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Simister SK, Sato EH, Fleming K, Chalmers PN, Tashjian RZ. Comparing outcomes of central ingrowth peg vs. noningrowth pegged glenoid components during revision to reverse total shoulder arthroplasty. JSES Int 2023; 7:623-627. [PMID: 37426913 PMCID: PMC10328762 DOI: 10.1016/j.jseint.2023.03.009] [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
Background One innovation to reduce glenoid loosening in total shoulder arthroplasty (TSA) is a large, central ingrowth peg. However, when bone ingrowth fails to occur, there is often increased bone loss surrounding the central peg which may increase complexity of subsequent revisions. Our goal was to compare outcomes between central ingrowth pegs and noningrowth pegged glenoid components during revision to reverse total shoulder arthroplasty. Methods In a comparative retrospective case series, all patients who underwent TSA-to-reverse TSA revision between 2014 and 2022 were reviewed. Demographic varibles as well as clinical and radiographic outcomes were collected. Ingrowth central peg and noningrowth pegged glenoid groups were compared using t-test, Mann-Whitney U, Chi-Square, or Fisher's exact tests where indicated. Results Overall, 49 patients were included: 27 underwent revision from noningrowth and 22 from central ingrowth components. Females more commonly had noningrowth components (74% vs. 45%, P = .04) and preoperative external rotation was higher in central ingrowth components (P = .02). Time to revision was significantly earlier in central ingrowth components (2.4 vs. 7.5 years, P = .01). Structural glenoid allografting was required more with noningrowth components (30% vs. 5%, P = .03) and time to revision in patients ultimately requiring allograft reconstruction was significantly later (9.96 vs. 3.68 years, P = .03). Conclusion Central ingrowth pegs on glenoid components were associated with decreased need for structural allograft reconstruction during revision; however, time to revision was earlier in these components. Further research should focus on whether glenoid failure is due to glenoid component design, time to revision, or both.
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Affiliation(s)
- Samuel K. Simister
- Corresponding author: Samuel K. Simister, BS, Department of Orthopaedic Surgery, University of Utah, 847 S. Greenwood Terrace, Salt Lake City, UT 84105, USA.
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Ricchetti ET, Jun BJ, Jin Y, Ho JC, Patterson TE, Dalton JE, Derwin KA, Iannotti JP. Relationship Between Glenoid Component Shift and Osteolysis After Anatomic Total Shoulder Arthroplasty: Three-Dimensional Computed Tomography Analysis. J Bone Joint Surg Am 2021; 103:1417-1430. [PMID: 33835109 PMCID: PMC8360268 DOI: 10.2106/jbjs.20.00833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis. METHODS In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic TSA with a polyethylene glenoid component, sequential 3D CT analysis was performed preoperatively (CT1), early postoperatively (CT2), and at a minimum 2-year follow-up (CT3). Glenoid component shift was defined as a change in component version or inclination of ≥3° from CT2 to CT3. Glenoid component central anchor peg osteolysis (CPO) was assessed at CT3. Factors associated with glenoid component shift and CPO were evaluated. RESULTS Glenoid component shift occurred from CT2 to CT3 in 78 (51%) of the 152 patients. CPO was seen at CT3 in 19 (13%) of the 152 patients, including 15 (19%) of the 78 with component shift. Walch B2 glenoids with a standard component and glenoids with higher preoperative retroversion were associated with a higher rate of shift, but not of CPO. B3 glenoids with an augmented component and glenoids with greater preoperative joint-line medialization were associated with CPO, but not with shift. More glenoid component joint-line medialization from CT2 to CT3 was associated with higher rates of shift and CPO. A greater absolute change in glenoid component inclination from CT2 to CT3 and a combined absolute glenoid component version and inclination change from CT2 to CT3 were associated with CPO. Neither glenoid component shift nor CPO was associated with worse clinical outcomes. CONCLUSIONS Postoperative 3D CT analysis demonstrated that glenoid component shift commonly occurs following anatomic TSA, with increased inclination the most common direction. Most (81%) of the patients with glenoid component shift did not develop CPO. Longer follow-up is needed to determine the relationships of glenoid component shift and CPO with loosening over time. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Bong-Jae Jun
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Yuxuan Jin
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Thomas E. Patterson
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Jarrod E. Dalton
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Kathleen A. Derwin
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and
Rheumatologic Institute (E.T.R., J.C.H., T.E.P., and J.P.I.), Department of
Biomedical Engineering, Lerner Research Institute (B.-J.J. and K.A.D.), and
Department of Quantitative Health Sciences (Y.J. and J.E.D.), Cleveland Clinic,
Cleveland, Ohio
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Glenoid Component Loosening in Anatomic Total Shoulder Arthroplasty: Association between Radiological Predictors and Clinical Parameters-An Observational Study. J Clin Med 2021; 10:jcm10020234. [PMID: 33440646 PMCID: PMC7826694 DOI: 10.3390/jcm10020234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
