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Effect of the critical shoulder angle on severe cranialization following total shoulder arthroplasty. J Orthop 2020; 21:240-244. [PMID: 32280160 DOI: 10.1016/j.jor.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/22/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study assesses the relationship of CSA, cranialization and radiographic glenoid loosening following TSA in the long-term follow-up. METHODS 26 shoulders with TSA were examined radiographically postoperatively and after a mean 12.6 years. Severe cranialization was defined as direct humeral contact with the acromion and/or acetabularization of the acromion. RESULTS A CSA ≥35° was associated with severe cranialization. Glenoid loosening was present in 6/24 shoulders (25%). Severe cranialization was associated with glenoid loosening (p = 0.003). CONCLUSION A postoperative CSA ≥ 35° was associated with severe humeral cranialization after TSA in the long-term follow-up. Severe cranialization correlated with glenoid loosening.Level of evidence IV - retrospective cohort study.
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Mencia MM, Goalan R, Skeete R. Atraumatic dissociation of a modular shoulder hemiarthroplasty: a case report and literature review. JSES Int 2020; 4:400-403. [PMID: 32490434 PMCID: PMC7256893 DOI: 10.1016/j.jseint.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad
| | - Raakesh Goalan
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Trinidad
| | - Rondell Skeete
- Department of Surgery, Port of Spain General Hospital, Trinidad
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Sabesan VJ, Lima DJL, Whaley JD, Pathak V, Zhang L. The effect of glenohumeral radial mismatch on different augmented total shoulder arthroplasty glenoid designs: a finite element analysis. J Shoulder Elbow Surg 2019; 28:1146-1153. [PMID: 30770315 DOI: 10.1016/j.jse.2018.11.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Augmented glenoid implants to correct bone loss can possibly reconcile current prosthetic failures and improve long-term performance for total shoulder arthroplasty. Biomechanical implant studies have suggested benefits from augmented glenoid components, but limited evidence exists on optimal design. METHODS An integrated kinematic finite element analysis (FEA) model was used to evaluate optimal augmented glenoid design based on biomechanical performance in translation in the anteroposterior plane similar to clinical loading and failure mechanisms with osteoarthritis. Computer-aided design software models of 2 different commercially available augmented glenoid designs-wedge (Equinox; Exactech, Inc., Gainesville, FL, USA) and step (STEPTECH; DePuy Synthes, Warsaw, IN, USA) were created according to precise manufacturer's dimensions of the implants. Using FEA, they were virtually implanted to correct 20° of retroversion. Two glenohumeral radial mismatches, 3.5/4 mm and 10 mm, were evaluated for joint stability and implant fixation simulating high-risk conditions for failure. RESULTS The wedged and step designs showed similar glenohumeral joint stability under both radial mismatches. Surrogate for micromotion was a combination of distraction, translation, and compression. With similar behavior and measurements for distraction and translation, compression dictated micromotion (wedge: 3.5 mm = 0.18 mm and 10 mm = 0.10 mm; step: 3.5 mm = 0.19 mm and 10 mm = 0.25 mm). Stress levels on the backside of the implant and on the cement mantle were higher using a step design. DISCUSSION Greater radial mismatch has the advantage of providing higher glenohumeral stability with tradeoffs, such as higher implant and cement mantle stress levels, and micromotion worse when using a step design.
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Affiliation(s)
- Vani J Sabesan
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Diego J L Lima
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - James D Whaley
- Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Varun Pathak
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, MI, USA
| | - Liying Zhang
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, MI, USA
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Biomechanical comparison of 2 augmented glenoid designs: an integrated kinematic finite element analysis. J Shoulder Elbow Surg 2019; 28:1166-1174. [PMID: 30876745 DOI: 10.1016/j.jse.2018.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Augmented glenoid implants are available to help restore the biomechanics of the glenohumeral joint with excessive retroversion. It is imperative to understand their behavior to make a knowledgeable preoperative decision. Therefore, our goal was to identify an optimal augmented glenoid design based on finite element analysis (FEA) under maximum physiological loading. METHODS FEA models of 2 augmented glenoid designs-wedge and step-were created per the manufacturers' specifications and virtually implanted in a scapula model to correct 20° of retroversion. Simulation of shoulder abduction was performed using the FEA shoulder model. The glenohumeral force ratio, relative micromotion, and stress levels on the cement mantle, glenoid vault, and backside of the implants were compared between the 2 designs. RESULTS The force ratio was 0.56 for the wedge design and 0.87 for the step design. Micromotion (combination of distraction, translation, and compression) was greater for the step design than the wedge design. Distraction measured 0.05 mm for the wedge design and 0.14 mm for the step component. Both implants showed a similar pattern for translation; however, compression was almost 3 times greater for the step component. Both implants showed high stress levels on the cement mantle. At the glenoid vault and on the implants, the stress levels were 1.65 MPa and 6.62 MPa, respectively, for the wedge design and 3.78 MPa and 13.25 MPa, respectively, for the step design. CONCLUSION Implant design slightly affects joint stability; however, it plays a major role regarding long-term survival. Overall, the augmented wedge design provides better implant fixation and stress profiles with less micromotion.
