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Serial 3D CT analysis of humeral head alignment in relation to glenoid correction and outcomes after total shoulder arthroplasty. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Liu C, Shi L, Amirouche F. Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2022; 6:24715492221142856. [PMCID: PMC9742691 DOI: 10.1177/24715492221142856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
Total shoulder arthroplasty is an increasingly popular option for the treatment of glenohumeral arthritis. Historically, the effectiveness of the procedure has largely been determined by the long-term stability of the glenoid component. Glenoid component loosening can lead to clinically concerning complications including pain with movement, loss of function, and accumulation of debris which may require surgery to revise. In response, there has been a push to optimize the design of the glenoid prosthesis. Traditional contemporary glenoid components use pegs for fixation and are made entirely of polyethylene. Variations on the standard implant include keeled, metal-backed, hybrid, augmented, and inlay designs. There is a wealth of biomechanical and clinical studies that report on the effectiveness of these different designs. The purpose of this review is to summarize existing literature regarding glenoid component design and identify key areas for future research. Knowledge of the rationale underlying glenoid design will help surgeons select the best component for their patients and optimize outcomes following TSA.
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Affiliation(s)
- Charles Liu
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA,Charles Liu, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | - Lewis Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, USA
| | - Farid Amirouche
- Department of Orthopaedics, The University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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Bola M, Simões J, Ramos A. Finite element analysis to predict short and medium-term performance of the anatomical Comprehensive® Total Shoulder System. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106751. [PMID: 35306286 DOI: 10.1016/j.cmpb.2022.106751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The number of Total Shoulder Arthroplasties (TSA) has increased in these last years with significant increase of clinical success. However, glenoid component loosening remains the most common cause of failure. OBJECTIVE In this study we evaluated the critical conditions to predict short and medium-term performance of the uncemented anatomical Comprehensive® Total Shoulder System using a finite element model that was validated experimentally. METHODS The finite element models of an implanted shoulder analysed included total shoulder components with pegs. The models were simulated in 3 phases of adduction: 45°, 60° and 90° to determine the most critical situation. Two different bone-implant fixation conditions were considered: post-surgery and medium term (2 years). RESULTS These show that the critical condition is for the shoulder in 90° adduction were the highest contact stress (70 MPa) was observed in the glenoid component. Relatively to the interface implant-bone strains, the maximum (-16000 µε) was observed for the short-term in the lateral region of the humerus. The highest micromotions were observed in the central fixation post of the glenoid component, ranging from 20 to 25 µm, and 325 µm in the lateral plane of the humeral component. CONCLUSION The predicted results are in accordance with clinical studies published and micromotions of the humeral component can be used to predict loosening and to differentiate shoulder implant designs.
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Affiliation(s)
- Margarida Bola
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal
| | - José Simões
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal; ESAD- College of Art and Design, Avenida Calouste Gulbenkian, Senhora da Hora, Matosinhos 4460-268, Portugal
| | - António Ramos
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal.
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Jacxsens M, Dayerizadeh N, Vandenbosch D, Van Tongel A, De Wilde L. Clinical and radiographic outcomes of an all-polyethylene fluted central peg glenoid component, implanted utilizing an off-label, uncemented technique, at a minimum 5-year follow-up. J Shoulder Elbow Surg 2020; 29:2292-2298. [PMID: 32499196 DOI: 10.1016/j.jse.2020.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component loosening remains an important concern in anatomic total shoulder arthroplasty. The aim of this study was to evaluate the clinical and radiographic results of a fully uncemented all-polyethylene fluted central peg bone-ingrowth glenoid component at a minimum 5-year follow-up. METHODS Thirty-five shoulders in 31 patients (mean age, 73 years) with a mean follow-up of 100 months were retrospectively evaluated at an early and mid-term time point for Constant score (CS). Computed tomography visualized glenoid component fixation at both time points. RESULTS Mean CS improved from 40 preoperatively to 66 postoperatively at latest follow-up (P < .001). A mean CS of 74 at early follow-up remained consistent with a mean CS of 66 at latest follow-up (P = .158), with only strength demonstrating a decrease over time (P < .001). An initial osseointegration rate of 81% at early follow-up decreased to 71% at latest follow-up with 74% of the shoulders demonstrating progressive radiolucent lines, resulting in a radiographic loosening rate of 31%. Of the 35 shoulders, 4 were revised (survival rate of 88%), of which 2 due to symptomatic aseptic loosening. CONCLUSIONS Uncemented fixation of an all-polyethylene central peg bone-ingrowth glenoid was associated with satisfactory clinical and radiographic scores, and an acceptable revision rate at mid- to long-term follow-up. Despite initial bony osseointegration in the majority of cases, radiographic loosening over time remains a concern, potentially jeopardizing long-lasting fixation of this type of glenoid component when implanted in an off-label uncemented fashion.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nader Dayerizadeh
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Dominiek Vandenbosch
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.