The mechanisms of glenoid component loosening in anatomic total shoulder arthroplasty (aTSA) are still unclear, and it remains undetermined which specific radiographic features are associated with clinical outcomes. Patients with primary osteoarthritis who underwent aTSA with a stemless implant and a pegged glenoid between January 2011 and December 2016 were extracted from a local registry. Anteroposterior radiographs were evaluated at six, 12, 24 months, and five years post-TSA for lateral humeral offset (LHO), joint gap (JG), acromiohumeral distance (AHD), and radiolucency (modified Franklin score); 147 patients were included. Mixed-model linear regression was used. Both constant score (CS) and subjective shoulder value (SSV) markedly decreased at five years follow-up compared to one year (p < 0.001 for both). AHD, LHO, and JG all showed a consistent and statistically significant decline over time, with the joint gap decreasing by half. Consistently, smaller JG and AHD were correlated with lower SSV (p = 0.03 and p = 0.07, respectively). Massive loosening was associated with a 14.5 points lower SSV (p < 0.01). Finally, narrowing of the JG was significantly correlated with increased radiolucency (p < 0.001) and tended toward worse SSV (p = 0.06). In summary, radiographic parameters displaying medialization and cranialization after aTSA with a cemented pegged glenoid are useful predictors of impaired shoulder function.
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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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What can be learned from an analysis of 215 glenoid component failures? J Shoulder Elbow Surg 2018; 27:478-486. [PMID: 29310914 DOI: 10.1016/j.jse.2017.09.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component failure is a prevalent mechanical complication of anatomic total shoulder arthroplasty. The objective of this study was to identify surgeon-controlled factors that may be addressed to reduce the rate of glenoid component failure that is sufficiently symptomatic to merit surgical revision. METHODS We reviewed the clinical and radiographic features of 215 total shoulder arthroplasties that we revised for symptomatic glenoid component failure. RESULTS Glenoid component failure was associated with poor patient self-assessed shoulder function (mean Simple Shoulder Test score, 3.0 ± 2.7). These shoulders often showed multiple failure modes; 72% had glenoid component loosening, 69% had polyethylene wear, 51% had glenohumeral decentering, and 25% had humeral component loosening. Metal-backed/hybrid and keeled glenoid designs had higher rates of loosening (P = .010), malposition (P = .007), dislocation (P < .001), and early failure (P = .044) in comparison to pegged designs. Glenoid components with cement on the backside were more prevalent among those revised sooner than 5 years after the index surgery (P < .001). CONCLUSIONS Glenoid component failure remains a major cause of poor patient outcomes after total shoulder arthroplasty. The occurrence of severe glenoid component failure might be reduced by paying attention to glenoid component design and insertion technique, restoring the normal balance of the humeral head in the center of the glenoid, and considering a reverse total shoulder when the shoulder is unstable because of soft tissue deficiency.
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Triplet JJ, Momoh E, Kurowicki J, Villarroel LD, Law TY, Levy JC. E-mail reminders improve completion rates of patient-reported outcome measures. JSES OPEN ACCESS 2017; 1:25-28. [PMID: 30675535 PMCID: PMC6340825 DOI: 10.1016/j.jses.2017.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Patient-reported outcome measures (PROMs) have become increasingly important in assessing clinical outcomes. However, acquisition of data at routine time intervals can be challenging. The ability of e-mail reminders to save follow-up intervals when office visits are missed is unknown. Materials and Methods A retrospective review of a consecutive series of 186 shoulder surgical patients who underwent surgery between October 2, 2012, and July 2, 2013, was conducted. Simple Shoulder Test and 12-Item Short Form Health Survey scores were completed at preoperative visits using office-based tablet surveys. Patients were observed for completeness of PROMs at expected routine follow-up of 1 year and 2 years. When office visits were missed, e-mail reminders with links to online surveys were sent to patients without further incentives. Improvement in data acquisition achieved using e-mail reminders when patient follow-up was missed was assessed. The influence of the procedure performed was further analyzed to determine whether patients treated with different surgical procedures would be more compliant with PROM completion. Results Use of e-mail reminders significantly increased the number of patients for whom complete follow-up data were obtained. Compared with tablet surveys completed during office visits alone, the addition of e-mail reminders increased the collection of complete PROM data (both 1- and 2-year follow-up) by 25.8% (P < .001). Similar findings were observed for total shoulder arthroplasty and arthroscopic rotator cuff repair patients (increased by 25.7% and 34.4%, respectively; P < .001). Conclusion E-mail reminders serve as a mechanism to increase the completeness of follow-up data in the absence of in-office patient evaluation.
