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Hao KA, Hones KM, Elwell J, Aibinder WR, Wright JO, Wright TW, King JJ, Schoch BS. Anatomic Versus Reverse Total Shoulder Arthroplasty for Primary Osteoarthritis With an Intact Rotator Cuff: A Midterm Comparison of Early Top Performers. J Am Acad Orthop Surg 2024:00124635-990000000-01031. [PMID: 38996212 DOI: 10.5435/jaaos-d-24-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/16/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Several surgeons state that their best anatomic total shoulder arthroplasty (aTSA) outperforms their best reverse total shoulder arthroplasty (rTSA) when performed for rotator cuff-intact glenohumeral osteoarthritis. We identified the top-performing aTSAs and rTSAs at short-term follow-up and compared their clinical performance at midterm follow-up to validate this common claim. METHODS A retrospective review of a multicenter shoulder arthroplasty database was conducted. All shoulders undergoing primary aTSA or rTSA for rotator cuff-intact glenohumeral osteoarthritis between 2007 and 2020 were reviewed. Shoulders with a follow-up clinical visit between 2 and 3 years and a clinical follow-up of minimum 5 years were included. Two separate cohorts were identified: patients with a top 20% (1) American Shoulder and Elbow Surgeons (ASES) score and (2) Shoulder Arthroplasty Smart (SAS) score at 2 to 3 years of follow-up. Clinical outcomes including range of motion, outcome scores, and rates of complications and revision surgeries were compared at minimum 5-year follow-up. RESULTS The ASES score cohort comprised 185 aTSAs (mean age 67 years, 42% female) and 49 rTSAs (mean age 72 years, 45% female). The SAS score cohort comprised 145 aTSAs (mean age 67 years, 59% female) and 42 rTSAs (mean age 71 years, 57% female). Active external rotation (ER) was greater after aTSA at midterm follow-up in both ASES and SAS score cohorts; however, preoperative to postoperative improvement was equivalent. Postoperative ER and SAS scores were greater after aTSA in both cohorts (P < 0.05); however, no other significant differences in any preoperative or postoperative clinical outcomes were present (P > 0.05), and patients achieved the minimal clinically important difference and substantial clinical benefit at similar rates for all outcomes. No difference was found in the incidence of complications and revision surgeries between top-performing aTSAs and rTSAs. CONCLUSION Among top-performing shoulder arthroplasties at early follow-up, aTSA does not appear to outperform rTSA, except superior ER at midterm follow-up. LEVEL OF EVIDENCE Retrospective comparative cohort study, Level Ⅲ.
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Affiliation(s)
- Kevin A Hao
- From the College of Medicine, University of Florida, Gainesville, FL (Hao), Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL (Hones, J.O. Wright, T.W. Wright, and King), the Exactech, Inc., Gainesville, FL (Elwell), Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL (Schoch), Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI (Aibinder)
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2
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Sears BW, Christensen RG, Kelly JD, Khazzam MS, Mauter LA, Bader JE, Hatzidakis AM. Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components. J Shoulder Elbow Surg 2024; 33:872-879. [PMID: 37689103 DOI: 10.1016/j.jse.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. METHODS We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. RESULTS Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r = 0.93, radiolucency to Lazarus r = 0.92 (P value <.001 for all). CONCLUSION This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.
