of components in total shoulder arthroplasty (TSA). The results have not yet been confirmed in a prospective clinical trial. Our aim was to assess whether the use of PSGs in patients with osteoarthritis of the shoulder would allow accurate and reliable implantation of the glenoid component. PATIENTS AND METHODS A total of 17 patients (three men and 14 women) with a mean age of 71 years (53 to 81) awaiting TSA were enrolled in the study. Pre- and post-operative version and inclination of the glenoid were measured on CT scans, using 3D planning automatic software. During surgery, a congruent 3D-printed PSG was applied onto the glenoid surface, thus determining the entry point and orientation of the central guide wire used for reaming the glenoid and the introduction of the component. Manual segmentation was performed on post-operative CT scans to compare the planned and the actual position of the entry point (mm) and orientation of the component (°). RESULTS The mean error in the accuracy of the entry point was -0.1 mm (standard deviation (sd) 1.4) in the horizontal plane, and 0.8 mm (sd 1.3) in the vertical plane. The mean error in the orientation of the glenoid component was 3.4° (sd 5.1°) for version and 1.8° (sd 5.3°) for inclination. CONCLUSION Pre-operative planning with automatic software and the use of PSGs provides accurate and reproducible positioning and orientation of the glenoid component in anatomical TSA. Cite this article: Bone Joint J 2016;98-B:1080-5.
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Affiliation(s)
- M O Gauci
- Hôpital Pasteur 2, 30 Voie Romaine, Nice, 06000, France
| | - P Boileau
- Hôpital Pasteur 2, 30 Voie Romaine, Nice, 06000, France
| | - M Baba
- Specialty Orthopaedics, Sydney, Australia
| | - J Chaoui
- Telecom Brittany, 655 Avenue du Technopole, 29200 Plouzané, France
| | - G Walch
- Centre Orthopédique Santy, Unité Epaule, 24 Avenue Paul Santy, 69008 Lyon, France
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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.
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Amy CYL, Chester LWH, Lit CH, Lam CW, Kevin WKH, Bong WS, Cheung WW. Are the Current Size Options of Glenoid Baseplates for Reverse Shoulder Arthroplasty Sufficient for our Local Population? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2016. [DOI: 10.1016/j.jotr.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background/Purpose Reverse shoulder arthroplasty (RSA) is an effective treatment for patients who suffer from shoulder pain and dysfunction associated with a variety of shoulder pathologies including severe rotator cuff deficiency with or without glenohumeral arthritis. It has been widely used in European countries and the United States and is now gaining popularity in Asia, including Hong Kong. However, there are only limited size options available for glenoid baseplates, with 25 mm being the smallest size in some commonly used systems. The aim of our study is to perform computerized tomography (CT) measurements of the glenoid dimension in the Chinese population and to see if the current glenoid baseplate component size option is sufficient for our local population. Methods A total of 70 CT scans of shoulder regions were analysed. Measurements included maximum superoinferior height and the anteroposterior height. Results The glenoid dimensions were smaller compared to those from previous studies in Caucasian counterparts. Some 41% of female glenoids had widths measuring < 25 mm (25 mm being the smallest size available in some commonly used RSA systems). Conclusion Although there are only limited size options available for the glenoid baseplate in RSA, from our data, it should be able to cover most patients in our local population. However, surgeons should exercise special care when contemplating performing reverse shoulder replacement for small size females in our local population.
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Affiliation(s)
| | | | - Chow Hung Lit
- Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong
| | - Chan Wai Lam
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong
| | | | - Woo Siu Bong
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong
| | - Wong Wing Cheung
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong
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Ernstbrunner L, Werthel JD, Hatta T, Thoreson AR, Resch H, An KN, Moroder P. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic 'ball-and-socket' joint model. Bone Joint Res 2016; 5:453-460. [PMID: 27729312 PMCID: PMC5075797 DOI: 10.1302/2046-3758.510.bjr-2016-0078.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/29/2016] [Indexed: 12/28/2022] Open
Abstract
Objectives The bony shoulder stability ratio (BSSR) allows for quantification of the bony stabilisers in vivo. We aimed to biomechanically validate the BSSR, determine whether joint incongruence affects the stability ratio (SR) of a shoulder model, and determine the correct parameters (glenoid concavity versus humeral head radius) for calculation of the BSSR in vivo. Methods Four polyethylene balls (radii: 19.1 mm to 38.1 mm) were used to mould four fitting sockets in four different depths (3.2 mm to 19.1mm). The SR was measured in biomechanical congruent and incongruent experimental series. The experimental SR of a congruent system was compared with the calculated SR based on the BSSR approach. Differences in SR between congruent and incongruent experimental conditions were quantified. Finally, the experimental SR was compared with either calculated SR based on the socket concavity or plastic ball radius. Results The experimental SR is comparable with the calculated SR (mean difference 10%, sd 8%; relative values). The experimental incongruence study observed almost no differences (2%, sd 2%). The calculated SR on the basis of the socket concavity radius is superior in predicting the experimental SR (mean difference 10%, sd 9%) compared with the calculated SR based on the plastic ball radius (mean difference 42%, sd 55%). Conclusion The present biomechanical investigation confirmed the validity of the BSSR. Incongruence has no significant effect on the SR of a shoulder model. In the event of an incongruent system, the calculation of the BSSR on the basis of the glenoid concavity radius is recommended. Cite this article: L. Ernstbrunner, J-D. Werthel, T. Hatta, A. R. Thoreson, H. Resch, K-N. An, P. Moroder. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic ‘ball-and-socket’ joint model. Bone Joint Res 2016;5:453–460. DOI: 10.1302/2046-3758.510.BJR-2016-0078.R1.