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Schiefer M, Siqueira G, Figueira A, Souza PM, Monteiro MT, Motta Filho G. Integração óssea e prevalência de linhas radiotransparentes ao redor dos pinos de componentes glenoidais minimamente cimentados na artroplastia total de ombro. Rev Bras Ortop 2020; 57:120-127. [PMID: 35198119 PMCID: PMC8856858 DOI: 10.1055/s-0040-1715509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component.
Methods
Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component.
Results
Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results.
Conclusion
Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results.
Level of evidence
IV; Case series; Treatment study.
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Affiliation(s)
- Márcio Schiefer
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Gláucio Siqueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Alan Figueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Patrícia Martins Souza
- Departamento de Radiologia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Martim Teixeira Monteiro
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Geraldo Motta Filho
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
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Denard PJ, Gobezie R, Griffin JW, Romeo AA, Lederman E. Osseous Integration of the Central Peg of an All-Polyethylene Glenoid With 3 Different Surgical Techniques. Orthopedics 2020; 43:278-283. [PMID: 32745227 DOI: 10.3928/01477447-20200721-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
All-polyethylene glenoid components designed for osseous integration of the central peg can be placed with no graft (NG), autogenous bone graft (ABG), or demineralized bone matrix (DBM). The purpose of this study was to compare osseous integration with these 3 techniques. A randomized controlled trial was performed of 153 total shoulder arthroplasties using a pegged allpolyethylene glenoid component designed for osseous integration. Central peg treatment included NG, ABG, or DBM. The primary outcome was central peg osseous integration defined as bone presence between the central fins 1 year postoperatively. Central osseous integration was observed in 90% of cases treated with ABG, 68% of cases treated with DBM, and 68% of cases treated with NG (P=.022). Postoperative Wirth grading revealed radiolucency around the central peg (grade 1) in 2.4% of cases with ABG, 5.4% of cases with DBM, and 9.8% of cases with NG (P=.134). At short-term follow-up, osseous integration of the central peg of an all-polyethylene glenoid designed for bony growth between the central fins appears to be highest when treating the central peg with ABG compared with leaving the central peg untreated or using DBM. [Orthopedics. 2020;43(5):278-283.].
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Shanmugaraj A, Sarraj M, Coughlin RP, Guerrero EM, Ekhtiari S, Ayeni OR, Garrigues GE. Surgical Management of Glenohumeral Osteoarthritis With Glenoid Erosion and Static Posterior Subluxation (Walch B2): Techniques, Outcomes, and Survivorship Rates. Orthopedics 2020; 43:e191-e201. [PMID: 32324248 DOI: 10.3928/01477447-20200415-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to systematically assess the surgical techniques and outcomes related to the management of Walch B2 glenoids. PubMed, Medline, and Embase were searched from inception to July 2018. Overall, 24 studies (787 B2 glenoids) were identified. Revision-free survivorship was highest for reverse total shoulder arthroplasty (98.6%) and anatomic total shoulder arthroplasty with asymmetric reaming and a non-augmented glenoid implant (95.6%). Walch B2 glenoids are most commonly managed by asymmetric reaming in the context of anatomic total shoulder arthroplasty, and by the ream-and-run technique in hemiarthroplasty. The optimal treatment strategy remains elusive due to a lack of high-quality, comparative studies with long-term surveillance. [Orthopedics. 2020;43(4):e191-e201.].
