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Smith AF, Schmidt CM, Tabbaa A, Gutiérrez S, Simon P, Mighell MA, Frankle MA. Glenoid-based reference system to differentiate shoulder pathologies on plain radiographs. J Shoulder Elbow Surg 2024; 33:S111-S121. [PMID: 37777046 DOI: 10.1016/j.jse.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Shoulder radiographs are used for evaluation and the planning of treatment of various pathologies. Making a diagnosis of these pathologies on plain radiographs occurs by recognizing the relationship of the humeral head on the registry of the glenoid. Quantification of these changes in registry does not currently exist. We hypothesize that a geometric relationship of the humeral head and the glenoid exists that is defined on an anteroposterior Grashey view radiograph by the relationship of the best-fit circle of the humeral head relative to the best-fit circle of the glenoid such that relative measurements will define the normal shoulder and the pathologic shoulder. METHODS One hundred fifty-six shoulders were included: 53 normal shoulders, 51 with primary glenohumeral osteoarthritis (GHOA), and 52 with cuff tear arthropathy (CTA). Humeral head best-fit circle was used to define the circle of the humeral head (cHH). A glenoid best-fit circle (cG) was defined by the following rules: (1) best fit of the glenoid articular surface and (2) was limited by the acromion such that either (a) it reaches maximal interaction with the inferior surface of the acromion or (b) the perimeter of the circle is at the lateralmost point of the acromion. The relationship between cHH and cG is defined by measurement of cHH in horizontal and vertical planes relative to the glenoid circle reference. The horizontal displacement angle (HDA) measures the horizontal position of cHH relative to cG, representing the degree of medialization toward the glenoid. The vertical displacement angle (VDA) measures the vertical position of cHH relative to cG, representing the degree of superiorization toward the acromion. Angles were compared by diagnosis and sex. RESULTS The mean HDA was 61.0° (95% confidence interval [CI] 60.3°-61.7°) in normal shoulders, 79.9° (95% CI 76.9°-82.9°) in GHOA, and 63.4° (95% CI 61.7°-65.1°) in CTA (P < .001). The mean VDA was 43.1° (95% CI 42.2°-44.0°) in normal shoulders, 40.9° (95% CI 39.9°-42.0°) in GHOA, and 59.7° (95% CI 57.6°-61.7°) in CTA (P < .001). Interobserver reliability was 0.991 (95% CI 0.94-1.0) and intraobserver reliability was 0.998 (95% CI 0.99-1.0). The geometric relationship of cHH to the glenoid circle reference was plotted for each group. CONCLUSION A geometric relationship exists of the humeral head in reference to the glenoid circle. Together, the HDA and the VDA distinguish between a normal shoulder and those with GHOA or CTA. This suggests that this novel methodology may provide a preoperative planning tool that is easily accessible.
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Affiliation(s)
- Austin F Smith
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; OrthoArizona, Phoenix, AZ, USA
| | - Christian M Schmidt
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ameer Tabbaa
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Sergio Gutiérrez
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Mark A Mighell
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Cointat C, Raynier JL, Vasseur H, Lareyre F, Raffort J, Gauci MO, Boileau P. Short-term outcomes and survival of pyrocarbon hemiarthroplasty in the young arthritic shoulder. J Shoulder Elbow Surg 2022; 31:113-122. [PMID: 34280573 DOI: 10.1016/j.jse.2021.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose was to report the short-term outcomes and survival of hemiarthroplasty with a pyrocarbon head (HA-PYC) for the treatment of shoulder osteoarthritis in patients aged ≤ 60 years. We hypothesized that HA-PYC could be an alternative to hemi-metal (avoiding the risk of rapid glenoid erosion) and total shoulder arthroplasty (TSA) (avoiding the risk of rapid glenoid loosening) in an active patient population. METHODS Sixty-four consecutive patients (mean age, 53 years) who underwent HA-PYC for glenohumeral osteoarthritis were included. The primary outcome was revision to TSA or reverse shoulder arthroplasty. Secondary outcome measures included functional outcome scores; return to work and sports; and radiographic evaluation of humeral reconstruction quality using the "circle method" of Mears, as well as glenoid erosion severity and progression using the Sperling classification. Patients were reviewed and underwent radiography at an average follow-up of 33 months (range, 24-60 months). RESULTS At last follow-up, the rate of survival of the HA-PYC prosthesis was 92%. Revision was performed in 5 patients, with a mean delay of 24 months (range, 15-37 months): 1 conversion to TSA and 4 conversions to reverse shoulder arthroplasty. The Constant score and Subjective Shoulder Value increased from 36 points (range, 26-50 points) to 75 points (range, 69-81 points) and from 35% (range, 20%-50%) to 80% (range, 75%-90%), respectively (P < .001). Postoperatively, 91% of the patients (42 of 46) returned to work and 88% (15 of 17) returned to sport. The severity of preoperative and postoperative glenoid wear (Sperling grade 3 or 4) had no influence on the functional results. Patients who underwent associated concentric glenoid reaming (n = 23) had similar Constant scores and Subjective Shoulder Values (P = .95) to other patients and did not show more progression of glenoid wear. Nonanatomic reconstruction of the proximal humerus (center of rotation of the prosthesis > 3 mm from the anatomic center) occurred in 29% (18 of 62 patients) and was associated with significantly lower functional and subjective results, more complications (subscapularis insufficiency and/or symptomatic glenoid erosion), and a higher risk of revision. The additional 1.5-mm thickness of the metal disc under the pyrocarbon head was found to be the main reason for oversizing of the prosthetic head. CONCLUSION HA-PYC is a reliable procedure to treat shoulder osteoarthritis and allows return to work and sports in a young (≤60 years) and active patient population. The severity of glenoid bone erosion or the association with glenoid reaming does not affect functional outcomes and failure risk. By contrast, nonanatomic reconstruction of the proximal humerus after HA-PYC (because of humeral head oversizing) occurred in one-third of the cases and is associated with lower functional outcomes, as well as higher risks of complications and revision.