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Reeves JM, Langohr GDG, Athwal GS, Johnson JA. The effect of stemless humeral component fixation feature design on bone stress and strain response: a finite element analysis. J Shoulder Elbow Surg 2018; 27:2232-2241. [PMID: 30104100 DOI: 10.1016/j.jse.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/26/2018] [Accepted: 06/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since the advent of stemless implants, several different fixation feature designs have been used to improve primary implant stability. These stemless designs are diverse, and the rationale for their selection and design has not been thoroughly studied. Accordingly, this investigation assessed the effect of stemless implant geometry on the simulated stress and strain response of the proximal humerus. METHODS Five humeral finite element models were used to examine 10 generic stemless implants with variable fixation features (2 central, 4 peripheral, and 4 boundary crossing). Loads representing 45° and 75° of shoulder abduction were simulated. Implants were compared based on the percentage of implant-bone surface area that remained in contact, the change in bone stress relative to the intact state, and the simulated potential for bone to resorb, remodel, or remain unchanged after reconstruction. RESULTS The implant-bone contact area was greatest for peripheral, followed by central and boundary-crossing designs. All implants elicited similar bone stress variations, which were greatest 0 to 5 mm beneath the resection and laterally. The simulated potential cortical response was also similar for all implants, with the greatest simulated resorbing potential 0 to 15 mm beneath the resection, and very little expected remodeling. Differences between implants were most prominent within the simulated potential trabecular response, with the central implants having the least bone volume percentage expected to resorb. CONCLUSIONS Simulated humeral bone response after stemless anatomic shoulder replacement depends on fixation feature geometry. Trade-offs exist between implant types. Centrally pegged implants produced the lowest simulated resorbing potential, whereas peripheral implants had the greatest percentages of implant-bone contact area.
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Affiliation(s)
- Jacob M Reeves
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - G Daniel G Langohr
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - George S Athwal
- The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, The University of Western Ontario, London, ON, Canada; Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada.
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Schoch B, Abboud J, Namdari S, Lazarus M. Glenohumeral Mismatch in Anatomic Total Shoulder Arthroplasty. JBJS Rev 2017; 5:e1. [DOI: 10.2106/jbjs.rvw.17.00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lewis GS, Conaway WK, Wee H, Kim HM. Effects of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: Finite element modeling of cadaver specimens. J Biomech 2017; 53:78-83. [PMID: 28159312 DOI: 10.1016/j.jbiomech.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/14/2016] [Accepted: 01/02/2017] [Indexed: 11/17/2022]
Abstract
A novel technique of "anterior offsetting" of the humeral head component to address posterior instability in total shoulder arthroplasty has been proposed, and its biomechanical benefits have been previously demonstrated experimentally. The present study sought to characterize the changes in joint mechanics associated with anterior offsetting with various amounts of glenoid retroversion using cadaver specimen-specific 3-dimensional finite element models. Specimen-specific computational finite element models were developed through importing digitized locations of six musculotendinous units of the rotator cuff and deltoid muscles based off three cadaveric shoulder specimens implanted with total shoulder arthroplasty in either anatomic or anterior humeral head offset. Additional glenoid retroversion angles (0°, 10°, 20°, and 30°) other than each specimen׳s actual retroversion were modeled. Contact area, contact force, peak pressure, center of pressure, and humeral head displacement were calculated at each offset and retroversion for statistical analysis. Anterior offsetting was associated with significant anterior shift of center of pressure and humeral head displacement upon muscle loading (p<0.05). Although statistically insignificant, anterior offsetting was associated with increased contact area and decreased peak pressure (p > 0.05). All study variables showed significant differences when compared between the 4 different glenoid retroversion angles (p < 0.05) except for total force (p < 0.05). The study finding suggests that the anterior offsetting technique may contribute to joint stability in posteriorly unstable shoulder arthroplasty and may reduce eccentric loading on glenoid components although the long term clinical results are yet to be investigated in future.