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Schoch BS, Zarezadeh A, Priddy M, King JJ, Wright TW. Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up. J Shoulder Elbow Surg 2020; 29:968-975. [PMID: 31812586 DOI: 10.1016/j.jse.2019.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional monoblock pegged glenoid components are implanted with cement, increasing operative time and potentially violating more bone than those inserted without cement. We study the early radiographic loosening and reoperation rate following uncemented fixation of a hybrid cage monoblock polyethylene glenoid component. METHODS Between 2013 and 2015, a total of 51 shoulders underwent anatomic shoulder arthroplasty (TSA) using a hybrid ingrowth cage polyethylene glenoid component by a single surgeon, with a minimum follow-up of 2 years. In all cases, the glenoid component was placed without cement. Mean follow-up was 33 months (range, 24-57). The primary outcome was Lazarus scale-assessed radiographic loosening. Secondary outcomes included reoperation, range of motion (ROM), and patient-reported outcome measures (PROMs). RESULTS Twelve glenoid components (24%) had radiolucent lines. Glenoid lines were rated grade 1, grade 2, and grade 5 (6, 4, and 2 shoulders, respectively). Six shoulders (12%) had humeral lucent lines. Two shoulders (4%) underwent reoperation, only 1 of these occurring due to isolated failure of the glenoid component. As a group, mean ROM and PROMs improved significantly compared with preoperative values and exceeded the minimal clinically important difference. CONCLUSION Glenoid loosening remains a major concern at mid- to long-term follow-up of TSA. Placement of this hybrid cage monoblock polyethylene glenoid component in a completely uncemented fashion does not lead to early clinical loosening, after which bony ingrowth into the central cage can be expected. Uncemented fixation of this hybrid cage component appears to be a safe treatment option for patients undergoing primary TSA.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Ali Zarezadeh
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Michael Priddy
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
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Prearthroplasty glenohumeral pathoanatomy and its relationship to patient's sex, age, diagnosis, and self-assessed shoulder comfort and function. J Shoulder Elbow Surg 2019; 28:2290-2300. [PMID: 31311749 DOI: 10.1016/j.jse.2019.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is great current interest in characterizing the prearthroplasty glenohumeral pathoanatomy because of its role in guiding surgical technique and its possible effects on arthroplasty outcome. METHODS We examined 544 patients within 6 weeks before arthroplasty with the goals of characterizing the following: demographic and radiographic characteristics; relationships of the radiographic pathoanatomy to the patient's age, sex, and diagnosis; inter-relationships among glenoid type, glenoid version, and amount of decentering of the humeral head on the glenoid; and relationships of the pathoanatomy to the patient's self-assessed comfort and function. RESULTS Male patients had a higher frequency of B2 glenoids and a lower frequency of A2 glenoids. The arthritic shoulders of men were more retroverted and had greater amounts of posterior decentering. Patients with types A1 and C glenoids were younger than those with other glenoid types. Shoulders with osteoarthritis were more likely to be type B2 and to be retroverted. Types B2 and C had the greatest degree of retroversion, whereas types B1 and B2 had the greatest amounts of posterior decentering. Shoulders with glenoid types B1 and B2 and those with more decentering did not have worse self-assessed shoulder comfort and function. CONCLUSIONS Glenohumeral pathoanatomy was found to have previously unreported relationships to the patient's sex, age, and diagnosis. Contrary to what might have been expected, more advanced glenohumeral pathoanatomy (ie, type B glenoids, greater retroversion, greater decentering) was not associated with worse self-assessed shoulder comfort and function.
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Welsher A, Gohal C, Madden K, Miller B, Bedi A, Alolabi B, Khan M. A comparison of pegged vs. keeled glenoid components regarding functional and radiographic outcomes in anatomic total shoulder arthroplasty: a systematic review and meta-analysis. JSES OPEN ACCESS 2019; 3:136-144.e1. [PMID: 31709353 PMCID: PMC6835032 DOI: 10.1016/j.jses.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The number of total shoulder arthroplasties (TSAs) performed is increasing annually, with a continued effort to improve outcomes using new techniques and materials. In anatomic TSAs, the main options for glenoid fixation currently involve keeled or pegged components. The aim of this review was to determine which fixation option provides optimal long-term functional outcomes with decreased rates of revision surgery and radiolucency. Methods The MEDLINE, Embase, PubMed, and Cochrane databases were searched from 2007 to July 10, 2017, for all articles that examined TSAs using either pegged or keeled glenoid fixations. All studies were screened in duplicate for eligibility. Two separate analyses were completed examining noncomparative and comparative studies independently. Results A total of 7 comparative studies and 25 noncomparative studies were included in the final analysis. Included in the analysis were 4 randomized (level I) studies, 1 level II study, 8 level III studies, and 19 level IV studies. Meta-analysis of the comparative studies demonstrated a higher rate of revision surgery with keeled fixations compared with pegged fixations (odds ratio, 6.22; 95% confidence interval [CI], 1.38-28.1; P = .02). No significant difference was found with respect to functional outcomes, such as the American Shoulder and Elbow Surgeons score (mean difference, 9.54; 95% CI, –8.25 to 27.34; P = .29) and Constant score (mean difference, 5.31; 95% CI, –12.28 to 22.89; P = .55), as well as radiolucency rates (odds ratio, 1.89; 95% CI, 0.56−6.39; P = .30). Conclusion Pegged glenoid fixation may result in a decreased risk of revision TSAs, but no significant differences in patient-reported outcomes have been identified to date.