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Affiliation(s)
- L Ernstbrunner
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria and Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland, Zurich, Switzerland
| | - J-D Werthel
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - T Hatta
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A R Thoreson
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - H Resch
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - K-N An
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - P Moroder
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria and Center for Musculoskeletal Surgery, Charite Universitaetsmedizin, Berlin, Germany
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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.
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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
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Ten Berg PWL, Dobbe JGG, Horbach SER, Gerards RM, Strackee SD, Streekstra GJ. Analysis of deformity in scaphoid non-unions using two- and three-dimensional imaging. J Hand Surg Eur Vol 2016; 41:719-26. [PMID: 26553886 DOI: 10.1177/1753193415614430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/30/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Pre-operative assessment of the deformity in scaphoid non-unions influences surgical decision-making. To characterize deformity, we used three-dimensional computed tomographic modelling in 28 scaphoid non-unions, and quantified bone loss, dorsal osteophyte volume and flexion deformity. We further related these three-dimensional parameters to the intrascaphoid and capitate-lunate angles, and stage of scaphoid non-union advanced collapse assessed on conventional two-dimensional images and to the chosen surgical procedure. Three-dimensional flexion deformity (mean 26°) did not correlate with intrascaphoid and capitate-lunate angles. Osteophyte volume was positively correlated with bone loss and stage of scaphoid non-union advanced collapse. Osteophyte volume and bone loss increased over time. Three-dimensional modelling enables the quantification of bone loss and osteophyte volume, which may be valuable parameters in the characterization of deformity and subsequent decision-making about treatment, when taken in addition to the clinical aspects and level of osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- P W L Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - R M Gerards
- Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands
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Dilisio MF, Warner JJP, Walch G. Accuracy of the Subchondral Smile and Surface Referencing Techniques in Reverse Shoulder Arthroplasty. Orthopedics 2016; 39:e615-20. [PMID: 27322170 DOI: 10.3928/01477447-20160610-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/25/2015] [Indexed: 02/03/2023]
Abstract
Inferior glenoid baseplate tilt relative to the coronal axis of the scapular body has been associated with improved results and fewer postoperative complications in reverse shoulder arthroplasty. However, the native glenoid surface is not always a reliable reference for the true scapular axis. Digital preoperative planning software and advanced imaging now allow surgeons to more precisely determine optimal glenoid placement. The purpose of this study was to evaluate the accuracy of the subchondral smile and cannulated surface guide techniques in achieving inferior glenoid baseplate tilt by using 3-dimensional preoperative planning software. Virtual glenoid baseplate preparation and implantation was performed using computed tomography scans of 16 shoulders with rotator cuff deficiency. Two techniques were used: a subchondral smile technique that preferentially reams the interior glenoid, resulting in the appearance of a smile, and a cannulated surface guide technique that references the native glenoid face to place the baseplate in 10° of inferior tilt. Using the subchondral smile technique, the glenoid baseplate was implanted at a mean of 8.9° of superior tilt relative to the transverse scapular axis. Using the surface guide technique, the glenoid baseplate was implanted at a mean of 2.8° of superior tilt. Neither the subchondral smile technique nor the 10° cannulated surface guide technique is a reliable method to produce inferior glenoid tilt relative to the transverse axis of the scapula. Three-dimensional preoperative planning software is a useful tool when attempting to achieve optimal glenoid baseplate positioning in reverse shoulder arthroplasty. [Orthopedics. 2016; 39(4):e615-e620.].
