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Crane C, Wagner C, Wong S, Hall B, Hull J, Irwin K, Williams K, Brooks A. Glenohumeral Osteoarthritis: A Biological Advantage or a Missed Diagnosis? J Clin Med 2024; 13:2341. [PMID: 38673614 PMCID: PMC11051042 DOI: 10.3390/jcm13082341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis's true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis.
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Affiliation(s)
- Camille Crane
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Caleb Wagner
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Stephen Wong
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Bryce Hall
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Jillian Hull
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Katharine Irwin
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Kaitlin Williams
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Amanda Brooks
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
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Muench LN, Murphey M, Oei B, Kia C, Obopilwe E, Cote MP, Mazzocca AD, Berthold DP. Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty. BMC Musculoskelet Disord 2023; 24:171. [PMID: 36882825 PMCID: PMC9990317 DOI: 10.1186/s12891-023-06273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Elliptical shape humeral head prostheses have been recently proposed to reflect a more anatomic shoulder replacement. However, its effect on obligate glenohumeral translation during axial rotation compared to a standard spherical head is still not well understood. The purpose of the study was to compare obligate humeral translation during axial rotation using spherical and elliptical shaped humeral head prostheses. It was hypothesized that the spherical head design would show significantly more obligate translation when compared to the elliptical design. METHODS Six fresh-frozen cadaveric shoulders were utilized for biomechanical testing of internal (IR) and external (ER) rotation at various levels of abduction (0°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native; total shoulder arthroplasty (TSA) using (2) an elliptical and (3) spherical humeral head implant. Obligate translation during IR and ER was quantified using a 3-dimensional digitizer. The radius of curvature of the superoinferior and anteroposterior dimensions of the implants was calculated across each condition. RESULTS Posterior and inferior translation as well as compound motion of spherical and elliptical heads during ER was similar at all abduction angles (P > 0.05, respectively). Compared to the native humeral head, both implants demonstrated significantly decreased posterior translation at 45° (elliptical: P = 0.003; spherical: P = 0.004) and 60° of abduction (elliptical: P < 0.001; spherical: P < 0.001). During internal rotation at 0° abduction, the spherical head showed significantly more compound motion (P = 0.042) compared to the elliptical head. The spherical implant also demonstrated increased anterior translation and compound motion during internal rotation at 60° abduction (P < 0.001) compared to the resting state. This difference was not significant for the native or elliptical head design at this angle (P > 0.05). CONCLUSION In the setting of TSA, elliptical and spherical head implants showed similar obligate translation and overall compound motion during axial rotation. A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Matthew Murphey
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Bridget Oei
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Augustus D Mazzocca
- Massachusetts General Brigham, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients. Diagnostics (Basel) 2022; 12:diagnostics12102507. [PMID: 36292196 PMCID: PMC9600260 DOI: 10.3390/diagnostics12102507] [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: 08/16/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient’s age has to be taken into account in shoulder diagnostics and surgery.
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Standard radiological classification of glenohumeral osteoarthritis does not correlate with the complexity of the arthritic glenoid deformity. Arch Orthop Trauma Surg 2022; 142:1413-1420. [PMID: 33507378 DOI: 10.1007/s00402-021-03758-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Samilson-Prieto classification (SPC) depending on the humeral osteophyte length on a-pX-rays today is widely used to classify glenohumeral osteoarthritis in general. For treatment planning and prognosis, the patho-morphology of the glenoid and static posterior subluxation of the humeral head classified according to Walch is of much higher importance. Here, usually a CT or MRI scan is required for a correct classification. A possible correlation between both classifications is poorly explored. Without it, the complexity of the case might be mis-interpreted using the SPC. The aim of this study was to investigate such a correlation, i.e. whether it correlates with the glenoid deformity and degree of humeral head subluxation. PATIENTS AND METHODS Radiological datasets (X-ray and CT or MRI) of 352 patients with primary OA of the shoulder were evaluated by two observers experienced in shoulder surgery. For the Samilson-Prieto classification, true a-p shoulder radiographs and for the modified Walch classification CT or MRI scans in the axial plane were interpreted using a validated method. To investigate a correlation between both classifications, the Fisher's exact test was used. For the interobserver reliability, the weighted kappa coefficient κ was determined. RESULTS For the Walch classification, both observers found a similar percentage for the different types, with decreasing numbers from normal (type A1) to severely altered glenoids In the Samilson-Prieto classification, OA grade I was predominant, while grade II and III showed a relatively equal distribution. Interobserver reliability was high both for the Walch classification with a κ 0.923 (95% confidence interval 0.892; 0.954) and) for the SPC with a κ 0.88 (95% confidence interval 0.843; 0.916). A correlation between the two classifications in Fischer's exact test could not be shown (p = 0.584). DISCUSSION Since there is no correlation between both, using the Samilson-Prieto classification alone might miss relevant prognostic factors in gleno-humeral OA. Adequate imaging of the glenoid morphology also in the axial plane is absolutely mandatory to understand the complexity and chose the right treatment for each patient. LEVEL OF EVIDENCE Study of Diagnostic Test-Level II.
