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Strelzow JA, Kusins JR, Ferreira LM, LeBel ME. "Can You Feel It": An Early Experience with Simulated Vibration to Recreate Glenoid Reaming. JB JS Open Access 2023; 8:e22.00134. [PMID: 37377860 PMCID: PMC10292736 DOI: 10.2106/jbjs.oa.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
When developing educational simulators, meaningful haptic feedback is important. To our knowledge, no shoulder arthroplasty surgical simulator exists. This study focuses on simulating vibration haptics of glenoid reaming for shoulder arthroplasty using a novel glenoid reaming simulator. Methods We validated a novel custom simulator constructed using a vibration transducer transmitting simulated reaming vibrations to a powered nonwearing reamer tip through a 3D-printed glenoid. Validation and system fidelity were evaluated by 9 fellowship-trained shoulder surgeon experts performing a series of simulated reamings. We then completed the validation process through a questionnaire focused on experts' experience with the simulator. Results Experts correctly identified 52% ± 8% of surface profiles and 69% ± 21% of cartilage layers. Experts identified the vibration interface between simulated cartilage and subchondral bone (77% ± 23% of the time), indicating high fidelity for the system. An interclass correlation coefficient for experts' reaming to the subchondral plate was 0.682 (confidence interval 0.262-0.908). On a general questionnaire, the perceived utility of the simulator as a teaching tool was highly ranked (4/5), and experts scored "ease of instrument manipulation" (4.19/5) and "realism of the simulator" (4.11/5) the highest. The mean global evaluation score was 6.8/10 (range 5-10). Conclusions We examined a simulated glenoid reamer and feasibility of haptic vibrational feedback for training. Experts validated simulated vibration feedback for glenoid simulation reaming, and the results suggested that this may be a useful additional training adjuvant. Level of Evidence Level II, prospective study.
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Affiliation(s)
- Jason A. Strelzow
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, Illinois
| | - Jonathan R. Kusins
- Roth|McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Louis M. Ferreira
- Roth|McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Marie-Eve LeBel
- Roth|McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
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Mohammad Sadeghi M, Kececi EF, Kapicioglu M, Aralasmak A, Tezgel O, Basaran MA, Yildiz F, Bilsel K. Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types. J Orthop Surg (Hong Kong) 2022; 30:10225536221079432. [PMID: 35220811 DOI: 10.1177/10225536221079432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Incorrect positioning is one of the main factors for glenoid component loosening in reverse shoulder arthroplasty and component placement can be challenging. This study aimed to assess whether Patient-Specific Instrumentation (PSI) provides better guide pin positioning accuracy and is superior to standard guided and freehand instrumentation methods in cases of glenoid bone deformity. MATERIALS AND METHODS Based on the Walch classification, five different scapula types were acquired by computed tomography (CT). For each type, two different surgeons placed a guide pin into the scapula using three different methods: freehand method, conventional non-patient-specific guide, and PSI guide. Each method was repeated five times by both surgeons. In these experiments, a total of 150 samples of scapula models were used (5 × 2 × 3 × 5 = 150). Post-operative CT scans of the samples with the guide pin were digitally assessed and the accuracy of the pin placement was determined by comparison to the preoperative planning on a three-dimensional (3D) model. RESULTS The PSI method showed accuracies to the preoperative plan of 2.68 (SD 2.10) degrees for version angle (p < .05), 2.59 (SD 2.68) degrees for inclination angle (p < .05), and 1.55 (SD 1.26) mm for entry point offset (p < .05). The mean and standard deviation errors compared to planned values of version angle, inclination angle, and entry point offset were statistically significant for the PSI method for the type C defected glenoid and non-arthritic glenoid. CONCLUSION Using the PSI guide created by an image processing software tool for guide pin positioning showed advantages in glenoid component positioning over other methods, for defected and intact glenoid types, but correlation with clinical outcomes should be examined.
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Affiliation(s)
| | - Emin Faruk Kececi
- Department of Mechanical Engineering Kayseri, 346448Abdullah Gul University, Kayseri, Turkey
| | - Mehmet Kapicioglu
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Aralasmak
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Okan Tezgel
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Murat Alper Basaran
- Department of Management Engineering, 450199Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Fatih Yildiz
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
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Giles JW, Brodén C, Tempelaere C, Emery RJH, Rodriguez y Baena F. Development and ex-vivo assessment of a novel patient specific guide and instrumentation system for minimally invasive total shoulder arthroplasty. PLoS One 2021; 16:e0251880. [PMID: 34019573 PMCID: PMC8139503 DOI: 10.1371/journal.pone.0251880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved? Methods A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step. Results Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7–6.8±2.2–4.0° (0.001<p<0.009) across the humerus implants’ three rotations. Similarly, the glenoid component’s implantation accuracy was 3.0±1.7mm (p = 0.008) in translation and 2.3–4.3±2.2–4.4° (0.008<p<0.09) in rotation. Conclusion This system achieves minimally invasive shoulder replacement with accuracy similar to traditional open techniques while avoiding common causes of complications. Significance This novel technique could lead to a paradigm shift in shoulder arthroplasty for patients with moderate arthritis, which could significantly improve rehabilitation and functional outcomes.