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Affiliation(s)
- Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA 17033, United States
| | - William K Conaway
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA 17033, United States
| | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA 17033, United States
| | - H Mike Kim
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
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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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Theopold J, Pieroh P, Scharge ML, Marquaß B, Hohmann T, Josten C, Hepp P. Improved accuracy of K-wire positioning into the glenoid vault by intraoperative 3D image intensifier-based navigation for the glenoid component in shoulder arthroplasty. Orthop Traumatol Surg Res 2016; 102:575-81. [PMID: 27132036 DOI: 10.1016/j.otsr.2016.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/24/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This article aimed to show that navigation, based on an intraoperative mobile 3D image intensifier, can improve the accuracy of central K-wire placement into the glenoid vault for glenoid component. HYPOTHESIS The navigated k-wire placement is more accurate and shows a smaller deviation angle to the standard centerline compared to the classical "free hand technic". METHODS In 34 fresh frozen sheep scapulae, 17 K-wire placements using the navigation (group 1) were compared with 17 using standard "face plane technique" (group 2). The relation to glenoid standard and alternative centerlines (CL) and the position within the glenoid vault were analyzed. RESULTS In groups 1 and 2 the angle between the K-wire and standard CL was 2.2° and 4.7°, respectively (P=0.01). The angle between the K-wire and alternative CL was 14.4° for group 1 and 17.2° for group 2 (P=0.02). More navigated K-wire positions were identified within a 5mm corridor along the glenoid vault CL (52 vs. 39; P=0.004). DISCUSSION Intraoperative 3D image intensifier-based navigation was more accurate and precise than standard K-wire placement. TYPE OF STUDY AND LEVEL OF PROOF Basic science study, evidence level III.
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Affiliation(s)
- J Theopold
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - P Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097 Halle (Saale), Germany.
| | - M L Scharge
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - B Marquaß
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - T Hohmann
- Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097 Halle (Saale), Germany.
| | - C Josten
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - P Hepp
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
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Glennie RA, Giles JW, Johnson JA, Athwal GS, Faber KJ. An in vitro study comparing limited to full cementation of polyethylene glenoid components. J Orthop Surg Res 2015; 10:142. [PMID: 26383832 PMCID: PMC4573681 DOI: 10.1186/s13018-015-0268-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Glenoid component survival is critical to good long-term outcomes in total shoulder arthroplasty. Optimizing the fixation environment is paramount. The purpose of this study was to compare two glenoid cementing techniques for fixation in total shoulder arthroplasty. Methods Sixteen cadaveric specimens were randomized to receive peg-only cementation (CPEG) or full back-side cementation (CBACK). Physiological cyclic loading was performed and implant displacement was recorded using an optical tracking system. The cement mantle was examined with micro-computed tomography before and after cyclic loading. Results Significantly greater implant displacement away from the inferior portion of the glenoid was observed in the peg cementation group when compared to the fully cemented group during the physiological loading. The displacement was greatest at the beginning of the loading protocol and persisted at a diminished rate during the remainder of the loading protocol. Micro-CT scanning demonstrated that the cement mantle remained intact in both groups and that three specimens in the CBACK group demonstrated microfracturing in one area only. Discussion Displacement of the CPEG implants away from the inferior subchondral bone may represent a suboptimal condition for long-term implant survival. Cement around the back of the implant is suggested to improve initial stability of all polyethylene glenoid implants. Clinical relevance Full cementation provides greater implant stability when compared to limited cementation techniques for insertion of glenoid implants. Loading characteristics are more favorable when cement is placed along the entire back of the implant contacting the subchondral bone.