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Muench LN, Otto A, Kia C, Obopilwe E, Cote MP, Imhoff AB, Beitzel K, Mazzocca AD, Mehl J. Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation. Arch Orthop Trauma Surg 2022; 142:67-76. [PMID: 32865631 PMCID: PMC8732933 DOI: 10.1007/s00402-020-03587-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/16/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Elliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement. Its effect on the rotational range of motion (ROM) compared to a standard spherical head is still not understood. The purpose was to investigate if there would be a difference in rotational ROM when comparing elliptical and spherical prosthetic heads in a dynamic shoulder model. The authors hypothesized that the use of elliptical heads would result in significantly more rotational ROM compared to the spherical head design. MATERIALS AND METHODS Six fresh-frozen, cadaveric shoulders were evaluated using a dynamic shoulder model. After being tested in the native condition, each specimen underwent 6 conditions in the hemiarthroplasty state: (1) matched-fit spherical head, (2) oversized spherical head, (3) undersized spherical head, (4) matched-fit elliptical head, (5) oversized elliptical head, and (6) undersized elliptical head. Following conversion to total shoulder arthroplasty (TSA), the 6 prior conditions were rerun. Each condition was tested at 0°, 30° and 60° of glenohumeral abduction. Rotational ROM was quantified using 3-dimensional tracking, while dynamically applying alternating forces for internal and external rotation via the rotator cuff tendons. RESULTS Elliptical and spherical prosthetic heads showed no significant difference in the degree of the total, internal, and external rotational ROM for both the hemiarthroplasty and TSA state. Conversion from hemiarthroplasty to TSA resulted in less degree of total rotational ROM for both head designs in all abduction positions, without reaching statistical significance. There was a significant decrease in total, internal, and external rotational ROM for both elliptical and spherical heads in every replacement condition, when comparing 0° to 30° and 60° of abduction (P < 0.05, respectively). CONCLUSION In a dynamic shoulder model, elliptical and spherical prosthetic head designs showed no significant difference in the degree of the total, internal, and external rotational ROM in both the hemiarthroplasty and TSA state. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Otto
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany ,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany ,Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
| | | | - Julian Mehl
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Serrano N, Kissling M, Krafft H, Link K, Ullrich O, Buck FM, Mathews S, Serowy S, Gascho D, Grüninger P, Fornaciari P, Bouaicha S, Müller-Gerbl M, Rühli FJ, Eppler E. CT-based and morphological comparison of glenoid inclination and version angles and mineralisation distribution in human body donors. BMC Musculoskelet Disord 2021; 22:849. [PMID: 34610804 PMCID: PMC8493698 DOI: 10.1186/s12891-021-04660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background For optimal prosthetic anchoring in omarthritis surgery, a differentiated knowledge on the mineralisation distribution of the glenoid is important. However, database on the mineralisation of diseased joints and potential relations with glenoid angles is limited. Methods Shoulder specimens from ten female and nine male body donors with an average age of 81.5 years were investigated. Using 3D-CT-multiplanar reconstruction, glenoid inclination and retroversion angles were measured, and osteoarthritis signs graded. Computed Tomography-Osteoabsorptiometry (CT-OAM) is an established method to determine the subchondral bone plate mineralisation, which has been demonstrated to serve as marker for the long-term loading history of joints. Based on mineralisation distribution mappings of healthy shoulder specimens, physiological and different CT-OAM patterns were compared with glenoid angles. Results Osteoarthritis grades were 0-I in 52.6% of the 3D-CT-scans, grades II-III in 34.3%, and grade IV in 13.2%, with in females twice as frequently (45%) higher grades (III, IV) than in males (22%, III). The average inclination angle was 8.4°. In glenoids with inclination ≤10°, mineralisation was predominantly centrally distributed and tended to shift more cranially when the inclination raised to > 10°. The average retroversion angle was − 5.2°. A dorsally enhanced mineralisation distribution was found in glenoids with versions from − 15.9° to + 1.7°. A predominantly centrally distributed mineralisation was accompanied by a narrower range of retroversion angles between − 10° to − 0.4°. Conclusions This study is one of the first to combine CT-based analyses of glenoid angles and mineralisation distribution in an elderly population. The data set is limited to 19 individuals, however, indicates that superior inclination between 0° and 10°-15°, and dorsal version ranging between − 9° to − 3° may be predominantly associated with anterior and central mineralisation patterns previously classified as physiological for the shoulder joint. The current basic research findings may serve as basic data set for future studies addressing the glenoid geometry for treatment planning in omarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04660-4.