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Affiliation(s)
- Arthur Welsher
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Kim Madden
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Bruce Miller
- MedSport, University of Michigan, Ann Arbor, MI, USA
| | - Asheesh Bedi
- MedSport, University of Michigan, Ann Arbor, MI, USA
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Corresponding author: Moin Khan, MD, MSc, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada.
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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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Van Vrekhem S, Vloebergh K, Asadian M, Vercruysse C, Declercq H, Van Tongel A, De Wilde L, De Geyter N, Morent R. Improving the surface properties of an UHMWPE shoulder implant with an atmospheric pressure plasma jet. Sci Rep 2018; 8:4720. [PMID: 29549270 PMCID: PMC5856771 DOI: 10.1038/s41598-018-22921-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/21/2018] [Indexed: 11/09/2022] Open
Abstract
Insufficient glenoid fixation is one of the main reasons for failure in total shoulder arthroplasty. This is predominantly caused by the inert nature of the ultra-high molecular weight polyethylene (UHMWPE) used in the glenoid component of the implant, which makes it difficult to adhesively bind to bone cement or bone. Previous studies have shown that this adhesion can be ameliorated by changing the surface chemistry using plasma technology. An atmospheric pressure plasma jet is used to treat UHMWPE substrates and to modify their surface chemistry. The modifications are investigated using several surface analysis techniques. The adhesion with bone cement is assessed using pull-out tests while osteoblast adhesion and proliferation is also tested making use of several cell viability assays. Additionally, the treated samples are put in simulated body fluid and the resulting calcium phosphate (CaP) deposition is evaluated as a measure of the in vitro bioactivity of the samples. The results show that the plasma modifications result in incorporation of oxygen in the surface, which leads to a significant improved adhesion to bone cement, an enhanced osteoblast proliferation and a more pronounced CaP deposition. The plasma-treated surfaces are therefore promising to act as a shoulder implant.
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Affiliation(s)
- S Van Vrekhem
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium.
| | - K Vloebergh
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - M Asadian
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - C Vercruysse
- Tissue Engineering Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 6B3, 9000, Ghent, Belgium
| | - H Declercq
- Tissue Engineering Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 6B3, 9000, Ghent, Belgium
| | - A Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 13K12, 9000, Ghent, Belgium
| | - L De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 13K12, 9000, Ghent, Belgium
| | - N De Geyter
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - R Morent
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
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Geraldes DM, Hansen U, Jeffers J, Amis AA. Stability of small pegs for cementless implant fixation. J Orthop Res 2017; 35:2765-2772. [PMID: 28387966 PMCID: PMC5763372 DOI: 10.1002/jor.23572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/03/2017] [Indexed: 02/04/2023]
Abstract
Most glenoid implants rely on large centrally located fixation features to avoid perforation of the glenoid vault in its peripheral regions. Upon revision of such components there may not be enough bone left for the reinsertion of an anatomical prosthesis. Multiple press-fit small pegs would allow for less bone resection and strong anchoring in the stiffer and denser peripheral subchondral bone. This study assessed the fixation characteristics, measured as the push-in (Pin ) and pull-out (Pout ) forces, and spring-back, measured as the elastic displacement immediately after insertion, for five different small press-fitted peg configurations manufactured out of UHMWPE cylinders (5 mm diameter and length). A total of 16 specimens for each configuration were tested in two types of solid bone substitute: Hard (40 PCF, 0.64 g/cm3 , worst-case scenario of Pin ) and soft (15 PCF, 0.24 g/cm3 , worst-case scenario of spring-back and Pout ). Two different diametric interference-fits were studied. Geometries with lower stiffness fins (large length to width aspect ratio) were the best performing designs in terms of primary fixation stability. They required the lowest force to fully seat, meaning they are less damaging to the bone during implantation, while providing the highest Pout /Pin ratio, indicating that when implanted they provide the strongest anchoring for the glenoid component. It is highlighted that drilling of chamfered holes could minimize spring-back displacements. These findings are relevant for the design of implants press-fitted pegs because primary fixation has been shown to be an important factor in achieving osseointegration and longevity of secondary fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2765-2772, 2017.