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Affiliation(s)
| | | | - James D Kelly
- California Pacific Orthopaedics, San Francisco, CA, USA
| | - Michael S Khazzam
- Department of Orthopaedic Surgery; Shoulder Service, University of Texas Southwestern Medical Center, Dallas, TX, USA
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3
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Muench LN, Kia C, Murphey M, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Berthold DP. Elliptical heads result in increased glenohumeral translation along with micro-motion of the glenoid component during axial rotation in total shoulder arthroplasty. Arch Orthop Trauma Surg 2023; 143:177-187. [PMID: 34216260 PMCID: PMC9886581 DOI: 10.1007/s00402-021-04018-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Elliptical-shaped humeral head prostheses have recently been proposed to reflect a more anatomic shoulder replacement. However, its subsequent effect on micro-motion of the glenoid component is still not understood. MATERIALS AND METHODS Six fresh-frozen, cadaveric shoulders (mean age: 62.7 ± 9.2 years) were used for the study. Each specimen underwent total shoulder arthroplasty using an anatomic stemless implant. At 15°, 30°, 45° and 60° of glenohumeral abduction, 50° of internal and external rotations in the axial plane were alternatingly applied to the humerus with both an elliptical and spherical humeral head design. Glenohumeral translation was assessed by means of a 3-dimensional digitizer. Micro-motion of the glenoid component was evaluated using four high-resolution differential variable reluctance transducer strain gauges, placed at the anterior, posterior, superior, and inferior aspect of the glenoid component. RESULTS The elliptical head design showed significantly more micro-motion in total and at the superior aspect of glenoid component during external rotation at 15° (total: P = 0.004; superior: P = 0.004) and 30° (total: P = 0.045; superior: P = 0.033) of abduction when compared to the spherical design. However, during internal rotation, elliptical and spherical heads showed similar amounts of micro-motion at the glenoid component at all tested abduction angles. When looking at glenohumeral translation, elliptical and spherical heads showed similar anteroposterior and superoinferior translation as well as compound motion during external rotation at all tested abduction angles. During internal rotation, the elliptical design resulted in significantly more anteroposterior translation and compound motion at all abduction angles when compared to the spherical design (P < 0.05). CONCLUSION In the setting of total shoulder arthroplasty, the elliptical head design demonstrated greater glenohumeral translation and micro-motion at the glenoid component during axial rotation when compared to the spherical design, potentially increasing the risk for glenoid loosening in the long term. 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
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Matthew Murphey
- 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
| | | | - Daniel P. Berthold
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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4
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Liu C, Shi L, Amirouche F. Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2022; 6:24715492221142856. [PMCID: PMC9742691 DOI: 10.1177/24715492221142856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
Total shoulder arthroplasty is an increasingly popular option for the treatment of glenohumeral arthritis. Historically, the effectiveness of the procedure has largely been determined by the long-term stability of the glenoid component. Glenoid component loosening can lead to clinically concerning complications including pain with movement, loss of function, and accumulation of debris which may require surgery to revise. In response, there has been a push to optimize the design of the glenoid prosthesis. Traditional contemporary glenoid components use pegs for fixation and are made entirely of polyethylene. Variations on the standard implant include keeled, metal-backed, hybrid, augmented, and inlay designs. There is a wealth of biomechanical and clinical studies that report on the effectiveness of these different designs. The purpose of this review is to summarize existing literature regarding glenoid component design and identify key areas for future research. Knowledge of the rationale underlying glenoid design will help surgeons select the best component for their patients and optimize outcomes following TSA.