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Affiliation(s)
- Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Marc Kissling
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Hannah Krafft
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Anatomy, University of Fribourg, Fribourg, Switzerland
| | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland
| | - Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Paolo Fornaciari
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital Fribourg, Fribourg, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland.
| | - Elisabeth Eppler
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland. .,Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany. .,Institute of Anatomy, University of Bern, Bern, Switzerland.
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Arenas-Miquelez A, Liu VK, Cavanagh J, Graham PL, Ferreira LM, Bokor DJ, Athwal GS, Raniga S. Does the Walch type B shoulder have a transverse force couple imbalance? A volumetric analysis of segmented rotator cuff muscles in osteoarthritic shoulders. J Shoulder Elbow Surg 2021; 30:2344-2354. [PMID: 33675976 DOI: 10.1016/j.jse.2021.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The etiology of the Walch type B shoulder remains unclear. We hypothesized that a scapulohumeral muscle imbalance, due to a disturbed transverse force couple (TFC) between the anterior and posterior rotator cuff muscles, may have a role in the pathogenesis of the type B morphology. The purpose of this study was to determine whether there is a TFC imbalance in the Walch type B shoulder using an imaging-based 3-dimensional (3D) volumetric and fatty infiltration assessment of segmented rotator cuff muscles. METHODS Computed tomography images of 33 Walch type A and 60 Walch type B shoulders with the complete scapula and humerus including the distal humeral epicondyles were evaluated. The 3D volumes of the entire subscapularis, supraspinatus, and infraspinatus-teres minor (Infra-Tm) were manually segmented and analyzed. Additionally, anthropometric parameters including glenoid version, glenoid inclination, posterior humeral head subluxation, and humeral torsion were measured. The 3D muscle analysis was then compared with the anthropometric parameters using the Wilcoxon rank sum and Kruskal-Wallis tests. RESULTS There were no significant differences (P > .200) in muscle volume ratios between the Infra-Tm and the subscapularis in Walch type A (0.93) and type B (0.96) shoulders. The fatty infiltration percentage ratio, however, was significantly greater in type B shoulders (0.94 vs. 0.75, P < .001). The Infra-Tm to subscapularis fatty infiltration percentage ratio was significantly larger in patients with >75% humeral head subluxation than in those with 60%-75% head subluxation (0.97 vs. 0.74, P < .001) and significantly larger in patients with >25° of retroversion than in those with <15° of retroversion (1.10 vs. 0.75, P = .004). The supraspinatus fatty infiltration percentage was significantly lower in Walch type B shoulders than type A shoulders (P = .004). Walch type A shoulders had mean humeral retrotorsion of 22° ± 10° whereas Walch type B shoulders had humeral retrotorsion of only 14° ± 9° relative to the epicondylar axis (P < .001). CONCLUSION The TFC is in balance in the Walch type B shoulder in terms of 3D volumetric rotator cuff muscle analysis; however, the posterior rotator cuff does demonstrate increased fatty infiltration. Posterior humeral head subluxation and glenoid retroversion, which are pathognomonic of the Walch type B shoulder, may lead to a disturbance in the length-tension relationship of the posterior rotator cuff, causing fatty infiltration.