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Affiliation(s)
- Diogo M. Geraldes
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Ulrich Hansen
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Jonathan Jeffers
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Andrew A. Amis
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom,Musculoskeletal Surgery Group, Department of Surgery and CancerImperial College London School of MedicineW6 8RF LondonUnited Kingdom
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Nuttall D, Birch A, Haines JF, Watts AC, Trail IA. Early migration of a partially cemented fluted glenoid component inserted using a cannulated preparation system. Bone Joint J 2017; 99-B:674-679. [DOI: 10.1302/0301-620x.99b5.bjj-2016-0745.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/11/2016] [Indexed: 12/15/2022]
Abstract
Aims Radiostereometric analysis (RSA) allows an extremely accurate measurement of early micromotion of components following arthroplasty. Patients and Methods In this study, RSA was used to measure the migration of 11 partially cemented fluted pegged glenoid components in patients with osteoarthritis who underwent total shoulder arthroplasty using an improved surgical technique (seven men, four women, mean age 68). Patients were evaluated clinically using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores and by CT scans two years post-operatively. Results There were two patterns of migration, the first showing little, if any, migration and the second showing rotation by > 6° as early as three months post-operatively. At two years, these two groups could be confirmed on CT scans, one with osseointegration around the central peg, and the second with cystic changes. Patients with osteolysis around the central peg were those with early migration and those with osseointegration had minimal early migration. Both groups,however,had similar clinical results. Conclusion Rapid early migration associated with focal lucency and absence of osseointegration was observed in three of 11 glenoid components, suggesting that lack of initial stability leads to early movement and failure of osseointegration. Cite this article: Bone Joint J 2017;99-B:674–9.
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Affiliation(s)
- D. Nuttall
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire
WN6 9EP, England, UK
| | - A. Birch
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire
WN6 9EP, England, UK
| | - J. F. Haines
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire
WN6 9EP, England, UK
| | - A. C. Watts
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire
WN6 9EP, England, UK
| | - I. A. Trail
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire
WN6 9EP, England, UK
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15
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Geraldes DM, Hansen U, Amis AA. Parametric analysis of glenoid implant design and fixation type. J Orthop Res 2017; 35:775-784. [PMID: 27219615 DOI: 10.1002/jor.23309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/06/2016] [Indexed: 02/04/2023]
Abstract
Common post-operative problems in shoulder arthroplasty such as glenoid loosening and joint instability may be reduced by improvements in glenoid design, shape, material choice, and fixation method. A framework for parametric analysis of different implant fixation configurations was developed in order to efficiently sift through potential glenoid component designs. We investigated the influence of design factors such as fixation type, component thickness, and peg position, number, diameter, and length in a multi-factorial design investigation. The proposed method allowed for simultaneous comparison of the mechanical performance of 344 different parametric variations of 10 different reference geometries with either large central fixation features or small peripheral pegs, undergoing four different worst-case scenario loading conditions, and averaging 64.7 s per model. The impact of design parameters were assessed for different factors responsible for post-operative problems in shoulder arthroplasty, such as bone volume preservation, stresses in the implant, central displacement or fixation stability, and the worst performing geometries all relied on conventional central fixation. Of the remaining geometries, four peripheral fixation configurations produced von Mises stresses comfortably below the material's yield strength. We show that the developed method allows for simple, direct, rapid, and repeatable comparison of different design features, material choices, or fixation methods by analyzing how they influence the bone-implant mechanical environment. The proposed method can provide valuable insight in implant design optimization by screening through multiple potential design modifications at an early design evaluation stage and highlighting the best performing combinations according to the failure mechanism to mitigate. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:775-784, 2017.