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Affiliation(s)
- Charles Liu
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA,Charles Liu, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | - Lewis Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, USA
| | - Farid Amirouche
- Department of Orthopaedics, The University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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5
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Creighton RA, Burrus MT, Werner BC, Gobezie R, Lederman E, Denard PJ. Short-term clinical and radiographic outcomes of a hybrid all-polyethylene glenoid based on preoperative glenoid morphology. J Shoulder Elbow Surg 2022; 31:2554-2561. [PMID: 35750156 DOI: 10.1016/j.jse.2022.05.016] [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: 03/16/2022] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary purpose of this study was to compare 2-year anatomic total shoulder arthroplasty (TSA) functional and radiographic outcomes between Walch type A and B glenoids treated with an all-polyethylene glenoid designed for hybrid fixation with peripheral cement and central osseous integration. The secondary purpose was to evaluate outcomes based on central peg technique. The hypotheses were that there would be no difference in short-term radiographic or functional outcome scores based on preoperative glenoid morphology or central peg technique. METHODS We performed a multicenter retrospective review of patients who underwent TSA with the same hybrid all-polyethylene glenoid and had minimum 2-year follow-up. Patient-reported outcomes and radiographic outcomes were analyzed based on preoperative Walch morphology and central peg technique. Radiographic analysis included preoperative glenoid morphology; preoperative and postoperative glenoid version, glenoid inclination, and posterior humeral head subluxation; and postoperative glenoid radiolucencies according to the Wirth and Lazarus classifications. RESULTS A total of 266 patients with a mean age of 64.9 ± 8.2 years were evaluated at a mean of 28 months postoperatively. Postoperatively, there were significant improvements in all functional outcome measures (P < .001), range-of-motion measures (forward elevation, external rotation at 0°, external rotation at 90°, internal rotation by spinal level, and internal rotation at 90°; P < .001), and strength measures (Constant, external rotation, and modified belly press; P < .001). There were no clinically meaningful differences in functional outcomes or statistically significant differences in radiographic appearance between Walch type A and B glenoids. Subgroup analysis revealed that glenoids with a cemented central peg had the worst radiographic outcomes based on Lazarus scoring. CONCLUSION Patients undergoing TSA with a hybrid in-line pegged glenoid have excellent clinical outcomes at short-term follow-up regardless of preoperative glenoid morphology. Different central peg techniques do not appear to play a significant role in the risk of glenoid component lucencies at 2 years postoperatively.
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6
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Bonnevialle N, Berhouet J, Pôtel P, Müller JH, Godenèche A. Mechanical behavior of hybrid glenoid components compared to all-PE components: a finite element analysis. J Exp Orthop 2022; 9:58. [PMID: 35718812 PMCID: PMC9206973 DOI: 10.1186/s40634-022-00494-8] [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: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this finite element study was to compare bone and cement stresses and implant micromotions among all-polyethylene (PE) and hybrid glenoid components. The hypothesis was that, compared to all-PE components, hybrid components yield lower bone and cement stresses with smaller micromotions. Methods Implant micromotions and cement and bone stresses were compared among 4 all PE (U-PG, U-KG, A-KG, I-KG) and 2 hybrid (E-hCG, I-hPG) virtually implanted glenoid components. Glenohumeral joint reaction forces were applied at five loading regions (central, anterior, posterior, superior and inferior). Implant failure was assumed if glenoid micromotion exceeded 75 µm or cement stresses exceeded 4 MPa. The critical cement volume (CCV) was based on the percentage of cement volume that exceeded 4 MPa. Results were pooled and summarized in boxplots, and differences evaluated using pairwise Wilcoxon Rank Sum tests. Results Differences in cement stress were found only between the I-hPG hybrid component (2.9 ± 1.0 MPa) and all-PE keeled-components (U-KG: 3.8 ± 0.9 MPa, p = 0.017; A-KG: 3.6 ± 0.5 MPa, p = 0.014; I-KG: 3.6 ± 0.6 MPa, p = 0.040). There were no differences in cortical and trabecular bone stresses among glenoid components. The E-hCG hybrid component exceeded micromotions of 75 µm in 2 patients. There were no differences in %CCV among glenoid components. Conclusions Finite element analyses reveal that compared to all-PE glenoid components, hybrid components yield similar average stresses within bone and cement. Finally, risk of fatigue failure of the cement mantle is equal for hybrid and all-PE components, as no difference in %CCV was observed. Level of evidence IV, in-silico. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00494-8.