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Three-dimensional anthropometric analysis of the glenohumeral joint in a normal Japanese population. J Shoulder Elbow Surg 2016; 25:493-501. [PMID: 26482874 DOI: 10.1016/j.jse.2015.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND An understanding of normal glenohumeral geometry is important for anatomical reconstruction in shoulder arthroplasty. Unfortunately, the details of the glenohumeral joint in Asian populations have not been sufficiently evaluated. The purpose of this study was to evaluate the 3-dimensional geometry of the glenohumeral joint in the normal Japanese population and to clarify its morphologic features. METHODS Anthropometric analysis of the glenohumeral joint was performed using computed tomography scans of 160 normal shoulders from healthy Japanese volunteers. The glenohumeral dimensions and orientation were analyzed 3-dimensionally. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were evaluated. RESULTS The normal Japanese humeral head has an average width of 41.4 mm, thickness of 13.2 mm, diameter of 42.9 mm, retroversion of 32°, and inclination of 135°. The glenoid has an average height of 31.5 mm, width of 23.1 mm, diameter of 62.0 mm, retroversion of 0°, and inferior inclination of 2°. The values of the glenohumeral dimensions were uniform in men and women, and the humeral head and glenoid were larger in men than in women. The glenohumeral size was well correlated between the 2 sides, and there were direct correlations among the heights, humeral length, humeral head size, and glenoid size. CONCLUSIONS The present study revealed the glenohumeral geometry in the normal Japanese population. The present results would be useful to determine the size of implants and to improve the design of shoulder prostheses that reflect the normal anatomy of the Asian glenohumeral joint.
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Knowles NK, Carroll MJ, Keener JD, Ferreira LM, Athwal GS. A comparison of normal and osteoarthritic humeral head size and morphology. J Shoulder Elbow Surg 2016; 25:502-9. [PMID: 26597658 DOI: 10.1016/j.jse.2015.08.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate and to compare the size and morphologic patterns among normal and osteoarthritic (OA) humeral heads. METHODS This comparative anatomic imaging study evaluated 150 humeral heads that were separated into 3 cohorts: normal, OA with symmetric glenoid erosion, and OA with asymmetric (type B2) glenoid erosion. Three-dimensional models were created of the humeral head from computed tomography data, and point coordinates were extracted for evaluation. Parameters measured were diameter (sphere fit and circle fit), chord distance (superoinferior and anteroposterior), and humeral head height. RESULTS The sphere-fit diameter of the humeral head for the entire OA cohort (100 patients; mean diameter, 59 ± 9 mm) was significantly greater (P < .001) than that of the normal cohort (50 patients; mean diameter, 49 ± 5 mm). Similarly, the humeral head circle-fit diameters in the superoinferior and anteroposterior planes were significantly greater (P < .001) in the combined OA cohorts (59 ± 9 mm and 56 ± 10 mm, respectively) compared with the normal cohort (51 ± 5 mm and 47 ± 5 mm, respectively). However, there were no significant differences (P ≥ .099) between the symmetric and asymmetric OA cohorts in sphere-fit or circle-fit diameters. The mean values of humeral head heights were not significantly different (P = .382) between cohorts, 19 ± 2 mm, 18 ± 2 mm, and 18 ± 2 mm for the normal, symmetric, and asymmetric cohorts, respectively. DISCUSSION Although OA humeral head morphology varies significantly from normal, it does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. Understanding of the morphologic variability of the pathologic humeral head may provide insight into the pathoanatomy of osteoarthritis and the development of various erosion patterns.
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Affiliation(s)
- Nikolas K Knowles
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | | | - Jay D Keener
- Washington University/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Louis M Ferreira
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada.