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Affiliation(s)
| | - Enesi Momoh
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | | | - Tsun Yee Law
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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Is there evidence that the outcomes of primary anatomic and reverse shoulder arthroplasty are getting better? INTERNATIONAL ORTHOPAEDICS 2017; 41:1235-1244. [DOI: 10.1007/s00264-017-3443-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
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Matsen FA, Russ SM, Vu PT, Hsu JE, Lucas RM, Comstock BA. What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties. Clin Orthop Relat Res 2016; 474:2496-2510. [PMID: 27457623 PMCID: PMC5052198 DOI: 10.1007/s11999-016-4990-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. QUESTIONS/PURPOSES We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? METHODS Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a "better" outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. RESULTS After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p < 0.001), lower baseline Simple Shoulder Test score (OR, 1.32; 95% CI, 1.23-1.42; p < 0.001), no prior shoulder surgery (OR, 1.79; 95% CI, 1.18-2.70; p = 0.006), humeral head not superiorly displaced on the AP radiograph (OR, 2.14; 95% CI, 1.15-4.02; p = 0.017), and glenoid type other than A1 (OR, 4.47; 95% CI, 2.24-8.94; p < 0.001). Neither preoperative glenoid version nor posterior decentering of the humeral head on the glenoid were associated with the outcomes. The model predictive of a better result was driven mainly by the six factors listed above. The area under the receiver operating characteristic curve generated from the cross-validated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as a better outcome). A cutoff probability of 0.68 yielded the best performance of the model with cross-validation predictions of better outcomes for 236 patients (80%) and worse outcomes for 58 patients (20%); sensitivity of 91% (95% CI, 88%-95%); specificity of 65% (95% CI, 53%-77%); positive predictive value of 92% (95% CI, 88%-95%); and negative predictive value of 64% (95% CI, 51%-76%). CONCLUSIONS We found six easy-to-determine preoperative patient and shoulder factors that were significantly associated with better outcomes of shoulder arthroplasty. A model based on these characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty. Future research could refine this model with larger patient populations from multiple practices. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
- Shoulder and Elbow Surgery, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Stacy M Russ
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Phuong T Vu
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Robert M Lucas
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Gilmer BB, Comstock BA, Jette JL, Warme WJ, Jackins SE, Matsen FA. The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases. J Bone Joint Surg Am 2012; 94:e102. [PMID: 22810409 DOI: 10.2106/jbjs.k.00486] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of the factors affecting the prognosis for improvement in function and comfort with time after shoulder arthroplasty is important to clinical decision-making. This study sought to identify some of these factors in 176 consecutive patients undergoing the ream-and-run procedure. METHODS The time course for improvement in patient function and comfort was determined for the entire group as well as for subsets by sex, age, diagnosis, preoperative function, and surgery date. Patients having repeat surgery were analyzed in detail. RESULTS Shoulder comfort and function increased progressively after the ream-and-run procedure, reaching a steady state by approximately twenty months. The shoulders in 124 patients with at least two years of follow-up were improved by a minimal clinically important difference. The shoulders in sixteen patients with at least two years of follow-up were not improved by the minimal clinically important difference. Twenty-two patients had repeat procedures, but only seven had revision to a total shoulder arthroplasty. Fourteen patients did not have either a known revision arthroplasty or two years of follow-up. The best prognosis was for male patients over the age of sixty years, with primary osteoarthritis, no prior surgical procedures, a preoperative score on the simple shoulder test of ≥5 points, and surgery after 2004. Repeat surgical procedures were more common in patients who had a greater number of surgical procedures before the ream-and-run surgery. CONCLUSIONS This study is unique in that it characterizes the factors affecting the time course for improvement in shoulder comfort and function after a ream-and-run procedure. Improvement occurs after this procedure for at least 1.5 years. This procedure appears to be best suited for an older male patient with reasonable preoperative shoulder function without prior shoulder surgery. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian B Gilmer