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Affiliation(s)
- Antonio Arenas-Miquelez
- MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Victor K Liu
- MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joseph Cavanagh
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Sydney, NSW, Australia
| | - Louis M Ferreira
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada; Department of Mechanical & Materials Engineering, The University of Western Ontario, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Desmond J Bokor
- MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Sumit Raniga
- MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse shoulder arthroplasty. EFORT Open Rev 2021; 6:918-931. [PMID: 34760291 PMCID: PMC8559568 DOI: 10.1302/2058-5241.6.210014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Cavanagh J, Lockhart J, Langohr GDG, Johnson JA, Athwal GS. A comparison of patient-specific instrumentation to navigation for conducting humeral head osteotomies during shoulder arthroplasty. JSES Int 2021; 5:875-880. [PMID: 34505099 PMCID: PMC8411057 DOI: 10.1016/j.jseint.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The humeral head osteotomy during shoulder arthroplasty influences humeral component height, version and possibly neck-shaft angle. These parameters all potentially influence outcomes of anatomic and reverse shoulder replacement to a variable degree. Patient-specific guides and navigation have been studied and utilized clinically for glenoid component placement. Little, however, has been done to evaluate these techniques for humeral head osteotomies. The purpose of this study, therefore, was to evaluate the use of patient-specific guides and surgical navigation for executing a planned humeral head osteotomy. Methods The DICOM images of 10 shoulder computed tomography scans (5 normal and 5 osteoarthritic) were used to print 3D polylactic models of the humerus. Each model was duplicated, such that there were 2 identical groups of 10 models. After preoperative planning of a humeral head osteotomy, Group 1 underwent osteotomy via a patient-specific guide, while group 2 underwent a real time navigated osteotomy with an optically tracked sagittal saw. The cut height (millimeters), version (degrees) and neck-shaft angle (degrees) were recorded and statistically compared between groups. Results There were no statistically significant differences between patient-specific guides and navigation for osteotomy cut height (P = .45) and humeral version (P = .059). Navigation, however, resulted in significantly less neck-shaft angle error than the patient specific guides (P = .023). Subgroup analysis of the osteoarthritic cases showed statistical significance for navigation resulting in less version error than the patient specific guides (P = .048). Conclusion No significant differences were found between patient specific guides and navigation for recreation of the preoperatively planned humeral head cut height and version. Neck-shaft angle, however, had significantly less deviation from the preoperative plan when conducted with navigation.
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Affiliation(s)
- Joseph Cavanagh
- Investigations performed at the Roth
- McFarlane Hand and Upper Limb Center Biomechanics Laboratory, London, ON, Canada
| | - Jason Lockhart
- Investigations performed at the Roth
- McFarlane Hand and Upper Limb Center Biomechanics Laboratory, London, ON, Canada
| | - G Daniel G Langohr
- Investigations performed at the Roth
- McFarlane Hand and Upper Limb Center Biomechanics Laboratory, London, ON, Canada
| | - James A Johnson
- Investigations performed at the Roth
- McFarlane Hand and Upper Limb Center Biomechanics Laboratory, London, ON, Canada
| | - George S Athwal
- Investigations performed at the Roth
- McFarlane Hand and Upper Limb Center Biomechanics Laboratory, London, ON, Canada
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Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:jcm10061196. [PMID: 33809287 PMCID: PMC7999215 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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11
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Lädermann A, Athwal GS, Bothorel H, Collin P, Mazzolari A, Raiss P, Charbonnier C. Scapulothoracic Alignment Alterations in Patients with Walch Type B Osteoarthritis: An In Vivo Dynamic Analysis and Prospective Comparative Study. J Clin Med 2020; 10:jcm10010066. [PMID: 33375443 PMCID: PMC7794942 DOI: 10.3390/jcm10010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Kinematic changes of the scapulothoracic joint may influence the relative position of the glenoid fossa and, consequently, the glenohumeral joint. As the alignment of the scapula relative to the thorax differs between individuals, such variability may be another factor in the development of posterior head subluxation. The purpose of this study was to compare scapulothoracic alignment in pathologic type B shoulders with contralateral healthy shoulders. Methods: Seven adult volunteers with unilateral type B glenohumeral osteoarthritis (OA) underwent bilateral computed tomography (CT) scans of the shoulders and arms. A patient-specific, three-dimensional measurement technique that coupled medical imaging (i.e., CT) and optical motion capture was used. Results: The scapulothoracic distance at the trigonum was 75 ± 15 mm for pathologic shoulders and 78 ± 11 mm for healthy shoulders (p = 0.583), while at the inferior angle, it was 102 ± 18 mm for pathologic shoulders and 108 ± 12 mm for healthy shoulders (p = 0.466). Conclusion: Scapula positioning at a resting position did not differ between pathologic and healthy shoulders. However, pathologic shoulders tended to be limited in maximal glenohumeral motion and exhibited greater anterior tilt of the scapula in internal rotation at 90 degrees, which may be adaptive to the restricted glenohumeral motion.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-719-75-55; Fax: +41-22-719-60-77
| | - George S. Athwal