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Affiliation(s)
- Joshua W. Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, British Columbia, Canada
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
- * E-mail: (JWG); (FRB)
| | - Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christine Tempelaere
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Roger J. H. Emery
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Baseplate Options for Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2020; 13:769-775. [PMID: 33034820 DOI: 10.1007/s12178-020-09677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Baseplate fixation has been known to be the weak link in reverse total shoulder arthroplasty (RTSA). A wide variety of different baseplates options are currently available. This review investigates the recent literature to present the reader with an overview of the currently available baseplate options and modes of fixation. RECENT FINDINGS The main elements that differentiate baseplates are the central fixation element, the size of the baseplate, the shape, the backside geometry, whether or not an offset central fixation exists, the number of peripheral screws, and the availability of peripheral augmentation. The wide array of baseplate options indicates that no particular design has proven superiority. As such, surgeons should be aware of their options and choose an implant that the surgeon is comfortable with and one that best suits the individual patient anatomy. With the growing number of RTSA procedures and registries with long-term follow-up, future investigations will hopefully delineate the ideal baseplate design to optimize survivorship.
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A 3-dimensional comparison of hand and power reamers in accuracy of glenoid retroversion correction. J Shoulder Elbow Surg 2020; 29:609-616. [PMID: 31668687 DOI: 10.1016/j.jse.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The study objective was to compare the reaming congruency of hand, power, and visual feedback axial alignment-guided (Marksman) reamers on glenoid models. We hypothesized that (1) a significant difference in average reaming deviation would be found between reamer types and (2) less ream-to-ream variation would occur with the Marksman reamer. METHODS Retroversion correction of 18 identical Sawbones glenoid models was conducted using either a hand, power, or Marksman reamer with a 40-mm curvature radius. Glenoid correction with either 0° or 10° reaming was conducted in triplicate sets for each reamer. Reamed glenoid computed tomography images were 3-dimensionally reconstructed using Mimics Medical software (version 21.0). Congruency between the glenoid surface and a 3-dimensional sphere with a 40-mm curvature radius was analyzed. Average deviation and ream-to-ream variance were compared between the hand, power, and Marksman reamer groups. RESULTS The power reamer demonstrated the smallest median deviation (0.08 mm; interquartile range [IQR], 0.07-0.19 mm), followed by the Marksman (0.09 mm; IQR, 0.08-0.17 mm) and hand (0.11 mm; IQR, 0.10-0.13 mm) reamers. Kruskal-Wallis analysis indicated no significant difference in deviation among the 3 reaming methods (P = .42). The Marksman reamer demonstrated the least variance (0.0034 mm), followed by the power (0.0076 mm) and hand (0.0093 mm) reamers. The results of the Conover squared ranks test indicated no significant difference in variance among the 3 reaming methods (P = .32). CONCLUSION Our findings showed no statistically significant difference in the accuracy or consistency of reaming between reamer types. Trends showed less variance in the Marksman reamer group compared with the hand and power reamer groups, although differences in variation between groups were not statistically significant.
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Kazley JM, Cole KP, Desai KJ, Zonshayn S, Morse AS, Banerjee S. Prostheses for reverse total shoulder arthroplasty. Expert Rev Med Devices 2019; 16:107-118. [DOI: 10.1080/17434440.2019.1568237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Keegan P. Cole
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | | | | | - Samik Banerjee
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Jauregui JJ, Nadarajah V, Shield WP, Henn RF, Gilotra M, Hasan SA. Reverse Shoulder Arthroplasty. JBJS Rev 2018; 6:e3. [DOI: 10.2106/jbjs.rvw.17.00152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Development of a vibration haptic simulator for shoulder arthroplasty. Int J Comput Assist Radiol Surg 2018; 13:1049-1062. [PMID: 29551012 DOI: 10.1007/s11548-018-1734-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Glenoid reaming is a technically challenging step during shoulder arthroplasty that could possibly be learned during simulation training. Creation of a realistic simulation using vibration feedback in this context is innovative. Our study focused on the development and internal validation of a novel glenoid reaming simulator for potential use as a training tool. METHODS Vibration and force profiles associated with glenoid reaming were quantified during a cadaveric experiment. Subsequently, a simulator was fabricated utilizing a haptic vibration transducer with high- and low-fidelity amplifiers; system calibration was performed matching vibration peak-peak values for both amplifiers. Eight experts performed simulated reaming trials. The experts were asked to identify isolated layer profiles produced by the simulator. Additionally, experts' efficiency to successfully perform a simulated glenoid ream based solely on vibration feedback was recorded. RESULTS Cadaveric experimental cartilage reaming produced lower vibrations compared to subchondral and cancellous bones ([Formula: see text]). Gain calibration of a lower-fidelity (3.5 [Formula: see text] and higher-fidelity (3.4 [Formula: see text] amplifier resulted in values similar to the cadaveric experimental benchmark (3.5 [Formula: see text]. When identifying random tissue layer samples, experts were correct [Formula: see text] of the time and success rate varied with tissue type ([Formula: see text]). During simulated reaming, the experts stopped at the targeted subchondral bone with a success rate of [Formula: see text]. The fidelity of the simulation did not have an effect on accuracy, applied force, or reaming time ([Formula: see text]). However, the applied force tended to increase with trial number ([Formula: see text]). CONCLUSIONS Development of the glenoid reaming simulator, coupled with expert evaluation furthered our understanding of the role of haptic vibration feedback during glenoid reaming. This study was the first to (1) propose, develop and examine simulated glenoid reaming, and (2) explore the use of haptic vibration feedback in the realm of shoulder arthroplasty.