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Affiliation(s)
- Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet - CHU de Toulouse - Place Baylac, 31059, Toulouse Cedex 09, France
| | - Julien Berhouet
- Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie, Université de Tours, 1C Avenue de la République, 37170, Chambray-les-Tours, France.,Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Equipe Reconnaissance de Forme Et Analyse de L'Image, Université de Tours - Ecole d'Ingénieurs Polytechnique Universitaire de Tours, 64 Avenue Portalis, 37200, Tours, France
| | | | | | | | - Arnaud Godenèche
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Memoz, Lyon, France
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7
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Malahias MA, Kostretzis L, Gkiatas I, Chronopoulos E, Brilakis E, Antonogiannakis E. Clinical and radiographic outcomes of total shoulder arthroplasty with a partially cemented all-polyethylene pegged bone-ingrowth glenoid component: a systematic review. Shoulder Elbow 2021; 13:627-641. [PMID: 34804212 PMCID: PMC8600676 DOI: 10.1177/1758573220944168] [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: 02/02/2020] [Accepted: 06/21/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several articles have been published reporting on the clinical performance of a novel pegged, all-polyethylene glenoid component design which features a central peg, circumferentially fluted, interference-fit peg for tissue integration and three small peripheral pegs for cementing. However, no systematic review exists to this date. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications up to May 2020. RESULTS Overall, 13 articles were included for analysis (560 operated shoulders, range of mean follow-up: 2-6 years). The survival rate was 98.2% (550 out of 560 cases), while the rate of aseptic loosening was 0.2% (1 out of 560 cases). There were 139 cases (out of 399 reported; 34.1%) with peri-glenoid radiolucency, and 35 cases (out of 223 reported; 15.7%) of asymptomatic central peg osteolysis, with 1 of them undergoing revision. CONCLUSIONS There was fair quality of evidence to show that partially cemented all-polyethylene pegged bone-ingrowth glenoid components produce promising results, with a low revision rate in the short- to medium-term follow-up. Nevertheless, this analysis showed high rates of both radiolucency of the glenoid component and osteolysis around the central peg which raise concern for potential failure of this glenoid component in the long-term follow-up. LEVEL OF EVIDENCE Systematic review, IV.
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Affiliation(s)
- Michael-Alexander Malahias
- 3rd Orthopaedic Department, Hygeia
Hospital, Athens, Greece,The Stavros Niarchos Foundation Complex
Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department, Aristotle
University of Thessaloniki, G.Gennimatas General Hospital, Thessaloniki,
Greece,Lazaros Kostretzis, 2nd Orthopaedic
Department, Aristotle University of Thessaloniki, G.Gennimatas General Hospital,
Eth. Aminis 41, Thessaloniki, Greece.
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex
Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department, National
& Kapodistrian University of Athens, School of Medicine, Athens, Greece
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8
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Schoch BS, King JJ, Zuckerman J, Wright TW, Roche C, Flurin PH. Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison. Shoulder Elbow 2021; 13:518-526. [PMID: 34659485 PMCID: PMC8512971 DOI: 10.1177/1758573220921150] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. METHODS Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. RESULTS At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). DISCUSSION At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo
Clinic, Jacksonville, FL, USA,Bradley S Schoch, Department of Orthopedic
Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Joseph J King
- Department of Orthopaedic Surgery and
Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph Zuckerman
- New York University Langone Orthopedic
Hospital, New York, NY, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and
Rehabilitation, University of Florida, Gainesville, FL, USA
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9
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McCormick KL, Tedesco LJ, Swindell HW, Forrester LA, Jobin CM, Levine WN. Statistical fragility of randomized clinical trials in shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1787-1793. [PMID: 33271323 DOI: 10.1016/j.jse.2020.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The P value is a statistical tool used to assess the statistical significance of clinical trial outcomes in orthopedic surgery. However, the P value does not evaluate research quality or clinical significance. The Fragility Index (FI) is an alternative statistical method that can be used to assess the quality and significance of clinical research and is defined as the number of patients in a study intervention group necessary to convert an outcome from statistically significant to statistically insignificant or vice versa. The primary purpose of this study was to evaluate the statistical robustness of clinical trials regarding shoulder arthroplasty using the FI. The secondary goal was to identify trial characteristics associated greater statistical fragility. METHODS A systematic review of randomized clinical trials in shoulder arthroplasty was performed. The FI was calculated for all dichotomous, categorical study outcomes discussed in the identified studies. Descriptive statistics and the Pearson correlation coefficient were used to evaluate all studies and characterize associations between study variables. RESULTS A total of 13 randomized controlled trials were identified and evaluated; these trials had a median sample size of 47 patients (mean, 54 patients; range, 26-102 patients) and a median of 7 patients (mean, 5.8 patients; range, 0-14 patients) lost to follow-up. The median FI was 6 (mean, 5; range, 1-11), a higher FI than what has been observed in other orthopedic subspecialties. However, the majority of outcomes (74.4%) had an FI that was less than the number of patients lost to follow-up, and most outcomes (89.7%) were statistically insignificant. CONCLUSION Randomized controlled trials in shoulder arthroplasty have comparable statistical robustness to the literature in other orthopedic surgical subspecialties. We believe that the inclusion of the FI in future comparative studies in the shoulder arthroplasty literature will allow surgeons to better assess the statistical robustness of future research.