- Department of Surgery, Roth MacFarlane Hand and Upper Limb Center, St. Joseph’s Health Care London, London, ON N6A 4V2, Canada;
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217 Meyrin, Switzerland;
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), 35760 Saint-Grégoire, France;
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
| | - Patric Raiss
- Shoulder and Elbow Surgery, OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
| | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Medical Research Department, Artanim Foundation, 1217 Meyrin, Switzerland
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12
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Abstract
Background Precise anatomic reconstruction of the proximal humerus is essential to a favorable outcome of total shoulder arthroplasty. Because of the wide variation in the geometric features of the proximal humerus, prosthetic designs incorporating these disparities are being developed. Methods The aim of this study is to use data obtained from cadavers and computed tomographic scans to investigate the 3-dimensional morphometric parameters of the proximal humerus of South African and Swiss samples and make an interpopulation comparison. In addition, the study combines the interarticular variations between populations with the differences in sex and shoulder sides. With the aid of medical imaging techniques and engineering design tools, various geometric features were measured. Results The results obtained from these analyses revealed several differences in sex and shoulder sides. On average, the Swiss were larger in most of the measured parameters than the South Africans. The male shoulders of Swiss and South Africans were observed to significantly vary in 4 of the parameters measured. The South African male and female right shoulders varied considerably in one-fourth of the measured shoulder variables. Generally, for both populations, the left and right shoulders of the same individuals were not different in all the measured variables irrespective of sex. Conclusion The knowledge acquired in this study is expected to assist in the development of a population-specific shoulder prosthetic design and surgical planning procedures.
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13
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Normal and Pathoanatomy of the Arthritic Shoulder: Considerations for Shoulder Arthroplasty. J Am Acad Orthop Surg 2019; 27:e1068-e1076. [PMID: 31206438 DOI: 10.5435/jaaos-d-18-00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The glenohumeral joint is a highly mobile, complex articulation that relies not only on the bony support between the humeral head and glenoid but also on appropriate balance and tension of the surrounding soft-tissue structures. Recreating the normal anatomic relationships is a basic premise in joint arthroplasty, which can be challenging in shoulder arthroplasty, as the normal glenohumeral anatomy has considerable variation from patient to patient. Also, as the anatomy of the glenohumeral joint becomes distorted with advanced shoulder pathology, it becomes a challenge to return the shoulder to its premorbid anatomic state. Failure to restore normal anatomic parameters after shoulder arthroplasty has been shown to have deleterious effects on postoperative function and implant survival. As the recognition of this has grown, shoulder prostheses have evolved to allow for considerable more variation in an attempt to recreate patient-specific anatomy. However, understanding the progression of shoulder pathology to better predict the patient's premorbid anatomy remains limited. A thorough understanding of the premorbid and pathologic anatomy of the glenohumeral joint will aid in preoperative planning and intraoperative execution and lead to a more predictable reconstruction of the shoulder, which is critical for a successful outcome after shoulder arthroplasty.
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14
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The Walch type B humerus: glenoid retroversion is associated with torsional differences in the humerus. J Shoulder Elbow Surg 2019; 28:1801-1808. [PMID: 31043349 DOI: 10.1016/j.jse.2019.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Walch type B glenoid has the hallmark features of retroversion, joint subluxation, and bony erosion. Although the type B glenoid has been well described, the morphology of the corresponding type B humerus is poorly understood. As such, the aim of this imaging-based anthropometric study was to investigate humeral torsion in Walch type B shoulders. METHODS Three-dimensional models of the full-length humerus were generated from computed tomography data for the Walch type B group (n = 59) and for a control group of normal nonarthritic shoulders (n = 59). An anatomic humeral head-neck plane was created and used to determine humeral torsion relative to the epicondylar axis. Measurements were repeated, and intraclass correlation coefficients were calculated. RESULTS The type B humeri had significantly (P < .001) less retrotorsion (14° ± 9°) than the control group (36° ± 12°) relative to the epicondylar axis. Male and female individuals within the control group showed statistically significant differences in humeral torsion (P = .043), which were not found in the type B group. Inter-rater reliability showed excellent agreement for humeral torsion (intraclass correlation coefficient, 0.962). A subgroup analysis between Walch type B2 and B3 shoulders showed no significant differences in any of the humeral or glenoid parameters. CONCLUSION The Walch type B humerus has significantly less retrotorsion than non-osteoarthritic shoulders. At present, it is unknown whether the altered humeral retrotorsion is a cause or effect of the type B glenoid. In addition, it is unknown whether surgeons should be reconstructing type B2 humeral component version to pathologic torsion or to nonpathologic population means to optimize arthroplasty survivorship.