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Affiliation(s)
- R Andrew Glennie
- Department of Orthopedics, Dalhousie University, Halifax, NS, Canada.
| | - Joshua W Giles
- Division of Orthopedics, Western University, 268 Grosvenor St, London, N6A 4L6, ON, Canada.
| | - James A Johnson
- Division of Orthopedics, Western University, 268 Grosvenor St, London, N6A 4L6, ON, Canada.
| | - George S Athwal
- Division of Orthopedics, Western University, 268 Grosvenor St, London, N6A 4L6, ON, Canada.
| | - Kenneth J Faber
- Division of Orthopedics, Western University, 268 Grosvenor St, London, N6A 4L6, ON, Canada.
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Multi-patient finite element simulation of keeled versus pegged glenoid implant designs in shoulder arthroplasty. Med Biol Eng Comput 2015; 53:781-90. [DOI: 10.1007/s11517-015-1286-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Patel RJ, Choi D, Wright T, Gao Y. Nonconforming glenoid increases posterior glenohumeral translation after a total shoulder replacement. J Shoulder Elbow Surg 2014; 23:1831-1837. [PMID: 24939381 DOI: 10.1016/j.jse.2014.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The major complication in nonconforming total shoulder replacement (TSR) is glenoid loosening and is attributed to posteriorly directed humeral head translations. Whether the posterior translations observed clinically are induced by radial mismatch is unclear. The objective of our study was to explain the posterior glenohumeral translations observed clinically after TSR by determining the glenohumeral translation and contact force as a function of radial mismatch. We hypothesized that the posterior direction of glenohumeral translation during scaption would be related to the radial mismatch and that the joint contact force would increase as the radial mismatch increased. METHODS A 6-degrees-of-freedom computational model of the glenohumeral joint was developed. We determined the muscle forces, joint contact force, and glenohumeral translation for radial mismatches from 1 mm to 20 mm with the shoulder positioned from 20° to 60° of scaption. RESULTS As the radial mismatch increased, the contact location of the humeral head moved posteriorly and inferiorly. The middle deltoid force decreased by 3%, while the supraspinatus and infraspinatus muscle forces increased by 9% and 11%, respectively. The joint contact force remained relatively constant. CONCLUSIONS Increased posterior glenohumeral translations were observed with increased radial mismatch. Clinical observations of posterior translation may be attributed to the balancing forces of the middle deltoid, infraspinatus, and supraspinatus muscles. High radial mismatches may lead to eccentric posterior loading on the glenoid component, which could lead to implant loosening and failure.
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Affiliation(s)
- Radhika J Patel
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Daniel Choi
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Timothy Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Yingxin Gao
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA.
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Pomwenger W, Entacher K, Resch H, Schuller-Götzburg P. Need for CT-based bone density modelling in finite element analysis of a shoulder arthroplasty revealed through a novel method for result analysis. ACTA ACUST UNITED AC 2014; 59:421-30. [PMID: 24897390 DOI: 10.1515/bmt-2013-0125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 04/11/2014] [Indexed: 11/15/2022]
Abstract
Treatment of common pathologies of the shoulder complex, such as rheumatoid arthritis and osteoporosis, is usually performed by total shoulder arthroplasty (TSA). Survival of the glenoid component is still a problem in TSA, whereas the humeral component is rarely subject to failure. To set up a finite element analysis (FEA) for simulation of a TSA in order to gain insight into the mechanical behaviour of a glenoid implant, the modelling procedure and the application of boundary conditions are of major importance because the computed result strongly depends upon the accuracy and sense of realism of the model. The goal of this study was to show the influence on glenoid stress distribution of a patient-specific bone density distribution compared with a homogenous bone density distribution for the purpose of generating a valid model in future FEA studies of the shoulder complex. Detailed information on the integration of bone density properties using existing numerical models as well as the applied boundary conditions is provided. A novel approach involving statistical analysis of values derived from an FEA is demonstrated using a cumulative distribution function. The results show well the mechanically superior behaviour of a realistic bone density distribution and therefore emphasise the necessity for patient-specific simulations in biomechanical and medical simulations.
