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Twomey-Kozak J, Adu-Kwarteng K, Lunn K, Briggs DV, Hurley E, Anakwenze OA, Klifto CS. Recent Advances in the Design and Application of Shoulder Arthroplasty Implant Systems and Their Impact on Clinical Outcomes: A Comprehensive Review. Orthop Res Rev 2024; 16:205-220. [PMID: 39081796 PMCID: PMC11288362 DOI: 10.2147/orr.s312870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose of Review This narrative review comprehensively aims to analyze recent advancements in shoulder arthroplasty, focusing on implant systems and their impact on patient outcomes. The purpose is to provide a nuanced understanding of the evolving landscape in shoulder arthroplasty, incorporating scientific, regulatory, and ethical dimensions. Recent Findings The review synthesizes recent literature on stemless implants, augmented glenoid components, inlay vs onlay configurations, convertible stems, and associated complications. Notable findings include improved patient-reported outcomes with stemless implants, variations in outcomes between inlay and onlay configurations, and the potential advantages of convertible stems. Additionally, the regulatory landscape, particularly the FDA's 510(k) pathway, is explored alongside ethical considerations, emphasizing the need for standardized international regulations. Summary Recent innovations in shoulder arthroplasty showcase promising advancements, with stemless implants demonstrating improved patient outcomes. The review underscores the necessity for ongoing research to address unresolved aspects and highlights the importance of a standardized regulatory framework to ensure patient safety globally. The synthesis of recent findings contributes to a comprehensive understanding of the current state of shoulder arthroplasty, guiding future research and clinical practices.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kwabena Adu-Kwarteng
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kiera Lunn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Damon Vernon Briggs
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Döring J, Bormann T, Buchholz A, Hembus J, Rothammer B, Uhler M. [Tribology in arthroplasty : Friction and wear, a key to a long lifetime]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:479-486. [PMID: 38833160 DOI: 10.1007/s00132-024-04520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
This article is intended to highlight one of the key roles in endoprosthetic treatment with artificial implants and the extension of service life. Like every joint, artificial joints are subject to the physical laws of friction and wear-in short, tribology. Material pairings, surfaces and mechanisms of action in particular play a decisive role here. The special features and current findings relating to the three largest synovial joints (hip, knee and shoulder) will be discussed in detail and suggestions will be made for future developments. Continuous developments in the field of the tribology of artificial joints can massively improve care for patients. The revision figures and reasons already show the success of individual improvements in recent years.
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Affiliation(s)
- Joachim Döring
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Therese Bormann
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Adrian Buchholz
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Jessica Hembus
- Forschungslabor für Biomechanik und Implantattechnologie, Orthopädische Klinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Benedict Rothammer
- Lehrstuhl für Konstruktionstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Maximilian Uhler
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Davies A, Sabharwal S, Liddle AD, Zamora Talaya MB, Rangan A, Reilly P. Revision rate in metal compared to ceramic humeral head total shoulder arthroplasty and hemiarthroplasty. Bone Joint J 2024; 106-B:482-491. [PMID: 38688478 DOI: 10.1302/0301-620x.106b5.bjj-2023-1093.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey. Methods NJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation. Results A total of 4,799 TSAs (3,578 metal, 1,221 ceramic) and 1,363 HAs (1,020 metal, 343 ceramic) were included. The rate of revision was higher for metal compared with ceramic TSA, hazard ratio (HR) 3.31 (95% confidence interval (CI) 1.67 to 6.58). At eight years, prosthesis survival for ceramic TSA was 98.7% (95% CI 97.3 to 99.4) compared with 96.4% (95% CI 95.2 to 97.3) for metal TSA. The majority of revision TSAs were for cuff insufficiency or instability/dislocation. There was no significant difference in the revision rate for ceramic compared with metal head HA (HR 1.33 (95% CI 0.76 to 2.34)). For ceramic HA, eight-year prosthetic survival was 92.8% (95% CI 86.9 to 96.1), compared with 91.6% (95% CI 89.3 to 93.5) for metal HA. The majority of revision HAs were for cuff failure. Conclusion The rate of all-cause revision was higher following metal compared with ceramic humeral head TSA in patients with OA and an intact rotator cuff. There was no difference in the revision rate for HA according to bearing surface.