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Zhang H, Heckelman LN, Spritzer CE, Owusu-Akyaw KA, Martin JT, Taylor DC, Moorman C, Garrigues GE, DeFrate LE. In Vivo Assessment of Exercise-Induced Glenohumeral Cartilage Strain. Orthop J Sports Med 2018; 6:2325967118784518. [PMID: 30023404 PMCID: PMC6047251 DOI: 10.1177/2325967118784518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The human shoulder joint is the most mobile joint in the body. While in vivo shoulder kinematics under minimally loaded conditions have been studied, it is unclear how glenohumeral cartilage responds to high-demand loaded exercise. HYPOTHESIS A high-demand upper extremity exercise, push-ups, will induce compressive strain in the glenohumeral articular cartilage, which can be measured with validated magnetic resonance imaging (MRI)-based techniques. STUDY DESIGN Descriptive laboratory study. METHODS High-resolution MRI was used to measure in vivo glenohumeral cartilage thickness before and after exercise among 8 study participants with no history of upper extremity injury or disease. Manual MRI segmentation and 3-dimensional modeling techniques were used to generate pre- and postexercise thickness maps of the humeral head and glenoid cartilage. Strain was calculated as the difference between pre- and postexercise cartilage thickness, normalized to the pre-exercise cartilage thickness. RESULTS Significant compressive cartilage strains of 17% ± 6% and 15% ± 7% (mean ± 95% CI) were detected in the humeral head and glenoid cartilage, respectively. The anterior region of the glenoid cartilage experienced a significantly higher mean strain (19% ± 6%) than the posterior region of the glenoid cartilage (12% ± 8%). No significant regional differences in postexercise humeral head cartilage strain were observed. CONCLUSION Push-ups induce compressive strain on the glenohumeral joint articular cartilage, particularly at the anterior glenoid. This MRI-based methodology can be applied to further the understanding of chondral changes in the shoulder under high-demand loading conditions. CLINICAL RELEVANCE These results improve the understanding of healthy glenohumeral cartilage mechanics in response to loaded upper extremity exercise. In the future, these methods can be applied to identify which activities induce high glenohumeral cartilage strains and deviations from normal shoulder function.
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Affiliation(s)
- Hanci Zhang
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Lauren N. Heckelman
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - Kwadwo A. Owusu-Akyaw
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - John T. Martin
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Dean C. Taylor
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - C.T. Moorman
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Grant E. Garrigues
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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16
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West EA, Knowles NK, Athwal GS, Ferreira LM. A 3D comparison of humeral head retroversion by sex and measurement technique. Shoulder Elbow 2018; 10:192-200. [PMID: 29796107 PMCID: PMC5960870 DOI: 10.1177/1758573217711897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate humeral head reconstruction during shoulder arthroplasty is partially dependent on correctly estimating and replicating native version. The present study evaluated the effects of sex and measurement technique on three-dimensional (3D) humeral version measurements made using the transepicondylar, forearm and flexion-extension axes. METHODS Fifty-two full-arm computed tomography scans were converted to 3D models and geometry extracted to define landmarks and coordinate systems. An anatomic humeral head osteotomy plane was used to measure version relative to the three measurement techniques and compare between sexes. RESULTS The measurement technique used had a significant affect (p < 0.001) on the resulting version measurement. The forearm axis technique consistently resulted in higher measured version compared to either the flexion-extension [mean (SD) males 9° (4°), females 13° (5°), p < 0.001] or the transepicondylar axes [mean (SD) males 8° (4°), females 11° (4°), p < 0.001]. Version in males was 7° greater than females when referencing either the flexion-extension [p = 0.029; mean (SD) males 37.7° (11°), females 30.4° (13°)] or transepicondylar axes [p = 0.045; mean (SD) males 39° (11°), females 32° (12°)]. CONCLUSIONS The choice of measurement technique can affect the humeral version angle. These results are important because measuring version using the epicondyles pre-operatively, and subsequently the forearm intra-operatively, will result in approximately 10° under-retroverted osteotomy. For example, 0° neutral version cut during reverse arthroplasty measured referencing the forearm results in 10° anteverted osteotomy when referencing the distal humerus.