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Terrier A, Larrea X, Malfroy Camine V, Pioletti DP, Farron A. Importance of the subscapularis muscle after total shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2013; 28:146-50. [PMID: 23333178 DOI: 10.1016/j.clinbiomech.2012.11.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rotator cuff muscles are the main stabilizer of the glenohumeral joint. After total shoulder arthroplasty using anterior approaches, a dysfunction of the subscapularis muscle has been reported. In the present paper we tested the hypothesis that a deficient subscapularis following total shoulder arthroplasty can induce joint instability. METHODS To test this hypothesis we have developed an EMG-driven musculoskeletal model of the glenohumeral joint. The model was based on an algorithm that minimizes the difference between measured and predicted muscular activities, while satisfying the mechanical equilibrium of the glenohumeral joint. A movement of abduction in the scapular plane was simulated. We compared a normal and deficient subscapularis. Muscle forces, joint force, contact pattern and humeral head translation were evaluated. FINDINGS To satisfy the mechanical equilibrium, a deficient subscapularis induced a decrease of the force of the infraspinatus muscle. This force decrease was balanced by an increase of the supraspinatus and middle deltoid. As a consequence, the deficient subscapularis induced an upward migration of the humeral head, an eccentric contact pattern and higher stress within the cement. INTERPRETATION These results confirm the importance of the suscapularis for the long-term stability of total shoulder arthroplasty.
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Affiliation(s)
- A Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 19, 1015 Lausanne, Switzerland.
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Terrier A, Brighenti V, Pioletti DP, Farron A. Importance of polyethylene thickness in total shoulder arthroplasty: a finite element analysis. Clin Biomech (Bristol, Avon) 2012; 27:443-8. [PMID: 22221345 DOI: 10.1016/j.clinbiomech.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Articular surfaces reconstruction is essential in total shoulder arthroplasty. Because of the limited glenoid bone support, thin glenoid component could improve anatomical reconstruction, but adverse mechanical effects might appear. METHODS With a numerical musculoskeletal shoulder model, we analysed and compared three values of thickness of a typical all-polyethylene glenoid component: 2, 4 (reference) and 6mm. A loaded movement of abduction in the scapular plane was simulated. We evaluated the humeral head translation, the muscle moment arms, the joint force, the articular contact pattern, and the polyethylene and cement stress. Findings Decreasing polyethylene thickness from 6 to 2mm slightly increased humeral head translation and muscle moment arms. This induced a small decreased of the joint reaction force, but important increase of stress within the polyethylene and the cement mantel. Interpretation The reference thickness of 4mm seems a good compromise to avoid stress concentration and joint stuffing.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 19, 1015 Lausanne, Switzerland.
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Glenoid component loosening due to deficient subscapularis: a case study of eccentric loading. J Shoulder Elbow Surg 2011; 20:e16-21. [PMID: 21719311 DOI: 10.1016/j.jse.2011.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/15/2011] [Accepted: 03/27/2011] [Indexed: 02/01/2023]
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Abstract
Management of glenohumeral arthrosis with a total shoulder prosthesis is becoming increasingly common. However, failure of the glenoid component remains one of the most common causes for failure. Our understanding of this problem has evolved greatly since the first implants were placed in the 1970's. However glenoid failure remains a challenging problem to address and manage. This article reviews the current knowledge regarding the glenoid in total shoulder arthroplasty touching on anatomy, component design, implant fixation, causes of implant failure, management of glenoid failure and alternatives to glenoid replacement.
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Irlenbusch U, End S, Kilic M. Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis. INTERNATIONAL ORTHOPAEDICS 2010; 35:705-11. [PMID: 20625897 DOI: 10.1007/s00264-010-1084-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 06/07/2010] [Accepted: 06/19/2010] [Indexed: 11/24/2022]
Abstract
Reconstruction of the anatomy of the proximal humerus is a prerequisite to achieving good long-term clinical results after shoulder arthroplasty. Modern, adjustable prostheses have greater flexibility of inclination, retroversion, and medial and dorsal offset in comparison with older prostheses. Such improvements should allow for better reconstruction of the centre of rotation compared to older prostheses. Reconstruction of the humeral head centre was assessed in 106 modern adjustable (Affinis) and 47 second-generation prostheses. All reconstructions were compared both to the preoperative state and the unoperated shoulder. To describe the pre- and postoperative states, the geometry and position of the humeral head in relation to the glenoid were analysed on patient radiographs. Applying the defined parameters, modern adjustable prostheses showed better reconstruction than second generation prostheses. Parameter values measured in reconstructions using fourth generation prostheses were comparable to those of the unoperated shoulder, but differed significantly from the preoperative state. Second generation prostheses, in contrast, only show non-specific differences in parameter values. This suggests that an approximate reconstruction of normal anatomy can be achieved using a modern fourth generation prosthesis. Reconstruction of the complex anatomy of the proximal humerus is significantly better with modern adjustable prostheses compared to second generation prostheses. Improved clinical outcome can therefore be predicted in a functional and intact rotator cuff. The advantage of using modern prostheses systems over older models is clearly demonstrated in this study.
