1
|
Hays C. Current Role of Reverse Total Shoulder Arthroplasty in the Management of Glenohumeral Osteoarthritis. Orthop Clin North Am 2024; 55:489-502. [PMID: 39216954 DOI: 10.1016/j.ocl.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Reverse total shoulder arthroplasty (RSA) was historically reserved for the elderly, low-demand patient with rotator cuff arthropathy (RCA) or as a salvage procedure after failed primary arthroplasty. Surgeon expertise and the advancement of implant design has allowed RSA to now become commonplace not only for RCA but also for glenohumeral osteoarthritis. RSA provides a robust glenoid baseplate fixation, which allows for easier and more reliable bone grafting or augmentation when needed. For patients with severe glenoid bone loss, RSA has been shown to have superior or equivalent patient-reported outcomes and shoulder range of motion when compared with total shoulder arthroplasty.
Collapse
Affiliation(s)
- Claire Hays
- Department of Orthopaedic Surgery, Campbell Clinic - University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
2
|
Testa EJ, Katz L, Zhang H, Chang K, Kutschke MJ, Dworkin M, Owens BD. Rotator Cuff Tears to Shoulder Instability: The Relationship Between Acromial Morphology and Shoulder Pathology. JBJS Rev 2024; 12:01874474-202401000-00004. [PMID: 38181125 DOI: 10.2106/jbjs.rvw.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» The acromion is a well-studied region of the scapula that has demonstrated substantial relationships to various shoulder pathologies.» Abnormal acromial morphology is associated with rotator cuff pathology, and our understanding of this risk factor inspired acromioplasty as an adjunctive treatment for rotator cuff tears.» The acromion is linked closely to shoulder kinematics and biomechanics, as it serves as the origin for the deltoid muscle.» In degenerative shoulder disease, eccentric glenohumeral osteoarthritis has been associated with a higher, flatter acromial roof.» Increasing literature is emerging connecting morphology of the acromion with shoulder instability.
Collapse
Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Luca Katz
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Helen Zhang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Kenny Chang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Michael J Kutschke
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Myles Dworkin
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| |
Collapse
|
3
|
Hochreiter B, Beeler S, Hofstede S, Sigrist B, Snedeker JG, Gerber C. Posterior stability of the shoulder depends on acromial anatomy: a biomechanical study of 3D surface models. J Exp Orthop 2023; 10:59. [PMID: 37261546 PMCID: PMC10235013 DOI: 10.1186/s40634-023-00623-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE Primary glenohumeral osteoarthritis is commonly associated with static posterior subluxation of the humeral head. Scapulae with static/dynamic posterior instability feature a superiorly and horizontally oriented acromion. We investigated whether the acromion acts as a restraint to posterior humeral translation. METHODS Five three-dimensional (3D) printed scapula models were biomechanically tested. A statistical shape mean model (SSMM) of the normal scapula of 40 asymptomatic shoulders was fabricated. Next, a SSMM of scapular anatomy associated with posterior subluxation was generated using data of 20 scapulae ("B1"). This model was then used to generate three models of surgical correction: glenoid version, acromial orientation, and acromial and glenoid orientation. With the joint axially loaded (100N) and the humerus stabilized, an anterior translation force was applied to the scapula in 35°, 60° and 75° of glenohumeral flexion. Translation (mm) was measured. RESULTS In the normal scapula, the humerus translates significantly less to contact with the acromion compared to all other configurations (p < .000 for all comparisons; i.e. 35°: "normal" 8,1 mm (± 0,0) versus "B1" 11,9 mm (± 0,0) versus "B1 Acromion Correction" 12,2 mm (± 0,2) versus "B1 Glenoid Correction" 13,3 mm (± 0,1)). Restoration of normal translation was only achieved with correction of glenoid and acromial anatomy (i.e. 75°: "normal" 11 mm (± 0,8) versus "B1 Acromion Correction" 17,5 mm (± 0,1) versus "B1 Glenoid Correction" 19,7 mm (± 1,3) versus "B1 Glenoid + Acromion Correction" 11,5 mm (± 1,1)). CONCLUSIONS Persistence or recurrence of static/dynamic posterior instability after correction of glenoid version alone may be related to incomplete restoration of the intrinsic stability that is conferred by a normal acromial anatomy. LEVEL OF EVIDENCE V biomechanical study.