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 N.E. Pacific Street, Seattle, WA 98195, USA
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Collin P, Tay AKL, Melis B, Boileau P, Walch G. A ten-year radiologic comparison of two-all polyethylene glenoid component designs: a prospective trial. J Shoulder Elbow Surg 2011; 20:1217-23. [PMID: 22078322 DOI: 10.1016/j.jse.2011.06.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/12/2011] [Accepted: 06/13/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic glenoid component loosening remains a common problem in total shoulder arthroplasty (TSA). This study presents long-term prospective follow-up of 2 cemented all-polyethylene glenoid components with different backside design geometry and the effect on the presence and progression of radiolucent lines (RLLs). MATERIALS AND METHODS Fifty-six TSAs were performed for primary osteoarthritis. Two surgeons used an identical technique to implant 32 flat-back and 24 convex-back glenoids. In particular, the glenoid components were cemented after a minimal reaming and bone compaction. Standardized postoperative radiologic and clinical follow-up was at 2 and 10 years. Three independent observers evaluated the x-ray images for RLLs around the base plate and keel. The results were analyzed for progression and influencing factors. RESULTS At 10 years, progression of RLL was seen in both components, but there was no difference between the 2 glenoid designs (P = .16). Younger patient age (P = .03), hand dominance (P = .017), and presence of early RLLs (P = .018) were significant factors for progression of RLLs. Constant scores deteriorated with progression of RLLs (P = .006). The glenoid revision rate at 10 years was 5%. CONCLUSION At 10 years there was no difference in the presence or progression of RRLs between a flat-back and a convex-back glenoid all-polyethylene design. Young age, hand dominance, and poor implantation technique influence glenoid RLLs and affect the clinical result of TSA.
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Affiliation(s)
- Philippe Collin
- Centre Hospitalier Privé Saint Grégoire, Saint Grégoire, Rennes, France.
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Saltzman MD, Chamberlain AM, Mercer DM, Warme WJ, Bertelsen AL, Matsen FA. Shoulder hemiarthroplasty with concentric glenoid reaming in patients 55 years old or less. J Shoulder Elbow Surg 2011; 20:609-15. [PMID: 21167745 DOI: 10.1016/j.jse.2010.08.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/19/2010] [Accepted: 08/24/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral arthritis in younger individuals is challenging because of the complex pathology, need for extended durability, and high expectations of the patients. Humeral hemiarthroplasty combined with concentric glenoid reaming is a surgical option for the management of glenohumeral arthritis that avoids the risks of glenoid component failure and avoids the challenges of tissue interposition. The results of this procedure in young patients have not been previously reported. METHODS Sixty-five shoulders in patients who were 55 years old or less at the time of surgery underwent humeral hemiarthroplasty combined with concentric glenoid reaming and were followed for a minimum of 2 years or until the time of revision surgery. Patient self-assessments of shoulder comfort and function were compared before and after surgery. For 22 of these shoulders, standardized radiographs were available for follow-up evaluation. RESULTS Nine shoulders required revision surgery. These shoulders had 3 ± 3 prior surgeries, in comparison to 1 ± 1 prior surgeries for the unrevised group. For the 56 unrevised shoulders, the number of Simple Shoulder Test functions that could be performed improved from a mean of 4.1 before surgery to a mean of 9.5 at an average follow-up of 43 months (range, 24-85) (P < .001). For the 22 shoulders with radiographic follow-up, medial glenoid erosion averaged 1.1 mm (range, 0.0-6.3 mm) at an average of 44 months after the procedure. CONCLUSION In selected patients 55 years or younger with glenohumeral arthritis, this procedure can provide significant improvement in self-assessed shoulder comfort and function.
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Affiliation(s)
- Matthew D Saltzman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA.