| | - George S Athwal
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
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Dilisio MF, May NR, Vincent SA, High RR, Walker CW, Manzer MN, Apker KA, Fehringer EV. The association of incomplete glenoid component seating and periprosthetic glenoid radiolucencies after total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:442-7. [PMID: 26456426 DOI: 10.1016/j.jse.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiolucent lines surrounding prosthetic glenoid components are commonly seen after unconstrained total shoulder arthroplasty and can be a harbinger of subsequent glenoid component failure. Whether less than 100% glenoid seating is associated with the development of radiolucent lines around glenoid prostheses is unknown. This study investigated the association between incomplete glenoid component seating and periprosthetic glenoid radiolucencies. METHODS Thirty-six unconstrained total shoulder arthroplasties were performed in 29 patients for primary glenohumeral osteoarthritis with a minimum 2-year follow-up. All were implanted with a partially cemented all-polyethylene glenoid prosthesis. Patients were evaluated with standardized plain films preoperatively and postoperatively and with thin-cut computed tomography (CT) scans at the latest follow-up. The Lazarus and Yian classifications were used to assess radiolucency and seating on radiographs and CT scans. Ratings were calculated for intraobserver and interobserver reliability and given κ, the Kendall coefficient, and interclass correlation coefficient values. RESULTS At a mean of 43 months (range 24-26 months) after surgery, neither Lazarus plain film radiolucency scores (P = .78) nor Yian CT radiolucency scores (P = .68) were associated with Lazarus plain film seating scores. Neither Lazarus plain film radiolucency scores (P = .25) nor Yian CT radiolucency scores (P = .91) were associated with modified Lazarus CT scan seating scores. CT allowed for better intraobserver and interobserver reliability in all categories. CONCLUSION Radiolucencies around a partially cemented glenoid component were not associated with the degree of component seating. Complete seating of the glenoid component is not necessary to achieve radiographic implant stability at a mean follow-up of 43 months.
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Affiliation(s)
- Matthew F Dilisio
- Creighton University Orthopaedics, CHI Health Alegent Creighton Clinic, Omaha, NE, USA.
| | - Nolan R May
- New West Sports Medicine & Orthopaedics, Kearney, NE, USA
| | - Scott A Vincent
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robin R High
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Craig W Walker
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melissa N Manzer
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kim A Apker
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edward V Fehringer
- Orthopaedics and Sports Medicine, Columbus Community Hospital, Columbus, NE, USA
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Karelse A, Leuridan S, Van Tongel A, Debeer P, Van Der Sloten J, Denis K, De Wilde LF. Consequences of reaming with flat and convex reamers for bone volume and surface area of the glenoid; a basic science study. J Orthop Surg Res 2015; 10:181. [PMID: 26608075 PMCID: PMC4658756 DOI: 10.1186/s13018-015-0312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 10/29/2015] [Indexed: 11/12/2022] Open
Abstract
Background The effect of reaming on bone volume and surface area of the glenoid is not precisely known. We hypothesize that (1) convex reamers create a larger surface area than flat reamers, (2) flat reamers cause less bone loss than convex reamers, and (3) the amount of bone loss increases with the amount of version correction. Methods Reaming procedures with different types of reamers are performed on similar-sized uniconcave and biconcave glenoids created from Sawbones foam blocks. The loss of bone volume, the size of the remaining surface area, and the reaming depth are measured and evaluated. Results Reaming with convex reamers results in a significantly larger surface area than with flat reamers for both uniconcave and biconcave glenoids (p = 0.013 and p = 0.001). Convex reamers cause more bone loss than flat reamers, but the difference is only significant for uniconcave glenoids (p = 0.007). Conclusions In biconcave glenoids, convex reamers remove a similar amount of bone as flat reamers, but offer a larger surface area while maximizing the correction of the retroversion. In pathological uniconcave glenoids, convex reamers are preferred because of the conforming shape.
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Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Steven Leuridan
- Department of Mechanical Engineering, Biomechanics Section, Catholic University of Leuven, Celestijnenlaan 300C, 3001, Heverlee, Belgium.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Philippe Debeer
- Department of Orthopaedics, University Hospital Pellenberg, Weligerveld 1, B-3212, Pellenberg, Belgium.
| | - Jos Van Der Sloten
- Catholic University of Leuven, Celestijnenlaan 300C, 3001, Heverlee, Belgium.
| | - Kathleen Denis
- Catholic University of Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015; 24:e149-58. [PMID: 25591458 PMCID: PMC4433827 DOI: 10.1016/j.jse.2014.10.021] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate assessment of the critical shoulder angle (CSA) is important in clinical evaluation of degenerative rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the CSA, developed a classification system to identify malpositioned radiographs, and assessed the relationship between the CSA and demographic factors. METHODS Glenoid height, width, and retroversion were measured on 3-dimensional computed tomography reconstructions of 68 cadaver scapulae. A digitally reconstructed radiograph was aligned perpendicular to the scapular plane, and retroversion was corrected to obtain a true anteroposterior (AP) view. In 10 scapulae, incremental anteversion/retroversion and flexion/extension views were generated. The CSA was measured, and a clinically applicable classification system was developed to detect views with >2° change in CSA vs. true AP view. RESULTS The average CSA was 33° ± 4°. Intraobserver and interobserver reliability was high (intraclass correlation coefficient ≥ 0.81) but decreased with increasing viewing angle. Views beyond 5° anteversion, 8° retroversion, 15° flexion, and 26° extension resulted in >2° deviation of the CSA compared with the true AP view. The classification system was capable of detecting aberrant viewing perspectives with sensitivity of 95% and specificity of 53%. Correlations between glenoid size and CSA were small (R ≤ 0.3), and CSA did not vary by gender (P = .426) or side (P = .821). CONCLUSIONS The CSA was most susceptible to malposition in anteversion/retroversion. Deviations as little as 5° in anteversion resulted in a CSA >2° from true AP view. A new classification system refines the ability to collect true AP radiographs of the scapula. The CSA was unaffected by demographic factors.