Collapse
Affiliation(s)
- Bettina Hochreiter
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland.
| | - Silvan Beeler
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Simon Hofstede
- Department of Orthopaedics, Biomechanical Research Laboratory, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Bastian Sigrist
- Research in Orthopaedic Computer Science (ROCS), University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopaedics, Biomechanical Research Laboratory, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zurich, Switzerland
| |
Collapse
|
4
|
Gerber C, Sigrist B, Hochreiter B. Correction of Static Posterior Shoulder Subluxation by Restoring Normal Scapular Anatomy Using Acromion and Glenoid Osteotomies: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00030. [PMID: 37172119 DOI: 10.2106/jbjs.cc.23.00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE A 40-year-old man presented with progressive shoulder pain, associated with static posterior subluxation and mild eccentric glenohumeral osteoarthritis. Compared with a mean statistical shape model of a normal shoulder, the patient's acromion was abnormally high and horizontal, and the glenoid abnormally inclined inferiorly and minimally retroverted. Restoration of normal scapular anatomy using 3-dimensional planned acromial and glenoid osteotomies led to recentering of the joint and full shoulder function up to 24 months postoperatively. CONCLUSION The correction of associated acromial and glenoid malformation can revert early static posterior subluxation of the shoulder. Whether successful recentering prevents progression of osteoarthritis remains to be established.
Collapse
Affiliation(s)
- Christian Gerber
- Department of Orthopaedics University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
| | - Bastian Sigrist
- Department of Orthopaedics, Laboratory for Research in Orthopaedic Computer Science (ROCS), University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Bettina Hochreiter
- Department of Orthopaedics University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
| |
Collapse
|
5
|
Verhaegen F, Meynen A, Pitocchi J, Debeer P, Scheys L. Quantitative statistical shape model-based analysis of humeral head migration, Part 2: Shoulder osteoarthritis. J Orthop Res 2023; 41:21-31. [PMID: 35343599 DOI: 10.1002/jor.25335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
We wanted to investigate the quantitative characteristics of humeral head migration (HHM) in shoulder osteoarthritis (OA) and their possible associations with scapular morphology. We quantified CT-scan-based-HHM in 122 patients with a combination of automated 3D scapulohumeral migration (=HHM with respect to the scapula) and glenohumeral migration (=HHM with respect to the glenoid) measurements. We divided OA patients in Group 1 (without HHM), Group 2a (anterior HHM) and Group 2b (posterior HHM). We reconstructed and measured the prearthropathy scapular anatomy with a statistical shape model technique. HHM primarily occurs in the axial plane in shoulder OA. We found "not-perfect" correlation between subluxation distance AP and scapulohumeral migration values (rs = 0.8, p < 0.001). Group 2b patients had a more expressed prearthropathy glenoid retroversion (13° vs. 7°, p < 0.001) and posterior glenoid translation (4 mm vs. 6 mm, p = 0.003) in comparison to Group 1. Binary logistic regression analysis indicated prearthropathy glenoid version as a significant predictor of HHM (χ² = 27, p < 0.001). Multivariate regression analysis showed that the pathologic version could explain 56% of subluxation distance-AP variance and 75% of the scapulohumeral migration variance (all p < 0.001). Herewith, every degree increase in pathologic glenoid retroversion was associated with an increase of 1% subluxation distance-AP, and scapulohumeral migration. The occurrence of posterior HHM is associated with prearthropathy glenoid retroversion and more posterior glenoid translation. The reported regression values of HHM in the function of the pathologic glenoid version could form a basis toward a more patient-specific correction of HHM.
Collapse
Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Alexander Meynen
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Philippe Debeer
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Division of Orthopaedics, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Verhaegen F, Meynen A, Plessers K, Scheys L, Debeer P. Quantitative SSM-based analysis of humeral head migration in rotator cuff tear arthropathy patients. J Orthop Res 2022; 40:1707-1714. [PMID: 34664739 DOI: 10.1002/jor.25195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff tear arthropathy (RCTA) is characterized by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study is to investigate the quantitative characteristics of this migration and its association with glenoid erosions and prearthropathy scapular anatomy. We quantified HHM and prearthropathy scapular anatomy of 64 RCTA patients with statistical shape modeling-based techniques. Glenoid erosion was classified according to Sirveaux et al. A cutoff value for confirming HHM was 5 mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with a mean subluxation distance (SLD) of 3 mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9 mm, SLD in the anteroposterior plane of -1 mm (SD ± 4 mm), SLD in the superoinferior plane of 7 mm (SD ± 3 mm), and subluxation angle (SLA) of -5° (SD ± 40°). Analysis with Fisher's exact test showed a clear association between HHM and glenoid erosions (p = 0.002). Multivariate regression analysis of Group 2 showed that prearthropathy lateral acromial angle combined with critical shoulder angle (p = 0.004) explained 21% of the observed variability in SLD. The prearthropathy glenoid version explained 23% of the variability in SLA (p = 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the prearthropathy scapular anatomy and the magnitude and direction of HHM.