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Massimini DF, Li G, Warner JP. Glenohumeral contact kinematics in patients after total shoulder arthroplasty. J Bone Joint Surg Am 2010; 92:916-26. [PMID: 20360516 DOI: 10.2106/jbjs.h.01610] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of in vivo glenohumeral joint contact mechanics after total shoulder arthroplasty may provide insight for the improvement of patient function, implant longevity, and surgical technique. The objective of this study was to determine the in vivo glenohumeral joint contact locations in patients after total shoulder arthroplasty. We hypothesized that the glenohumeral joint articular contact would be centered on the glenoid surface because of the ball-in-socket geometric features of the implants. METHODS Dual-plane fluoroscopic images and computer-aided design models were used to quantify patient-specific glenohumeral articular contact in thirteen shoulders following total shoulder arthroplasty. The reconstructed shoulder was imaged at arm positions of 0 degrees, 45 degrees, and 90 degrees of abduction (in the coronal plane) and neutral rotation and at 90 degrees of abduction with maximum internal and external rotation. The patients were individually investigated, and their glenohumeral joint contact centroids were reported with use of contact frequency. RESULTS In all positions, the glenohumeral joint contact centroids were not found at the center of the glenoid surface but at an average distance (and standard deviation) of 11.0 +/- 4.3 mm from the glenoid center. Forty (62%) of the sixty-five total contact occurrences were found on the superior-posterior quadrant of the glenoid surface. The position of 0 degrees of abduction in neutral rotation exhibited the greatest variation of quadrant contact location; however, no contact was found on the superior-anterior quadrant of the glenoid surface in this position. CONCLUSIONS In vivo, glenohumeral joint contact after total shoulder arthroplasty is not centered on the glenoid surface, suggesting that kinematics after shoulder arthroplasty may not be governed by ball-in-socket mechanics as traditionally thought. Although contact locations as a function of arm position vary among patients, the superior-posterior quadrant seems to experience the most articular contact in the shoulder positions tested.
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Affiliation(s)
- Daniel F Massimini
- Bioengineering Laboratory, GRJ-1215, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elbow Surg 2009; 18:515-20. [PMID: 19559369 DOI: 10.1016/j.jse.2009.03.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 02/06/2009] [Accepted: 03/19/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The correct implantation of the glenoid component is of paramount importance in total shoulder arthroplasty (TSA). We hypothesized that the accuracy of the glenoid positioning in the transverse plane can be improved using intraoperative navigation. MATERIALS AND METHODS This prospective, randomized clinical study comprised 2 groups of 10 patients each with osteoarthritis of the shoulder TSA, with or without intraoperative navigation. Glenoid version was measured on axial computed tomography scans preoperatively and 6 weeks postoperatively. RESULTS The operating time was significantly longer in the navigation group (169.5 +/- 15.2 vs 138 +/- 18.4 min). We found an average change of retroversion from 15.4 degrees +/- 5.8 degrees (range, 3.0 degrees -24.0 degrees) preoperatively to 3.7 degrees +/- 6.3 degrees (range, -8.0 degrees to 15.0 degrees) postoperatively in the navigation group compared with 14.4 degrees +/- 6.1 degrees (range, 2.0 degrees -24.0 degrees) preoperatively to 10.9 degrees +/- 6.8 degrees (range, 0.0 degrees -19.0 degrees) postoperatively in the group without navigation (P = .021). CONCLUSION We found an improved accuracy in glenoid positioning in the transverse plane using intraoperative navigation. The validity of the study is limited by the small number, which advocates continuation with more patients and longer follow-up. LEVEL OF EVIDENCE Level 2; Therapeutic study.