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Affiliation(s)
- Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander D Liddle
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Amar Rangan
- Department of Health Sciences, University of York, York, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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Cooper KS, Powell GM, Baffour FI, Johnson MP, Frick MA. Incidence of complications related to shoulder arthroplasties identified on computed tomography. Emerg Radiol 2023:10.1007/s10140-023-02157-2. [PMID: 37415035 DOI: 10.1007/s10140-023-02157-2] [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: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Determine incidence of shoulder arthroplasty complications identified on computed tomography (CT). MATERIALS AND METHODS Retrospective institutional database review of patients with shoulder arthroplasties who underwent CT between 01/2006-11/2021 at a tertiary academic referral center with subspecialized orthopedic shoulder surgeons. CT reports were reviewed for arthroplasty type and complication. Data were stratified and summarized. Associations between complications and arthroplasty types were determined with Chi-squared goodness of fit test. RESULTS Eight hundred twelve CTs in 797 unique patients were included (438 (53.9%) females and 374 (46.1%) males; mean age 67 ± 11 years). There were 403 total shoulder arthroplasties (TSA), 317 reverse total shoulder arthroplasties (rTSA), and 92 hemiarthroplasties (HA). Complications were present in 527/812 (64.9%) and incidences were: loosening/aseptic osteolysis 36.9%, periprosthetic failure 21.6%, periprosthetic fracture 12.3%, periprosthetic dislocation 6.8%, joint/pseudocapsule effusion 5.9%, prosthetic failure 4.8%, infection 3.8%, and periprosthetic collection 2.1%. Complications per arthroplasty were: 305/403 (75.7%) TSAs, 176/317 (55.5%) rTSAs, and 46/92 (50%) HAs (p < 0.001). Periprosthetic fracture (20.8%), prosthetic dislocation (9.8%), and prosthetic failure (7.9%) were highest in rTSAs (p < 0.001, p < 0.013, p < 0.001, respectively). Loosening/aseptic osteolysis most frequent in TSAs (54.1%) (p < 0.001). Periprosthetic failure most frequent in HA (32.6%) (p < 0.001). Significant associations were identified with joint/pseudocapsule effusion and loosening/aseptic osteolysis (p = 0.04) and prosthetic dislocation (p < .001). CONCLUSION In this single tertiary academic referral center cohort, the incidence of shoulder arthroplasty complication identified on CT was 64.9% and the most commonly occurring complication was loosening/aseptic osteolysis (36.9%). TSA had the highest incidence of complication (75.7%).
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Affiliation(s)
- Kendall S Cooper
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Garret M Powell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Hospital and Emergency Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Hospital and Emergency Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Matthew P Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Matthew A Frick
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Raval P, Deore V, Bishnoi A, Armstrong A, Modi A, Pandey R. Mid-term results for a stemless anatomical total shoulder replacement, with a ceramic head, for glenohumeral osteoarthritis. Shoulder Elbow 2023; 15:283-291. [PMID: 37325387 PMCID: PMC10268144 DOI: 10.1177/17585732211058725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 09/20/2023]
Affiliation(s)
- P Raval
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - V Deore
- Department of Trauma and Orthopaedics, The Mid Yorkshire Hospital NHS Trust, UK
| | - A Bishnoi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Armstrong
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Modi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - R Pandey
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
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Edwards GA, Coghlan J, Hughes J, Wright W, Dallalana R, Bell ASN. Encouraging outcomes of stemless ceramic head anatomic shoulder arthroplasty in severe primary osteoarthritis (Walch type B glenoids). Shoulder Elbow 2023; 15:28-36. [PMID: 36895605 PMCID: PMC9990115 DOI: 10.1177/17585732211048120] [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: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Background: We report the radiological and functional outcomes at five years in patients with severe osteoarthritis of the glenohumeral joint and a Walch type B glenoid who have undergone stemless anatomic total shoulder replacement. Methods: A retrospective analysis of case notes, computed tomography scans and plain radiographs of patients undergoing anatomic total shoulder replacement for primary glenohumeral osteoarthritis were performed. Patients were grouped by the severity of their osteoarthritis using the modified Walch classification, glenoid retroversion and posterior humeral head subluxation. An evaluation was made using modern planning software. Functional outcomes were assessed using the American shoulder and elbow surgeons score, shoulder pain and disability index and visual analogue scale. Annual Lazarus scores were reviewed as regard to glenoid loosening. Results: Thirty patients were reviewed at 5 years. Analysis of all patient-reported outcome measures demonstrated significant improvement at 5-year review, American shoulder and elbow surgeons (p = <0.0001), shoulder pain and disability index (p = 0.0001), visual analogue scale (p = 0.0001). Radiological associations between Walch scores and Lazarus scores were not statistically significant (p = 0.1251) at 5 years. There were no associations between features of glenohumeral osteoarthritis and patient-reported outcome measures. Discussion: The severity of osteoarthritis did not show any association with glenoid component survivorship or with patient-reported outcome measures at 5 years review. Level of evidence: IV.