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Affiliation(s)
- Thomas Suter
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Ariane Gerber Popp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- 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, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
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Knowles NK, Keener JD, Ferreira LM, Athwal GS. Quantification of the position, orientation, and surface area of bone loss in type B2 glenoids. J Shoulder Elbow Surg 2015; 24:503-10. [PMID: 25440510 DOI: 10.1016/j.jse.2014.08.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this computed tomography-based study was to quantify erosions in B2 glenoids. We hypothesized that erosions do not occur symmetrically and that they have a predictable orientation. METHODS This study evaluated 55 type B2 glenoid cases. Computed tomography data were used to create three-dimensional reconstructions, and point coordinates were extracted from each reconstruction for morphologic analysis of the osteoarthritic glenoid and humerus. RESULTS There was a significant difference between the mean orientation angle (28° ± 11°) of the posterior glenoid line of erosion and the superoinferior axis (P < .001), which resulted in the average erosion being directed toward the 8-o'clock position. On average, the erosion started 1.6 ± 3.4 mm posterior to the glenoid center point. In 35% of B2 cases, the line of erosion was curved. The mean surface area was 763 ± 296 mm(2) for the neoglenoid and 957 ± 276 mm(2) for the paleoglenoid, indicating that the neoglenoid occupied 44% ± 12% of the total glenoid area. In this cohort, the mean radius of the humeral head neoarticulation was 32 ± 6 mm, the neoglenoid radius was 37 ± 8 mm, and the paleoglenoid radius was 34 ± 7 mm. The radius of the humeral head was significantly less than that of the neoglenoid (P < .001) and the paleoglenoid (P = .009). In addition, the radius of the neoglenoid was significantly greater than the radius of the paleoglenoid (P = .012). DISCUSSION Type B2 glenoids have a predictable wear pattern, which is not axisymmetric to the glenoid superoinferior axis. In addition, the identified anatomic characteristics of B2 erosions will aid surgeons in the operative management of bone loss and may assist manufacturers in the design of augmented components.
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Affiliation(s)
- Nikolas K Knowles
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Louis M Ferreira
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada.
| | - George S Athwal
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada
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Walch G, Vezeridis PS, Boileau P, Deransart P, Chaoui J. Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study. J Shoulder Elbow Surg 2015; 24:302-9. [PMID: 25183662 DOI: 10.1016/j.jse.2014.05.029] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component positioning is a key factor for success in total shoulder arthroplasty. Three-dimensional (3D) measurements of glenoid retroversion, inclination, and humeral head subluxation are helpful tools for preoperative planning. The purpose of this study was to assess the reliability and precision of a novel surgical method for placing the glenoid component with use of patient-specific templates created by preoperative surgical planning and 3D modeling. METHODS A preoperative computed tomography examination of cadaveric scapulae (N = 18) was performed. The glenoid implants were virtually placed, and patient-specific guides were created to direct the guide pin into the desired orientation and position in the glenoid. The 3D orientation and position of the guide pin were evaluated by performing a postoperative computed tomography scan for each scapula. The differences between the preoperative planning and the achieved result were analyzed. RESULTS The mean error in 3D orientation of the guide pin was 2.39°, the mean entry point position error was 1.05 mm, and the mean inclination angle error was 1.42°. The average error in the version angle was 1.64°. There were no technical difficulties or complications related to use of patient-specific guides for guide pin placement. Quantitative analysis of guide pin positioning demonstrated a good correlation between preoperative planning and the achieved position of the guide pin. CONCLUSION This study demonstrates the reliability and precision of preoperative planning software and patient-specific guides for glenoid component placement in total shoulder arthroplasty.
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Affiliation(s)
- Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France.
| | | | | | | | - Jean Chaoui
- Telecom Bretagne, Brest, France; Imascap, Brest, France
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Smith T, Pastor M, Gettmann A, Wellmann M, Struck M. Glenohumerale Arthrolyse der Omarthroseschulter bei anatomischer Schulterprothesenimplantation. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 26:330-5, 338-40. [DOI: 10.1007/s00064-013-0283-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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