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Favre P, Snedeker JG, Gerber C. Numerical modelling of the shoulder for clinical applications. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2009; 367:2095-2118. [PMID: 19380327 DOI: 10.1098/rsta.2008.0282] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Research activity involving numerical models of the shoulder is dramatically increasing, driven by growing rates of injury and the need to better understand shoulder joint pathologies to develop therapeutic strategies. Based on the type of clinical question they can address, existing models can be broadly categorized into three groups: (i) rigid body models that can simulate kinematics, collisions between entities or wrapping of the muscles over the bones, and which have been used to investigate joint kinematics and ergonomics, and are often coupled with (ii) muscle force estimation techniques, consisting mainly of optimization methods and electromyography-driven models, to simulate muscular action and joint reaction forces to address issues in joint stability, muscular rehabilitation or muscle transfer, and (iii) deformable models that account for stress-strain distributions in the component structures to study articular degeneration, implant failure or muscle/tendon/bone integrity. The state of the art in numerical modelling of the shoulder is reviewed, and the advantages, limitations and potential clinical applications of these modelling approaches are critically discussed. This review concentrates primarily on muscle force estimation modelling, with emphasis on a novel muscle recruitment paradigm, compared with traditionally applied optimization methods. Finally, the necessary benchmarks for validating shoulder models, the emerging technologies that will enable further advances and the future challenges in the field are described.
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Affiliation(s)
- Philippe Favre
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
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Westerhoff P, Graichen F, Bender A, Rohlmann A, Bergmann G. An instrumented implant for in vivo measurement of contact forces and contact moments in the shoulder joint. Med Eng Phys 2009; 31:207-13. [DOI: 10.1016/j.medengphy.2008.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 07/16/2008] [Accepted: 07/18/2008] [Indexed: 10/21/2022]
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Hopkins AR, Hansen UN, Bull AMJ, Emery R, Amis AA. Fixation of the reversed shoulder prosthesis. J Shoulder Elbow Surg 2008; 17:974-80. [PMID: 18760632 DOI: 10.1016/j.jse.2008.04.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 03/31/2008] [Accepted: 04/30/2008] [Indexed: 02/01/2023]
Abstract
The last decade has seen an increased interest in reversed shoulder prostheses. Success rates with these designs have been varied, with initial performance marred by failures resulting from improper implant alignment and an emerging engineering understanding. Competitor products to the well-documented Grammont design have yielded increasingly high success rates. Understanding the relationships between implant design, surgical procedure, and clinical outcome is important so that current results can be improved upon. This study considers the performance of 3 different reversed shoulder designs from the perspective of osseointegration, with the results broadly validated through comparison with experimental data. Finite element modeling was used to clarify the relationships between lateral offset of the center of rotation, screw insertion angle, screw length, screw diameter, bone material quality, and the potential for interdigitation of the supporting bone onto the reversed prosthesis. The results indicate that screw length, insertion angle, and diameter, when maximized, allow the least relative motion between the implant and underlying bone. When the bone is stiffer, the relative motion of the implant is lower. In almost all scenarios modeled, the interface micromotion was small enough to suggest that the glenoid was stable enough to encourage bone ingrowth across the majority of the bone-implant interfaces.
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Affiliation(s)
- Andrew R Hopkins
- Biomechanics Section, Department of Mechanical Engineering, Imperial College London, London, England.
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Matsen FA, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am 2008; 90:885-96. [PMID: 18381328 DOI: 10.2106/jbjs.g.01263] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Glenoid component failure is the most common complication of total shoulder arthroplasty. Glenoid components fail as a result of their inability to replicate essential properties of the normal glenoid articular surface to achieve durable fixation to the underlying bone, to withstand repeated eccentric loads and glenohumeral translation, and to resist wear and deformation. The possibility of glenoid component failure should be considered whenever a total shoulder arthroplasty has an unsatisfactory result. High-quality radiographs made in the plane of the scapula and in the axillary projection are usually sufficient to evaluate the status of the glenoid component. Failures of prosthetic glenoid arthroplasty can be understood in terms of failure of the component itself, failure of seating, failure of fixation, failure of the glenoid bone, and failure to effectively manage eccentric loading. An understanding of these modes of failure leads to strategies to minimize complications related to prosthetic glenoid arthroplasty.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356500, Seattle, WA 98195-6500, USA.
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