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Affiliation(s)
| | - Jennifer Coghlan
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
| | - Jeff Hughes
- North Shore Private
Hospital, Chatswood, Sydney, Australia
| | | | | | - A/Prof Simon Nicolas Bell
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
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Kunze KN, Krivicich LM, Brusalis C, Taylor SA, Gulotta LV, Dines JS, Fu MC. Pathogenesis, Evaluation, and Management of Osteolysis After Total Shoulder Arthroplasty. Clin Shoulder Elb 2022; 25:244-254. [PMID: 35971608 PMCID: PMC9471816 DOI: 10.5397/cise.2021.00738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA—namely, periprosthetic joint infection—as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.
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Innovations in Shoulder Arthroplasty. J Clin Med 2022; 11:jcm11102799. [PMID: 35628933 PMCID: PMC9144112 DOI: 10.3390/jcm11102799] [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: 03/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.
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Davies A, Selmi H, Sabharwal S, Vella-Baldacchino M, Liddle AD, Reilly P. Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2022; 6:24715492221095991. [PMID: 35692902 PMCID: PMC9174976 DOI: 10.1177/24715492221095991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022] Open
Abstract
The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.
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Affiliation(s)
- Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Hussain Selmi
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | | | - Alex D. Liddle
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
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Uhler M, Braun S, Schroeder S, Renkawitz T, Kretzer JP. Wear investigation based on a novel, anatomic shoulder prosthesis with bearing materials inversion. J Mech Behav Biomed Mater 2022; 127:105080. [DOI: 10.1016/j.jmbbm.2022.105080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/30/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
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Simon MJK, Coghlan JA, Hughes J, Wright W, Dallalana RJ, Bell SN. Mid-term outcomes of a stemless ceramic head anatomic total shoulder replacement. BMC Musculoskelet Disord 2022; 23:50. [PMID: 35033044 PMCID: PMC8760766 DOI: 10.1186/s12891-021-04988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background In an anatomic shoulder replacement (aTSR) good results have been reported with the use of a stemless humeral prosthesis. In vitro a ceramic articulation with polyethylene has been shown to produce less polyethylene wear particles than with metal. This study aims to evaluate clinical and radiographic results of a stemless aTSR with a ceramic head articulating with a polyethylene glenoid component, with mid-term follow-up. Methods All patients (n = 92) in this prospective study had an aTSR utilizing a stemless humeral component with a ceramic head and a cemented double pegged cemented polyethylene glenoid component for glenohumeral osteoarthritis. Pre- and postoperative clinical evaluations at 2 years were performed using the ASES score, Constant score, SPADI score, DASH score, VAS pain score, patient satisfaction and range of motion. There was a 5-year evaluation of SPADI, ASES, pain, and satisfaction, plus radiographic assessment of glenoid component radiolucent lines and humeral osteolysis. Results Seventy-four cases (68.1 ± 7.1 years) had a five-year follow-up and demonstrated active elevation improvement from 91.3° preoperatively to 151.1° (p < 0.001). Further improvement was identified with the ASES from 41.6 to 94.3, the SPADI from 62.9 to 4.3, VAS pain from 5.6 to 0.4 (0–10), and satisfaction levels were at 96%. Sixty-two cases had no glenoid radiolucent lines with a maximum Lazarus score of 2 in one patient. Constant scores, available up to 2 years, improved significantly from 30.3 to 77.9 (p < 0.001). There was one case that required revision for glenoid loosening. Conclusions Overall, the 5-year results of this ceramic head prosthesis demonstrated good radiographic and clinical outcomes. Trial registration ACTRN12613001183774. Registered: 29 October 2013 - Retrospectively registered. Australian New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Maciej J K Simon
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia. .,University Medical Center Schleswig-Holstein, Campus Kiel, Department of Orthopaedics and Trauma Surgery, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Jennifer A Coghlan
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia.,Department of Surgery, (School of Clinical Sciences, Monash Health) Monash University, Monash University, Melbourne, VIC, Australia