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Affiliation(s)
- Emily A. West
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada,Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, ON, Canada
| | - Nikolas K. Knowles
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada,Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, ON, Canada
| | - George S. Athwal
- Department of Surgery, The University of Western Ontario, London, ON, Canada,Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, ON, Canada
| | - Louis M. Ferreira
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada,Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, ON, Canada,Louis M. Ferreira, 1151 Richmond St, London ON, N6A 3K7, Canada.
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17
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Chalmers PN, Granger EK, Orvets ND, Patterson BM, Chamberlain AM, Keener JD, Tashjian RZ. Does prosthetic humeral articular surface positioning associate with outcome after total shoulder arthroplasty? J Shoulder Elbow Surg 2018; 27:863-870. [PMID: 29289492 DOI: 10.1016/j.jse.2017.10.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the effect of humeral articular component positioning on changes in patient-reported outcomes after anatomic total shoulder arthroplasty. METHODS This was a retrospective series of consecutive patients at 2 high-volume referral centers. The study included patients with (1) a preoperative and postoperative radiograph demonstrating a perfect or nearly perfect profile of the humerus and implant and (2) Simple Shoulder Test, visual analog scale for pain, and American Society of Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment scores preoperatively and at greater than 2 years postoperatively. Head height, head diameter, tuberosity-to-head height distance, inclination, and medial offset of the center of rotation (COR) were measured preoperatively and postoperatively. Distance and direction from the ideal COR to the reconstructed center of rotation was measured. Measurements were correlated with improvement in functional outcomes. RESULTS The study included 95 patients, aged 66 ± 9 years, with a mean follow-up of 4.3 ± 1.7 years. An a priori power analysis suggested that a sample size of 95 patients provided 80% power to detect correlations of R2 = 0.07. The COR shift was >2 mm in 62% of patients and >4 mm 15%. Thirty-two percent had a change of ASES of <21 points. On multivariate analysis, there were no significant associations between any change in measured prosthetic radiographic parameters and changes in the visual analog scale, Simple Shoulder Test, or ASES scores (P > .05). CONCLUSION In this retrospective analysis of total shoulder arthroplasty in which most components were well positioned, humeral component positioning did not associate with change in postoperative outcomes. These findings should be prospectively confirmed.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Erin K Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan D Orvets
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Brendan M Patterson
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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18
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Dey R, Roche S, Rosch T, Mutsvangwa T, Charilaou J, Sivarasu S. Anatomic variations in glenohumeral joint: an interpopulation study. JSES OPEN ACCESS 2018; 2:1-7. [PMID: 30675559 PMCID: PMC6334885 DOI: 10.1016/j.jses.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study focused on the unique aspect of investigating shoulder morphometric differences between 2 distinct populations. Methods We used 90 computed tomography images of cadaveric shoulders for this study; 45 scans belonged to the South African (SA) cohort (49.74 ± 15.4 years) and the rest were Swiss (CH; 53.8 ± 21 years). The articulating surfaces of the glenohumeral joint were extracted, and their morphometric features, such as head circular diameter, glenoid and humeral head radius of curvature, head height, and humeral height, were measured. Results The mean interpopulation difference in the circular diameter of the humerus was 2.0 mm (P = .017) and 1.86 mm (P > .05) in the anterior-posterior and superior-inferior directions, respectively. The difference in the radius of curvature between the populations was 1.17 mm (P = .037). The SA shoulders were found to be longer than the CH shoulders by 8.4 mm (P > .05). There was no significant difference in the glenoid radius of curvature. The SA shoulders had higher glenohumeral mismatch (P = .005) and lower conformity index (P = .001) in comparison to the CH shoulders. Conclusion This study presents anatomic differences between African and European glenohumeral articulating surfaces. The results suggest that the glenohumeral geometry is both gender and population specific, and future joint replacements may be designed to address these differences.
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Affiliation(s)
- Roopam Dey
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Steven Roche
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Theo Rosch
- Jakaranda Hospital, Pretoria, South Africa
| | - Tinashe Mutsvangwa
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Johan Charilaou
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Corresponding author: Sudesh Sivarasu, PhD, Department of Human Biology, UCT Medical Campus, 7.17, Anatomy Building, Anzio Road, Observatory, Cape Town 7935, South Africa. (S. Sivarasu).
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Habermeyer P, Magosch P, Weiß C, Hawi N, Lichtenberg S, Tauber M, Ipach B. Classification of humeral head pathomorphology in primary osteoarthritis: a radiographic and in vivo photographic analysis. J Shoulder Elbow Surg 2017; 26:2193-2199. [PMID: 28943071 DOI: 10.1016/j.jse.2017.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head. METHODS The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads. RESULTS In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%. CONCLUSION It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.