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The influence of three-dimensional planning on decision-making in total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1477-1483. [PMID: 28162884 DOI: 10.1016/j.jse.2017.01.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term results and complication rates in shoulder arthroplasty are related to implant positioning. Current literature reports increased precision in glenoid component positioning using 3-dimensional (3D) computed tomography (CT) planning tools. This study evaluated the accuracy of glenoid version and inclination measurements using 2D CT scans compared with a validated 3D software program and its influence on decision making on implant selection. METHODS Preoperative CT scans were obtained from 50 patients undergoing total shoulder arthroplasty. Glenoid version and inclination measurements were performed in random order by 3 independent qualified orthopedic surgeons on reformatted 2D CT scans. Indication for anatomic or reverse shoulder arthroplasty was based on glenoid deformity and on rotator cuff conditions. Results were compared with those from a validated 3D computer software program, and the final decision was made according to the 3D planning. RESULTS Mean preoperative glenoid retroversion on reformatted 2D CT scans was 11.9° ± 9.6° and mean superior inclination was 10.7° ± 8.6°. When the 3D software was used, glenoid retroversion averaged 15.1° ± 10.6° and superior inclination averaged 8.9° ± 9.9°. The 2D CT demonstrated good interobserver and intraobserver reliability for glenoid version and inclination. Decision on the choice of implant was adjusted in 7 patients after the 3D planning. CONCLUSIONS Our findings show that measurements of glenoid version and inclination on reformatted 2D CT scans are less accurate compared with 3D measurements. A preoperative 3D planning software allows for improvement of virtual glenoid positioning and influences the decision making process.
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A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3256931. [PMID: 28105417 PMCID: PMC5220426 DOI: 10.1155/2016/3256931] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
Reversed total shoulder arthroplasty is a popular treatment in rotator cuff arthropathy and in displaced proximal humeral fractures in elderly. In 2016, 29 models of commercially available designs express this popularity. This study describes all the different design parameters available on the market. Prosthetic differences are found for the baseplate, glenosphere, polyethylene, and humeral component and these differences need to be weighed out carefully for each patient knowing that a gain in one mechanical parameter can balance the loss of another. Patient specific implants may help in the future.
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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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Karelse A, Leuridan S, Van Tongel A, Debeer P, Van Der Sloten J, Denis K, De Wilde LF. Consequences of reaming with flat and convex reamers for bone volume and surface area of the glenoid; a basic science study. J Orthop Surg Res 2015; 10:181. [PMID: 26608075 PMCID: PMC4658756 DOI: 10.1186/s13018-015-0312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 10/29/2015] [Indexed: 11/12/2022] Open
Abstract
Background The effect of reaming on bone volume and surface area of the glenoid is not precisely known. We hypothesize that (1) convex reamers create a larger surface area than flat reamers, (2) flat reamers cause less bone loss than convex reamers, and (3) the amount of bone loss increases with the amount of version correction. Methods Reaming procedures with different types of reamers are performed on similar-sized uniconcave and biconcave glenoids created from Sawbones foam blocks. The loss of bone volume, the size of the remaining surface area, and the reaming depth are measured and evaluated. Results Reaming with convex reamers results in a significantly larger surface area than with flat reamers for both uniconcave and biconcave glenoids (p = 0.013 and p = 0.001). Convex reamers cause more bone loss than flat reamers, but the difference is only significant for uniconcave glenoids (p = 0.007). Conclusions In biconcave glenoids, convex reamers remove a similar amount of bone as flat reamers, but offer a larger surface area while maximizing the correction of the retroversion. In pathological uniconcave glenoids, convex reamers are preferred because of the conforming shape.