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Affiliation(s)
- Caroline Cointat
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | - Jean Luc Raynier
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | | | | | | | - Marc Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
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Shelton TJ, Steele AE, Saiz AM, Bachus KN, Skedros JG. The Circle-Fit Method Helps Make Reliable Cortical Thickness Measurements Regardless of Humeral Length. Geriatr Orthop Surg Rehabil 2018; 9:2151459318818163. [PMID: 30627472 PMCID: PMC6311545 DOI: 10.1177/2151459318818163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background Although proximal humerus strength/quality can be assessed using cortical thickness measurements (eg, cortical index), there is no agreement where to make them. Tingart and coworkers used measurements where the proximal endosteum becomes parallel, while Mather and coworkers used measurements where the periosteum becomes parallel. The new circle-fit method (CFM) makes 2 metaphyseal (M1-M2) and 6 diaphyseal (D1-D6) measurements referenced from humeral head diameter (HHD). However, it is unknown whether these locations correlate to humeral length (HL). Accordingly, we asked: (1) Does HHD, Tingart distance, and Mather distance correlate with HL? (2) What is the location of HHD, Tingart distance, and Mather distance as a percentage of HL? and (3) Which CFM D1-D6 locations correlate with Tingart and Mather distances? Materials and Methods Measurements made on cortical thickness (CT) scout views of 19 humeri (ages: 16-73 years) included HHD, distances from the superior aspect of the humerus to proximal Tingart and Mather locations, and HL. Results Intraclass correlation was excellent for CFM-HHD, poor for Tingart, and moderate for Mather. The CFM-HHD had a stronger correlation to HL than Tingart and Mather. Mean HHD was 15.5% (0.9%) of HL while Tingart was 27.0% (4.1%) and Mather was 23.2% (3.8%). Tingart distance corresponded to D2/D3 CFM locations while the Mather distance was similar to D1/D2. Discussion The CFM reliably correlates with HL and provides a stronger correlation and less variance between specimens than the Tingart or Mather Methods. Conclusions Because the CFM produces reliable percent of HL locations, it should be used to define locations for obtaining biomechanically relevant CT measurements such as cortical index. Stronger correlations of these CFM-based measurements with proximal humerus strength will be important for developing advanced algorithms for fracture treatment.
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Affiliation(s)
- Trevor J Shelton
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Amy E Steele
- School of Medicine at University of California at Davis, Sacramento, CA, USA
| | - Augustine M Saiz
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Kent N Bachus
- Department of Veterans Affairs, Salt Lake City, UT, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - John G Skedros
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Utah Orthopaedic Specialists, Salt Lake City, UT, USA
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Dey R, Roche S, Rosch T, Mutsvangwa T, Charilaou J, Sivarasu S. Anatomic variations in glenohumeral joint: an interpopulation study. JSES OPEN ACCESS 2018; 2:1-7. [PMID: 30675559 PMCID: PMC6334885 DOI: 10.1016/j.jses.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study focused on the unique aspect of investigating shoulder morphometric differences between 2 distinct populations. Methods We used 90 computed tomography images of cadaveric shoulders for this study; 45 scans belonged to the South African (SA) cohort (49.74 ± 15.4 years) and the rest were Swiss (CH; 53.8 ± 21 years). The articulating surfaces of the glenohumeral joint were extracted, and their morphometric features, such as head circular diameter, glenoid and humeral head radius of curvature, head height, and humeral height, were measured. Results The mean interpopulation difference in the circular diameter of the humerus was 2.0 mm (P = .017) and 1.86 mm (P > .05) in the anterior-posterior and superior-inferior directions, respectively. The difference in the radius of curvature between the populations was 1.17 mm (P = .037). The SA shoulders were found to be longer than the CH shoulders by 8.4 mm (P > .05). There was no significant difference in the glenoid radius of curvature. The SA shoulders had higher glenohumeral mismatch (P = .005) and lower conformity index (P = .001) in comparison to the CH shoulders. Conclusion This study presents anatomic differences between African and European glenohumeral articulating surfaces. The results suggest that the glenohumeral geometry is both gender and population specific, and future joint replacements may be designed to address these differences.
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Affiliation(s)
- Roopam Dey
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Steven Roche
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Theo Rosch
- Jakaranda Hospital, Pretoria, South Africa
| | - Tinashe Mutsvangwa
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Johan Charilaou
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Corresponding author: Sudesh Sivarasu, PhD, Department of Human Biology, UCT Medical Campus, 7.17, Anatomy Building, Anzio Road, Observatory, Cape Town 7935, South Africa. (S. Sivarasu).
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Sabour S. Humeral head Circle-fit method greatly increases reliability and accuracy when measuring anterior-posterior radiographs of the proximal humerus. J Orthop Res 2017; 35:1865. [PMID: 28543981 DOI: 10.1002/jor.23610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Siamak Sabour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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