| | - Jeff Hughes
- Sydney Shoulder and Elbow Associates, Chatswood, Sydney, Australia
| | | | | | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia.,Department of Surgery, (School of Clinical Sciences, Monash Health) Monash University, Monash University, Melbourne, VIC, 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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13
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Mueller U, Harzi A, Loescher R, Buelhoff M, Eckert JA, Kretzer JP. Wear and damage in retrieved humeral inlays of reverse total shoulder arthroplasty-where, how much, and why? J Shoulder Elbow Surg 2021; 30:e517-e530. [PMID: 33220411 DOI: 10.1016/j.jse.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Polyethylene (PE) wear and material degradation have been reported as complications in reverse total shoulder replacements (rTSAs). In this regard, scapular notching is associated with more clinical complications. Therefore, the purposes of the study were to quantify the linear and volumetric wear, as a measure for the amount of removed material, and to qualitatively assess the PE damage modes to describe the material degradation in retrieved rTSA humeral PE inlays that contribute to failure of shoulder replacements. Furthermore, this study aimed to evaluate the effect of scapular notching on PE wear and rim damage of the humeral components. METHODS The total study population of 39 humeral inlays contains 2 cohorts that were used for the damage mode analysis and for the wear analysis, respectively. The extent and presence of wear damage modes in 5 defined zones were assessed by a grading system for all PE joint replacements. For quantitative wear analysis the most frequent design (n = 17) was chosen. Using a coordinate-measuring machine and postprocessing software, volumetric wear measurements for the retrieved humeral PE inlays were undertaken. Furthermore, prerevision radiographs were analyzed for scapular notching. Finally, retrieval findings were correlated with clinical and radiographic data to consider the effect of notching and to identify risk of failures for these prostheses. RESULTS Damage on the rim of the humeral PE inlays was more frequent and severe than on the intended articulation surface. Irrespective of the damage mode, the inferior rim zone sustained the greatest amount of wear damage followed by the posterior zone. Burnishing, scratching, pitting, and embedded particles are most likely to occur in the articular surface area, whereas surface deformation, abrasion, delamination and gross material degradation are predominantly present in the inferior and posterior rim zones. The retrieved inlays exhibited a mean volumetric wear rate of 296.9 mm³/yr ± 87.0 mm³/yr. However, if the notched and non-notched components were compared, a significant higher volumetric wear rate (296.5 ± 106.1 mm³/yr) was found for the notched components compared to the non-notched group (65.7 ± 7.4 mm³/yr). Generally, there was a significantly greater incidence of damage and greater amount of wear if scapular notching occurred. CONCLUSION The notched components showed a 5-fold increase in PE wear rate. Therefore, scapular notching has a strong effect on PE damage and wear. If scapular notching can be clinically avoided, the PE wear performance is in a similar magnitude as found for hip and knee replacements.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Amal Harzi
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raphael Loescher
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Buelhoff
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes A Eckert
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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14
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Prosthetic Bearing Surfaces in Anatomic and Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2021; 29:414-422. [PMID: 33443383 DOI: 10.5435/jaaos-d-20-00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023] Open
Abstract
Total shoulder arthroplasty (TSA) and reverse TSA have provided an effective treatment for glenohumeral osteoarthritis; however, longevity of the procedure may be limited by osteolysis and polyethylene wear. In TSA, glenoid component failure occurs through several mechanisms, the most common being aseptic loosening and polyethylene wear. Newer bearing surfaces such as highly cross-linked ultra-high-molecular-weight polyethylene, vitamin E processing, ceramic heads, and pyrolytic carbon surfaces have shown improved wear characteristics in biomechanical and some early clinical studies. The purpose of this review is to provide a historical perspective and current state of the art of bearing surface technology in anatomic and reverse TSA.