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Affiliation(s)
- Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Liana J Tedesco
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Hasani W Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Lynn Ann Forrester
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA.
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10
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Borbas P, Taylor DM, Lee S, Wijeratna M, Hoy G, Evans MC. Medium-Term Clinical and Radiographic Results of an All-Polyethylene, Pegged, Bone-Ingrowth Glenoid Component: A Concise Follow-up of a Previous Report. J Bone Joint Surg Am 2021; 103:251-256. [PMID: 33534293 DOI: 10.2106/jbjs.20.00084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT We previously reported the mean 4-year outcomes of anatomic total shoulder replacement using an all-polyethylene, pegged, hybrid-fixation (bone ingrowth and cement) glenoid component. In the present study, we report on that patient cohort after another 4 years of follow-up (mean, 101 months; range, 77 to 146 months). At that time, the median American Shoulder and Elbow Surgeons (ASES) score was 92 points (interquartile range [IQR], 81.7 to 98.3) and the median Oxford Shoulder Score was 47 points (IQR, 41 to 48). Osseointegration, demonstrated by bone ingrowth between the flanges on the central peg as seen on coronal computed tomography (CT), was complete in 75% of the shoulders, partial in 21%, and absent in 4%. There were radiolucent lines at the bone-prosthesis interface on CT, with a median Yian score of 1 (IQR, 0 to 2; range, 0 to 18). The conclusion in the present study was that shoulder arthroplasty with an all-polyethylene, hybrid-fixation (bone ingrowth and cement) pegged glenoid component has durable clinical and radiographic outcomes at medium-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul Borbas
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia.,Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Steven Lee
- The Avenue Hospital, Windsor, Victoria, Australia
| | - Malin Wijeratna
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia.,Austin Hospital, Heidelberg, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Matthew C Evans
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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11
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Dillon MT, Chan PH, Prentice HA, Burfeind WE, Yian EH, Singh A, Paxton EW, Navarro RA. The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2089-2096. [PMID: 32507730 DOI: 10.1016/j.jse.2020.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates. The purpose of this study was to evaluate risk of revision after anatomic TSA according to the glenoid component design. METHODS We conducted a cohort study including patients aged ≥18 years who underwent primary elective TSA for the diagnosis of osteoarthritis between 2010 and 2017. Patients with missing implant information, who received stemless humeral implants, or who received augmented glenoid implants, were excluded. Glenoid component designs used were categorized into 4 mutually exclusive treatment groups: polyethylene central-pegged ingrowth, polyethylene-metal hybrid, polyethylene all-cemented pegged, and polyethylene cemented keeled. Multivariable competing risk regression was used to evaluate the risk of glenoid loosening as a cause-specific revision by the glenoid component design. RESULTS Of the 5566 TSA included in the final cohort, 39.2% of glenoid implants were polyethylene central-pegged ingrowth, 31.1% were polyethylene-metal hybrid, 26.0% were polyethylene all-cemented pegged, and 3.6% were polyethylene cemented keeled. At 6-year final follow-up, 4.1% of TSA were revised for any cause, and 1.4% for glenoid loosening. Compared with the polyethylene central-pegged ingrowth design, no difference in glenoid loosening revision risk was observed for the polyethylene-metal hybrid design (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 0.42-3.20). However, both the polyethylene all-cemented pegged (HR = 2.48, 95% CI = 1.08-5.66) and polyethylene cemented keeled (HR = 3.84, 95% CI = 1.13-13.00) designs had higher risks for revision due to glenoid loosening. CONCLUSIONS We observed glenoid component designs to be associated with differential risks in revision due to glenoid loosening with polyethylene all-cemented pegged glenoids and polyethylene cemented keeled glenoids having higher risks when compared with polyethylene central-pegged ingrowth glenoids. Surgeons may want to consider the glenoid component design when performing anatomic TSA.