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Affiliation(s)
| | - Petra Magosch
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Christel Weiß
- Medizinische Fakultät Mannheim, Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Germany
| | - Nael Hawi
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
| | - Sven Lichtenberg
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injury, Paracelsus Medical University, Salzburg, Austria
| | - Bastian Ipach
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
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20
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Matsuki K, Sugaya H, Hoshika S, Ueda Y, Takahashi N, Tokai M, Onishi K, Banks SA. Geometric Analysis of the Proximal Humerus in Elderly Japanese Patients: Implications for Implant Selection in Reverse Shoulder Arthroplasty. Orthopedics 2017; 40:e485-e490. [PMID: 28295120 DOI: 10.3928/01477447-20170308-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
The implants used in reverse shoulder arthroplasty were originally designed for white patients; thus, they might not be optimal for smaller Asian patients. The selection of reverse shoulder arthroplasty systems is limited in Japan. The purpose of this study was to measure the geometry of the proximal humerus in elderly Japanese patients to inform implant selection according to humerus size. This study included 155 shoulders from 148 patients 50 years or older who underwent computed tomography for shoulder disorders other than arthritis and trauma. There were 67 male and 81 female patients with mean ages of 68 and 66 years, respectively. The humeral head diameter, head height, neck-shaft angle, neck diameters, and osteotomy diameters for 155° inclination implants were measured using surface models created from computed tomography scans. The mean diameter of head curvature, humeral head height, and neck-shaft angle were 48.2 mm, 19.8 mm, and 136° for male patients and 42.4 mm, 17.1 mm, and 136° for female patients, respectively. The mean mediolateral and anteroposterior neck diameters were 46.9 mm and 43.7 mm for men and 41.6 mm and 38.4 mm for women, respectively. The mean mediolateral and anteroposterior osteotomy diameters were 42.2 mm and 41.2 mm for male patients and 38.6 mm and 36.7 mm for female patients, respectively. There were significant differences between the sexes in all measurements except neck-shaft angle. Humeral implants with 155° inclination will not fit the humerus of smaller Japanese women. Thus, implants with anatomical inclination and an onlay humeral tray may be a better choice for smaller patients. [Orthopedics. 2017; 40(3):e485-e490.].
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21
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Suter T, Kolz CW, Tashjian RZ, Henninger HB, Gerber Popp A. Humeral head osteotomy in shoulder arthroplasty: a comparison between anterosuperior and inferoanterior resection techniques. J Shoulder Elbow Surg 2017; 26:343-351. [PMID: 27720559 DOI: 10.1016/j.jse.2016.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The best chance that a shoulder arthroplasty will restore motion and muscle balance across the glenohumeral joint is by closely replicating natural articular morphology. Defining the humeral osteotomy plane along clear landmarks at the anatomic neck is critical. We hypothesized that a new osteotomy, based on alternative landmarks on the anatomic neck, would restore 3-dimensional humeral head morphology more reliably than the traditional osteotomy. METHODS The anatomic neck was digitized in 30 human cadaver shoulders and compared with its 3-dimensional computed tomography reconstruction. Two different osteotomy techniques were virtually performed: the traditional, following the anterosuperior anatomic neck; and a new technique, defined by the inferoanterior anatomic neck. The length-width difference and orientation (retroversion, inclination) of the resection area were compared between the techniques and with native anatomy. RESULTS Length-width difference of the anterosuperior resection area was higher than in the inferoanterior osteotomy (6 ± 2 mm vs. 3 ± 1 mm; P < .001). Retroversion of the anterosuperior resection plane was higher than the native head (50° ± 12° vs. 37° ± 11°; P < .001), whereas retroversion after the inferoanterior osteotomy (32° ± 12°) did not differ from native (P = .057). Inclination differed after the anterosuperior osteotomy (129° ± 5°) and the inferoanterior osteotomy (127° ± 4°) compared with the native head (134° ± 4°; P ≤ .001). CONCLUSION The inferoanterior referenced osteotomy generated a more circular resection area, matching the native humeral head retroversion more closely than in the anterosuperior technique. This study suggests that in shoulder arthroplasty, the humeral resection level should be referenced at the inferoanterior rather than the anterosuperior anatomic neck. Further studies should investigate the biomechanical effects of this alternative resection plane.
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Affiliation(s)
- Thomas Suter
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Christopher W Kolz
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Ariane Gerber Popp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
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