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15
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Jordan RW, Kelly CP, Pap G, Joudet T, Nyffeler RW, Reuther F, Irlenbusch U. Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis - A prospective multicentre study. Shoulder Elbow 2021; 13:67-77. [PMID: 33717220 PMCID: PMC7905519 DOI: 10.1177/1758573219866431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Early reports of stemless shoulder arthroplasty have shown promising clinical and radiological outcomes. The purpose of this study was to report on the mid-term results of an implant that utilises a ceramic humeral head. METHODS A prospective, consecutive, multicentre study of stemless shoulder prosthesis with a minimum of four years of follow-up was conducted between August 2009 and May 2012. The adjusted Constant-Murley Score (CMS), revision rate and presence of radiolucent lines were recorded at intervals. RESULTS A total of 207 patients were eligible for study inclusion; 62.8% were female and mean age was 64.8 years (range 30-86). Mean follow-up was 70.7 months (range 48-100), 73% underwent TSA and 27% hemiarthroplasty. The mean CMS improvement was 42.6 (p < 0.0001) at 48 months. Radiolucencies were present in 2.7% of humeral zones and 14% of glenoid zones at 48-month follow-up. The revision rate was 6.3% with rotator cuff failure (2.9%) the most common indication. CONCLUSIONS Mid-term results demonstrate that the studied stemless implant with a ceramic humeral head had clinical and radiological outcomes that are comparable to other reported studies.
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Affiliation(s)
- RW Jordan
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England,RW Jordan, Robert Jones & Agnes Hunt Orthopaedic Hospital Gobowen, Oswestry SY10 7AG, England.
| | - CP Kelly
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England
| | - G Pap
- Helios Park-Hospital Leipzig, Leipzig, Germany
| | - T Joudet
- Clinique du Libournais, Libourne, France
| | | | - F Reuther
- DRK Clinic Berlin Koepenick, Berlin, Germany
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16
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Banci L, Meoli A, Hintner M, Bloch HR. Wear performance of inverted non-conforming bearings in anatomic total shoulder arthroplasty. Shoulder Elbow 2020; 12:40-52. [PMID: 33343715 PMCID: PMC7726178 DOI: 10.1177/1758573219826531] [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: 07/03/2018] [Revised: 12/10/2018] [Accepted: 01/02/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Glenoid component failures still represent the most common complication in total shoulder arthroplasty. These failures depend on several factors, including ultra-high molecular weight polyethylene (UHMWPE) wear. One reason for UHMWPE wear in total shoulder arthroplasty may be the current use of a spherical prosthetic humeral head against a radially mismatched UHMWPE glenoid component, which leads to reduced glenohumeral translations, glenoid edge loading and high translational forces during shoulder motions. The aim of this study was to assess the in vitro wear of an anatomic total shoulder prosthesis with non-spherical non-conforming bearings with inverted conventional materials. METHODS The wear of a vitamin E-blended UHMWPE non-spherical humeral head articulating against a non-conforming titanium-niobium nitride (TiNbN)-coated metallic glenoid was tested using a joint simulator. The wear test was performed by applying a constant load of 756 N with angular motions and translations. RESULTS After 2.5 million cycles, the mean wear rate of the humeral head was 0.28 ± standard deviation (SD) 0.45 mg/million cycles. CONCLUSION The low wear rate of the vitamin E UHMWPE humeral head supports the use of non-spherical non-conforming bearings with inverted conventional materials in anatomic total shoulder arthroplasty.
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Affiliation(s)
- Lorenzo Banci
- Permedica S.p.A., Merate, Italy,Lorenzo Banci, Permedica S.p.A. Via Como 38, 23807 Merate (LC), Italy.