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Affiliation(s)
- Mark T Dillon
- Department of Orthopaedics, The Permanente Medical Group, Sacramento, CA, USA.
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | | | | | - Edward H Yian
- Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, CA, USA
| | - Anshuman Singh
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA, USA
| | | | - Ronald A Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, Harbor City, CA, USA
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12
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Schiefer M, Siqueira G, Figueira A, Souza PM, Monteiro MT, Motta Filho G. Integração óssea e prevalência de linhas radiotransparentes ao redor dos pinos de componentes glenoidais minimamente cimentados na artroplastia total de ombro. Rev Bras Ortop 2020; 57:120-127. [PMID: 35198119 PMCID: PMC8856858 DOI: 10.1055/s-0040-1715509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component.
Methods
Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component.
Results
Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results.
Conclusion
Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results.
Level of evidence
IV; Case series; Treatment study.
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Affiliation(s)
- Márcio Schiefer
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Gláucio Siqueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Alan Figueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Patrícia Martins Souza
- Departamento de Radiologia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Martim Teixeira Monteiro
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Geraldo Motta Filho
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
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13
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Denard PJ, Gobezie R, Griffin JW, Romeo AA, Lederman E. Osseous Integration of the Central Peg of an All-Polyethylene Glenoid With 3 Different Surgical Techniques. Orthopedics 2020; 43:278-283. [PMID: 32745227 DOI: 10.3928/01477447-20200721-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
All-polyethylene glenoid components designed for osseous integration of the central peg can be placed with no graft (NG), autogenous bone graft (ABG), or demineralized bone matrix (DBM). The purpose of this study was to compare osseous integration with these 3 techniques. A randomized controlled trial was performed of 153 total shoulder arthroplasties using a pegged allpolyethylene glenoid component designed for osseous integration. Central peg treatment included NG, ABG, or DBM. The primary outcome was central peg osseous integration defined as bone presence between the central fins 1 year postoperatively. Central osseous integration was observed in 90% of cases treated with ABG, 68% of cases treated with DBM, and 68% of cases treated with NG (P=.022). Postoperative Wirth grading revealed radiolucency around the central peg (grade 1) in 2.4% of cases with ABG, 5.4% of cases with DBM, and 9.8% of cases with NG (P=.134). At short-term follow-up, osseous integration of the central peg of an all-polyethylene glenoid designed for bony growth between the central fins appears to be highest when treating the central peg with ABG compared with leaving the central peg untreated or using DBM. [Orthopedics. 2020;43(5):278-283.].