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Affiliation(s)
- Diogo M Geraldes
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, Exhibition Road, SW7 2AZ London, United Kingdom
| | - Ulrich Hansen
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, Exhibition Road, SW7 2AZ London, United Kingdom
| | - Andrew A Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, Exhibition Road, SW7 2AZ London, United Kingdom.,Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, W6 8RF London, United Kingdom
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16
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Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
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17
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Daner, III WE, Boardman, III ND. Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty. Case Rep Orthop 2016; 2016:6208294. [PMID: 27555976 PMCID: PMC4983338 DOI: 10.1155/2016/6208294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022] Open
Abstract
Glenoid loosening is the most common cause of failure in primary total shoulder arthroplasty (TSA) and often occurs years after the initial surgery. It is rare for a glenoid component to fail acutely. Several case reports of complete glenoid dissociation appear in the literature. It is important to report these failures to identify technical errors or component design flaws to improve outcomes in TSA. In this case report, we present an unrecognized acute failure of a cemented hybrid glenoid component at the time of surgery.
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Affiliation(s)
- William E. Daner, III
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
| | - Norman D. Boardman, III
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
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18
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Karelse A, Van Tongel A, Van Isacker T, Berghs B, De Wilde L. Parameters influencing glenoid loosening. Expert Rev Med Devices 2016; 13:773-84. [DOI: 10.1080/17434440.2016.1205483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Eichinger JK, Miller LR, Hartshorn T, Li X, Warner JJP, Higgins LD. Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival. J Shoulder Elbow Surg 2016; 25:772-80. [PMID: 26700556 DOI: 10.1016/j.jse.2015.09.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder arthroplasty in individuals aged 50 years or younger reportedly leads to worse outcomes than in older patients. Current methods of determining survivorship may be inadequate and may not reflect actual patient definitions of satisfaction. The purpose of this study is to evaluate and contrast the survival of patient satisfaction and implant survival in the youngest reported patients undergoing either a primary hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) using a third-generation stemmed prosthesis. METHODS Outcomes in 71 patients aged 50 years or younger who were treated with primary HA or TSA were evaluated for patient satisfaction and implant survival rates. Patient satisfaction survival was based on yes or no answers to 2 binary questions regarding willingness to undergo surgery again and whether surgery improved the patient's shoulder. RESULTS The Kaplan-Meier patient satisfaction survival rates at 5 years were 71.6% (95% confidence interval [CI], 46%-87%) for HAs and 95% (95% CI, 81%-99%) for TSAs. Multivariable regression analysis implicated postoperative pain as the primary causative factor for failure of patient satisfaction in all patients. In contrast, the implant survival rates at 5 years were 89% (95% CI, 69%-96%) for HAs and 95% (CI, 85%-100%) for TSAs. CONCLUSIONS Patients aged 50 years or younger who undergo shoulder arthroplasty have declining rates of self-reported satisfaction despite high implant survival rates, and this finding highlights the discordance between patient satisfaction and implant survival. Primary TSA outperforms HA in both implant survival and patient satisfaction survival rates at short-term follow-up. Future studies and registries must incorporate measurements of patient satisfaction and not just revision rates to truly interpret outcomes.
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Affiliation(s)
| | - Lindsay R Miller
- Sports Medicine & Shoulder Service, Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Timothy Hartshorn
- Beach Cities Orthopedics & Sports Medicine, Manhattan Beach, CA, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Jon J P Warner
- Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Laurence D Higgins
- Sports Medicine & Shoulder Service, Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, MA, USA
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20
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Gulotta LV, Chambers KL, Warren RF, Dines DM, Craig EV. No differences in early results of a hybrid glenoid compared with a pegged implant. Clin Orthop Relat Res 2015; 473:3918-24. [PMID: 26354176 PMCID: PMC4626480 DOI: 10.1007/s11999-015-4558-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/01/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Glenoid component loosening after total shoulder arthroplasty is one of the most common causes of failure. A hybrid glenoid that uses peripherally cemented pegs and a central press-fit post may improve implant longevity. QUESTIONS/PURPOSES We asked, compared with polyethylene pegged glenoid implants, do hybrid glenoid implants with a titanium post provide (1) better ingrowth with fewer radiolucencies, (2) better outcome and pain scores, and (3) lower risk of complications and revisions? METHODS Between 2009 and 2010, 126 patients underwent primary total shoulder arthroplasty for osteoarthritis. Patients