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Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Steven Leuridan
- Department of Mechanical Engineering, Biomechanics Section, Catholic University of Leuven, Celestijnenlaan 300C, 3001, Heverlee, Belgium.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Philippe Debeer
- Department of Orthopaedics, University Hospital Pellenberg, Weligerveld 1, B-3212, Pellenberg, Belgium.
| | - Jos Van Der Sloten
- Catholic University of Leuven, Celestijnenlaan 300C, 3001, Heverlee, Belgium.
| | - Kathleen Denis
- Catholic University of Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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Digital volume correlation and micro-CT: An in-vitro technique for measuring full-field interface micromotion around polyethylene implants. J Biomech 2015; 48:3447-54. [PMID: 26113290 DOI: 10.1016/j.jbiomech.2015.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 04/21/2015] [Accepted: 05/26/2015] [Indexed: 11/20/2022]
Abstract
Micromotion around implants is commonly measured using displacement-sensor techniques. Due to the limitations of these techniques, an alternative approach (DVC-μCT) using digital volume correlation (DVC) and micro-CT (μCT) was developed in this study. The validation consisted of evaluating DVC-μCT based micromotion against known micromotions (40, 100 and 150 μm) in a simplified experiment. Subsequently, a more clinically realistic experiment in which a glenoid component was implanted into a porcine scapula was carried out and the DVC-μCT measurements during a single load cycle (duration 20 min due to scanning time) was correlated with the manual tracking of micromotion at 12 discrete points across the implant interface. In this same experiment the full-field DVC-μCT micromotion was compared to the full-field micromotion predicted by a parallel finite element analysis (FEA). It was found that DVC-μCT micromotion matched the known micromotion of the simplified experiment (average/peak error=1.4/1.7 μm, regression line slope=0.999) and correlated with the micromotion at the 12 points tracked manually during the realistic experiment (R(2)=0.96). The DVC-μCT full-field micromotion matched the pattern of the full-field FEA predicted micromotion. This study showed that the DVC-μCT technique provides sensible estimates of micromotion. The main advantages of this technique are that it does not damage important parts of the specimen to gain access to the bone-implant interface, and it provides a full-field evaluation of micromotion as opposed to the micromotion at just a few discrete points. In conclusion the DVC-μCT technique provides a useful tool for investigations of micromotion around plastic implants.
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MATTEI LORENZO, MORTERA STEFANO, ARRIGONI CHIARA, CASTOLDI FILIPPO. Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates. JOINTS 2015; 3:72-7. [PMID: 26605254 PMCID: PMC4634807 DOI: 10.11138/jts/2015.3.2.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.
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Affiliation(s)
- LORENZO MATTEI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - STEFANO MORTERA
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - CHIARA ARRIGONI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - FILIPPO CASTOLDI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Knowles NK, Keener JD, Ferreira LM, Athwal GS. Quantification of the position, orientation, and surface area of bone loss in type B2 glenoids. J Shoulder Elbow Surg 2015; 24:503-10. [PMID: 25440510 DOI: 10.1016/j.jse.2014.08.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this computed tomography-based study was to quantify erosions in B2 glenoids. We hypothesized that erosions do not occur symmetrically and that they have a predictable orientation. METHODS This study evaluated 55 type B2 glenoid cases. Computed tomography data were used to create three-dimensional reconstructions, and point coordinates were extracted from each reconstruction for morphologic analysis of the osteoarthritic glenoid and humerus. RESULTS There was a significant difference between the mean orientation angle (28° ± 11°) of the posterior glenoid line of erosion and the superoinferior axis (P < .001), which resulted in the average erosion being directed toward the 8-o'clock position. On average, the erosion started 1.6 ± 3.4 mm posterior to the glenoid center point. In 35% of B2 cases, the line of erosion was curved. The mean surface area was 763 ± 296 mm(2) for the neoglenoid and 957 ± 276 mm(2) for the paleoglenoid, indicating that the neoglenoid occupied 44% ± 12% of the total glenoid area. In this cohort, the mean radius of the humeral head neoarticulation was 32 ± 6 mm, the neoglenoid radius was 37 ± 8 mm, and the paleoglenoid radius was 34 ± 7 mm. The radius of the humeral head was significantly less than that of the neoglenoid (P < .001) and the paleoglenoid (P = .009). In addition, the radius of the neoglenoid was significantly greater than the radius of the paleoglenoid (P = .012). DISCUSSION Type B2 glenoids have a predictable wear pattern, which is not axisymmetric to the glenoid superoinferior axis. In addition, the identified anatomic characteristics of B2 erosions will aid surgeons in the operative management of bone loss and may assist manufacturers in the design of augmented components.
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Affiliation(s)
- Nikolas K Knowles
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Louis M Ferreira
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada.
| | - George S Athwal
- Roth/McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Josephs Health Care, London, ON, Canada
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