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17
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Boulanaache Y, Becce F, Farron A, Pioletti DP, Terrier A. Glenoid bone strain after anatomical total shoulder arthroplasty: In vitro measurements with micro-CT and digital volume correlation. Med Eng Phys 2020; 85:48-54. [PMID: 33081963 DOI: 10.1016/j.medengphy.2020.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Abstract
Glenoid implant loosening remains a major source of failure and concern after anatomical total shoulder arthroplasty (aTSA). It is assumed to be associated with eccentric loading and excessive bone strain, but direct measurement of bone strain after aTSA is not available yet. Therefore, our objective was to develop an in vitro technique for measuring bone strain around a loaded glenoid implant. A custom loading device (1500 N) was designed to fit within a micro-CT scanner, to use digital volume correlation for measuring displacement and calculating strain. Errors were evaluated with three pairs of unloaded scans. The average displacement random error of three pairs of unloaded scans was 6.1 µm. Corresponding systematic and random errors of strain components were less than 806.0 µε and 2039.9 µε, respectively. The average strain accuracy (MAER) and precision (SDER) were 694.3 µε and 440.3 µε, respectively. The loaded minimum principal strain (8738.9 µε) was 12.6 times higher than the MAER (694.3 µε) on average, and was above the MAER for most of the glenoid bone volume (98.1%). Therefore, this technique proves to be accurate and precise enough to eventually compare glenoid implant designs, fixation techniques, or to validate numerical models of specimens under similar loading.
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Affiliation(s)
- Y Boulanaache
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - F Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A Farron
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - D P Pioletti
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - A Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland.
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18
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Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component. J Shoulder Elbow Surg 2020; 29:913-923. [PMID: 31899093 DOI: 10.1016/j.jse.2019.09.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND In vitro wear studies demonstrate decreased polyethylene wear with a ceramic compared with a metal humeral head. In this in vivo study, we analyzed prospectively collected 5-year data, comparing the outcomes of 2 types of humeral implants. METHODS Sixty-two anatomic total shoulder arthroplasties (TSAs) (59 patients) were performed using the same glenoid component and 2 types of modular humeral implants (metal-head long-stem prosthesis in group A vs. ceramic-head stemless prosthesis in group B). Radiographic analysis for proximal humeral osteolysis and glenoid component radiolucent lines was performed at an average of 5.5 years. Functional outcomes were prospectively evaluated according to the visual analog scale score for pain; satisfaction level; American Shoulder and Elbow Surgeons score; active elevation; Shoulder Pain and Disability Index score; and Disabilities of the Arm, Shoulder and Hand score. RESULTS There were 39 TSAs in group A (mean age, 68.1 years) and 23 TSAs in group B (mean age, 67 years). Clinical improvement was similar for both groups. Some proximal humeral osteolysis occurred in 56% of all TSAs. Group A showed increased osteolysis compared with group B (72% vs. 30%, P = .005). Glenoid radiolucent lines were far more frequent in group A, and group A showed a direct relationship between the extent of humeral osteolysis and the severity of glenoid radiolucent lines (P < .001). CONCLUSION The stemless ceramic-head replacements showed fewer glenoid radiolucent lines and less humeral osteolysis than the long-stem metal-head replacements. In the group with metal-head replacements, correlation was shown between glenoid radiolucent lines and humeral osteolysis.
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19
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Wear behaviour of polyethylene glenoid inserts against PyroCarbon humeral heads in shoulder arthroplasties. J Mech Behav Biomed Mater 2020; 103:103553. [DOI: 10.1016/j.jmbbm.2019.103553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022]
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20
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The effect of vitamin E-enhanced cross-linked polyethylene on wear in shoulder arthroplasty-a wear simulator study. J Shoulder Elbow Surg 2019; 28:1771-1778. [PMID: 31029519 DOI: 10.1016/j.jse.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear of the polyethylene glenoid component and subsequent particle-induced osteolysis remains one of the most important modes of failure of total shoulder arthroplasty. Vitamin E is added to polyethylene to act as an antioxidant to stabilize free radicals that exist as a byproduct of irradiation used to induce cross-linking. This study was performed to assess the in vitro performance of vitamin E-enhanced polyethylene compared with conventional polyethylene in a shoulder simulator model. METHODS Vitamin E-enhanced, highly cross-linked glenoid components were compared with conventional ultrahigh-molecular-weight polyethylene glenoids, both articulating with a ceramic humeral head component using a shoulder joint simulator over 500,000 cycles. Unaged and artificially aged comparisons were performed. Volumetric wear was assessed by gravimetric measurement, and wear particle analysis was also subsequently performed. RESULTS Vitamin E-enhanced polyethylene glenoid components were found to have significantly reduced wear rates compared with conventional polyethylene in both unaged (36% reduction) and artificially aged (49% reduction) comparisons. There were no differences detected in wear particle analysis between the 2 groups. CONCLUSION Vitamin E-enhanced polyethylene demonstrates improved wear compared with conventional polyethylene in both unaged and artificially aged comparisons and may have clinically relevant benefits.