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12
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Katz DC, Sauzières P, Valenti P, Kany J. The case for the metal-backed glenoid design in total anatomical shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0796-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Mercer DM, Gilmer BB, Saltzman MD, Bertelsen A, Warme WJ, Matsen FA. A quantitative method for determining medial migration of the humeral head after shoulder arthroplasty: preliminary results in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming. J Shoulder Elbow Surg 2011; 20:301-7. [PMID: 20655765 DOI: 10.1016/j.jse.2010.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/15/2010] [Accepted: 03/20/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Glenoid erosion and medial migration of the humeral head prosthesis have been observed after most types of shoulder arthroplasty. A method of measuring the change in humeral head position with time after shoulder prosthetic arthroplasty was applied it to 14 shoulders that underwent humeral hemiarthroplasty with concentric glenoid reaming. We hypothesized that the measurement technique would be reproducible and that the rate of wear would be small in the series of shoulders studied. MATERIALS AND METHODS Standardized anteroposterior and axillary radiographs were obtained after surgery. Two examiners measured the position of the humeral head center in relation to scapular reference coordinates for the anteroposterior and axillary projections and plotted these values against time after surgery. The change in position was characterized as the slope of this plot. Shoulders were included if there were at least 3 sets of postoperative films, the last being at least 2 years after surgery. RESULTS The slopes measured by the 2 examiners agreed within 0.5 mm/y for the anteroposterior and the axillary projections. For the series of shoulder arthroplasties, the rate of movement of the head center toward the scapula was less than 0.4 mm/y for either examiner in either projection. DISCUSSION Medial migration is a concern after any type of shoulder arthroplasty, whether a hemiarthroplasty, a biological interpositional arthroplasty, or a total shoulder arthroplasty. Quantifying the rate of medial migration over time after shoulder arthroplasty is an important element of clinical follow-up. CONCLUSIONS This is an inexpensive, practical, and reproducible method that can be used to determine the rate of medial migration of the humeral head on plain radiographs after shoulder arthroplasty. The average rate of medial migration in the shoulders in this study was small.
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Affiliation(s)
- Deana M Mercer
- Department of Orthopedics and Sports Medicine, University of Washington Medial Center, Seattle, WA 98195, USA
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Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH. Pegged versus keeled glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg 2010; 19:726-33. [PMID: 20149974 DOI: 10.1016/j.jse.2009.10.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/14/2009] [Accepted: 10/27/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Loosening of the glenoid component is a common complication in shoulder arthroplasty. We proposed to radiographically and clinically investigate the outcomes of keeled and pegged glenoid components to test the hypothesis that these implants would have equivalent performance. MATERIALS AND METHODS One hundred patients undergoing primary shoulder arthroplasty for osteoarthritis were reviewed. Fifty patients had pegged glenoid components, and fifty had keeled components. Standardized radiographs were taken. Preoperative films classified the severity of degenerative change. The postoperative films were analyzed for radiolucent lines and shift in component position-at-risk signs for loosening. RESULTS Mean radiographic follow-up was 51.3 months (range, 24-90 months) for the keeled group and 45.7 months (range, 27-98 months) for the pegged group. There were no differences in the degree of preoperative arthritic change between groups. Both groups had significant improvement in motion and pain (P < .001) postoperatively, with no differences in clinical outcome between cohorts (P > or = .20). Initial radiographs showed no radiolucencies around the pegs in 46 implants or around the keel in 49 components. At final follow-up, 10 glenoid implants were found to be at risk for loosening, 6 (12%) in the pegged group and 4 (8%) in the keeled group (P = .74). CONCLUSIONS Initial postoperative radiographs with pegged and keeled components show a low rate of radiolucent lines. These radiolucencies develop over time. However, there is no difference in clinical or radiographic outcomes between pegged and keeled components at intermediate-term follow-up.
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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: 203] [Impact Index Per Article: 12.7] [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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Cheung EV, Sperling JW, Cofield RH. Reimplantation of a Glenoid Component Following Component Removal and Allogenic Bone-Grafting. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200708000-00016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Matsen FA, Bicknell RT, Lippitt SB. Shoulder arthroplasty: the socket perspective. J Shoulder Elbow Surg 2007; 16:S241-7. [PMID: 17448695 DOI: 10.1016/j.jse.2007.02.112] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 01/25/2007] [Accepted: 02/05/2007] [Indexed: 02/01/2023]
Abstract
Although much attention has been directed to the development of the humeral components used in shoulder arthroplasty, the major unsolved challenge lies on the glenoid side of the articulation. This challenge arises from difficulties resisting eccentric loading and providing adequate implant-bone fixation. Current glenoid component designs use polyethylene and polymethyl methacrylate and are prone to loosening, plastic deformation, particulate debris, and third-body wear. Metal-backed components present further challenges, and results have generally been disappointing. There is interest in biologic resurfacing procedures, including the interposition of fascia, capsule, or meniscal allograft and nonprosthetic glenoid arthroplasty, or what has become known as the "ream-and-run" procedure. Despite encouraging results, important questions remain unanswered about these procedures. However, each may warrant further exploration with a goal of providing an effective and durable approach to glenoid arthritis that avoids the risks associated with polymethyl methacrylate and polyethylene.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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