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Schoch BS, Zarezadeh A, Priddy M, King JJ, Wright TW. Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up. J Shoulder Elbow Surg 2020; 29:968-975. [PMID: 31812586 DOI: 10.1016/j.jse.2019.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional monoblock pegged glenoid components are implanted with cement, increasing operative time and potentially violating more bone than those inserted without cement. We study the early radiographic loosening and reoperation rate following uncemented fixation of a hybrid cage monoblock polyethylene glenoid component. METHODS Between 2013 and 2015, a total of 51 shoulders underwent anatomic shoulder arthroplasty (TSA) using a hybrid ingrowth cage polyethylene glenoid component by a single surgeon, with a minimum follow-up of 2 years. In all cases, the glenoid component was placed without cement. Mean follow-up was 33 months (range, 24-57). The primary outcome was Lazarus scale-assessed radiographic loosening. Secondary outcomes included reoperation, range of motion (ROM), and patient-reported outcome measures (PROMs). RESULTS Twelve glenoid components (24%) had radiolucent lines. Glenoid lines were rated grade 1, grade 2, and grade 5 (6, 4, and 2 shoulders, respectively). Six shoulders (12%) had humeral lucent lines. Two shoulders (4%) underwent reoperation, only 1 of these occurring due to isolated failure of the glenoid component. As a group, mean ROM and PROMs improved significantly compared with preoperative values and exceeded the minimal clinically important difference. CONCLUSION Glenoid loosening remains a major concern at mid- to long-term follow-up of TSA. Placement of this hybrid cage monoblock polyethylene glenoid component in a completely uncemented fashion does not lead to early clinical loosening, after which bony ingrowth into the central cage can be expected. Uncemented fixation of this hybrid cage component appears to be a safe treatment option for patients undergoing primary TSA.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Ali Zarezadeh
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Michael Priddy
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
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15
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The effect of radial mismatch on radiographic glenoid loosening. JSES OPEN ACCESS 2019; 3:287-291. [PMID: 31891027 PMCID: PMC6928312 DOI: 10.1016/j.jses.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Methods Results Discussion
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16
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Schoch BS, Wright TW, Zuckerman JD, Bolch C, Flurin PH, Roche C, King JJ. Glenoid component lucencies are associated with poorer patient-reported outcomes following anatomic shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1956-1963. [PMID: 31202628 DOI: 10.1016/j.jse.2019.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND High rates of radiographic glenoid loosening following anatomic total shoulder arthroplasty (TSA) are documented at midterm follow-up. Small studies remain conflicted on the impact of lucent lines on clinical outcomes. This study assesses the impact of radiolucent lines on function and patient-reported outcomes (PROs) following TSA. METHODS We retrospectively evaluated 492 primary TSAs performed between February 2005 and April 2016. Radiographs were evaluated for glenoid loosening according to the Lazarus grade at a mean of 5.3 years (range, 2-12 years). Clinical outcome measures included range of motion and American Shoulder and Elbow Surgeons, Constant, University of California-Los Angeles, Simple Shoulder Test, and Shoulder Pain and Disability Index scores. Outcomes were compared between patients with and patients without glenoid lucent lines and in relation to lucency grade. RESULTS At most recent follow-up, 308 glenoids (63%) showed no radiolucent lines (group 0) and 184 demonstrated peri-glenoid lucencies (group 1). The groups were similar regarding age, sex, body mass index, comorbidities, and prior surgery. At follow-up, group 1 demonstrated significantly lower improvements in forward elevation (P = .02) and all PROs (P ≤ .005). Subgroup analysis by radiolucency grade showed that forward elevation diminished with increasing radiolucent score and exceeded the minimal clinically important difference (MCID) above grade 2 lucencies. A similar decline in PROs was observed with increasing lucency grade. These differences did not exceed the MCID below grade 5 lucencies. DISCUSSION Peri-implant glenoid lucencies following TSA are associated with lower forward elevation and PROs. Lucencies above grade 2 are associated with clinically important losses in overhead motion. However, differences below the MCID are maintained for PROs below grade 5 glenoid lucencies.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA.
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Joseph J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
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One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers. INTERNATIONAL ORTHOPAEDICS 2018; 43:367-378. [DOI: 10.1007/s00264-018-4213-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
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