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Schroeder S, Braun S, Mueller U, Sonntag R, Jaeger S, Kretzer JP. Particle analysis of shape factors according to American Society for Testing and Materials. J Biomed Mater Res B Appl Biomater 2019; 108:225-233. [PMID: 30977963 DOI: 10.1002/jbm.b.34382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 03/20/2019] [Indexed: 11/07/2022]
Abstract
Polyethylene wear is one of the major factors influencing the survivorship of joint replacements. Depending on the number, size and morphology of the polyethylene particles, biological responses of the periprosthetic soft tissue in terms of inflammatory processes can occur, leading to loosening of the implant. Various parameters are used to analyze wear particles, which are usually determined by examining scanning electron microscopy (SEM) images with a particle analysis program. In this study, three different software solutions for particle analysis (self-developed Particleanalyzer_HD, Leica QWin and ImageJ) were compared regarding particle number, size and morphology. These solutions were also compared to the American Society for Testing and Materials (ASTM) F1877-16 specifications regarding particle morphology. SEM image analysis revealed no differences for the equivalent circle diameter (p = 0.969). However, a significant difference was found for the aspect ratio between the Particleanalyzer_HD and the other two software solutions (p < 0.001) and between Leica QWin and the other two software solutions regarding the roundness (p < 0.001). Only the Particleanalyzer_HD showed an excellent agreement with the ASTM standard for both morphology parameters (intraclass correlation = 1.000). Only the Particleanalyzer_HD calculated the two morphology parameters according to the ASTM standard. A comparison of the particle morphology between different studies is barely possible, as different algorithms for particle analysis are used. It is strongly recommended that the calculation according to the ASTM standard is used to improve future comparability of findings from wear analysis studies. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:225-233, 2020.
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Affiliation(s)
- Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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23
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Braun S, Schroeder S, Mueller U, Sonntag R, Buelhoff M, Kretzer JP. Influence of joint kinematics on polyethylene wear in anatomic shoulder joint arthroplasty. J Shoulder Elbow Surg 2018; 27:1679-1685. [PMID: 29695317 DOI: 10.1016/j.jse.2018.02.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the positive results in total shoulder arthroplasties (TSAs), a higher revision rate is documented compared with total hip and knee replacements. Wear is the possible main cause of TSA failure in the long-term. This study investigated the effect of joint kinematics and the influence of the rotator cuff on the polyethylene wear performance in an anatomic TSA. METHODS Lifting a load of 2 kg with an abduction/adduction of 0° to 90° was simulated for 2 × 106 cycles as a primary motion using a fully kinematic joint simulator. A combined rotation in anteversion-retroversion of ±5° and ±10° was also simulated. The force in the superior-inferior direction and the axial joint compression were applied under force control based on in vivo data of the shoulder. A soft tissue restraint model was used to simulate an intact and an insufficient rotator cuff. RESULTS The highest wear rate in the intact rotator cuff group was 58.90 ± 1.20 mg/106 cycles with a combined rotation of ±10°. When an insufficient rotator cuff was simulated, the highest polyethylene wear rate determined was 79.67 ± 4.18 mg/106 cycles. CONCLUSIONS This study confirms a high dependency of the polyethylene wear behavior and dimension on the joint kinematics in total shoulder replacement. This can be explained by an increasing cross-shear stress on the polyethylene component. The results obtained indicate that additional combined kinematics are an indispensable part of wear tests on anatomic shoulder replacements.
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Affiliation(s)
- Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Buelhoff
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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