were included in this retrospective study if they consented for inclusion in a shoulder arthroplasty registry, had complete baseline and 2-year data, and had complete radiographs. Eighty-three (67%) were available at an average followup of 3.2 years (range, 24-45 months). Forty received a conventional all-polyethylene pegged glenoid and 43 received a hybrid component. During the period in question, four of the participating surgeons used only one implant, and four used only the other; there was one high-volume surgeon in each of the study groups. Radiographs were taken at the 2-year followup and analyzed for radiolucent lines. CT scans were obtained randomly for 10 patients with hybrid glenoid implants to assess bone ongrowth. American Shoulder and Elbow Surgeons score, VAS score, complications and revisions were recorded. RESULTS At final followup, radiolucent lines between the two study groups were not different (hybrid, 1.0 ± 0.4; pegged, 1.6 ± 0.3; mean difference, 0.6; 95% CI, 0.85-1.72; p = 0.323). Final VAS pain scores were not different (hybrid, 1.2 ± 0.2; pegged, 1.5 ± 0.3; p = 0.056). Change in American Shoulder and Elbow Surgeons scores were not different (hybrid, 33.7 ± 7.3; pegged, 35.5 ± 8.2; p = 0.283). There were no differences in complication risk (hybrid, one of 43 [2.3%]; pegged, three of 40 [7.5%]; relative risk, 2.3; 95% CI, 0.82-3.12; p = 0.061). CONCLUSIONS With the numbers available and at early followup, there were no differences between the hybrid and pegged glenoids in terms of fixation, functional outcome, pain scores, and complications. CT scans confirmed bone ongrowth on the porous titanium post in a small subcohort of patients. Further studies are needed to determine how this new implant will perform with time. Until then, its use should be initiated with caution. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Russell F. Warren
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - David M. Dines
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - Edward V. Craig
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
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21
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Five- to ten-year follow-up with a partially cemented all-polyethylene bone-ingrowth glenoid component. J Shoulder Elbow Surg 2015; 24:1458-62. [PMID: 25842027 DOI: 10.1016/j.jse.2015.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although total shoulder arthroplasty has demonstrated better clinical outcomes than hemiarthroplasty, glenoid component loosening is a common complication. Recently, a novel partially cemented all-polyethylene fluted central peg bone-ingrowth component was introduced. METHODS Forty-two consecutive total shoulder arthroplasties from 2003 to 2007 performed by a single surgeon were evaluated radiographically and clinically with American Shoulder and Elbow Surgeons (ASES) scores and range of motion. RESULTS The average follow-up was 80 months (63-114); the average forward elevation improved from 107° to 137°, and external rotation improved from 30° to 37° at the latest follow-up. The average ASES score improved from 50 to 84. There was a strong correlation with the mean peripheral peg lucent line score (Lazarus score), which was 0.81, with the mean anchor peg lucent line score, which was 0.50 (P < .001). An analysis of polyethylene before and after cross-linking revealed a strong correlation between components with cross-linking and the Lazarus scores and the central fluted peg scores. Overall, there was 97% survivorship at 80 months. On radiographs, 81% of the central fluted pegs had complete incorporation with no lucent lines. These lucent lines correlated with lower ASES scores, suggesting that loosening of the glenoid decreases functional outcome. CONCLUSION Care should be taken in preparing the central fluted peg as perforation of the vault can lead to central flute peg lucent line formation, whereas perforation of the peripheral pegs does not seem to negatively affect the outcome.
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22
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Gowda A, Pinkas D, Wiater JM. Treatment of Glenoid Bone Deficiency in Total Shoulder Arthroplasty: A Critical Analysis Review. JBJS Rev 2015; 3:01874474-201507000-00002. [PMID: 27490143 DOI: 10.2106/jbjs.rvw.n.00097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ashok Gowda
- Shoulder and Elbow Surgery, Beaumont Health System, 3601 West Thirteen Mile Road, Royal Oak, MI 48073
| | - Daphne Pinkas
- Shoulder and Elbow Surgery, Kayal Orthopaedic Center, P.C., 784 Franklin Avenue, Suite 250, Franklin Lakes, NJ 07417
| | - J Michael Wiater
- Shoulder and Elbow Surgery, Beaumont Health System, 3601 West Thirteen Mile Road, Royal Oak, MI 48073
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23
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Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 2015. [PMID: 26194874 DOI: 10.1016/j.jbiomech.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.
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Affiliation(s)
- Roberto Postacchini
- Department of Orthopedic Surgery, Israelitic Hospital, Italian University Sport and Movement, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
| | - Stefano Carbone
- Department of Orthopedic Surgery, Sapienza University, Rome, Italy
| | | | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
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Armstrong AD, Lewis GS. Design Evolution of the Glenoid Component in Total Shoulder Arthroplasty. JBJS Rev 2013; 1:01874474-201312000-00002. [DOI: 10.2106/jbjs.rvw.m.00048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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