Collapse
Affiliation(s)
| | - Alexander Meynen
- Division of Orthopaedics, Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Plessers
- Department of Biomechanics, KU Leuven and Materialise NV, Leuven, Belgium
| | - Lennart Scheys
- Division of Orthopaedics, Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Debeer
- Division of Orthopaedics, Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders. J Clin Med 2022; 11:jcm11020351. [PMID: 35054045 PMCID: PMC8779855 DOI: 10.3390/jcm11020351] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R2 = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R2 = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae.
Collapse
|
8
|
Wynell-Mayow W, Chong CC, Musbahi O, Ibrahim E. A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders. JSES Int 2021; 6:447-453. [PMID: 35572451 PMCID: PMC9091782 DOI: 10.1016/j.jseint.2021.10.007] [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] [Indexed: 11/17/2022] Open
Abstract
Background Degenerative rotator cuff tears and osteoarthritis (OA) are associated with differences in coronal plane scapular morphology, with particular focus on the effect of the critical shoulder angle (CSA) on shoulder biomechanics. The effect, if any, of axial plane scapular morphology is less well established. We have noticed wide disparity of axial coracoid tip position in relation to the face of the glenoid and sought to investigate the significance of this through measurement of the critical coracoid process angle (CCPA), which incorporates coracoid tip position and glenoid version. Methods CCPA, CSA, and glenoid retroversion were measured by three independent reviewers from the cross-sectional two-dimensional computed tomography (CT) and magnetic resonance imaging of 160 patients in four equal and matched case-control groups: (1) a control group of patients with a radiologically normal shoulder and no history of shoulder symptoms who had a CT thorax for another reason, (2) patients with primary OA with Walch type-A glenoid wear pattern on CT scan, (3) patients with type-B glenoid primary OA, and (4) patients with magnetic resonance imaging–proven atraumatic tears of the posterosuperior rotator cuff. Results Interobserver agreement was excellent for all measured parameters. The median CCPA was significantly lower in the type-B OA group (9.3˚) than that in controls (18.7˚), but not significantly different in the other study groups. There was a trend toward greater glenoid retroversion in the type-B OA group, but receiver operating characteristic curve analysis demonstrated the CCPA to be by far the most powerful discriminator for type-B OA. The optimal cutoff value was calculated for the CCPA at 14.3˚ with a sensitivity of 93% and specificity of 90% for type-B OA. Compared with controls, the CSA was significantly higher in the rotator cuff tear group and lower in both OA groups, but did not differentiate between type-A and type-B OA. Conclusion Combined with a lower CSA, a lower CCPA (<14.3˚) is strongly predictive of type-B glenoid OA. The authors propose a simple model of pectoralis major biomechanics to explain the effect of this axial plane anatomical variation, which requires further investigation.
Collapse
Affiliation(s)
- William Wynell-Mayow
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex
- Corresponding author: William Wynell-Mayow, MRCS, Flat 317, West Block, Forum Magnum Square, London, SE1 7GL.
| | - Chung Chi Chong
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex
| | - Omar Musbahi
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex
- MSk Lab, White City Campus, Imperial College London, London
| | - Edward Ibrahim
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, Middlesex
| |
Collapse
|
9
|
Biconcave glenoids show 3 differently oriented posterior erosion patterns. J Shoulder Elbow Surg 2021; 30:2620-2628. [PMID: 33964426 DOI: 10.1016/j.jse.2021.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior glenoid wear remains a challenge in anatomic and reverse total shoulder arthroplasty (rTSA) because of an asymmetric erosion with altered retroversion. The purpose of this study was to assess glenoid morphology and evaluate the influence of acromial orientation in posterior glenoid erosion patterns by using 3-dimensional (3D) models. MATERIAL AND METHODS Computed tomographic (CT) shoulder scans from 3 study centers of patients awaiting rTSA between 2017 and 2018 were converted into 3D models and analyzed by 2 observers. Morphology, orientation and greatest depth of erosion, inclination, current retroversion and premorbid retroversion, surface areas of the glenoid, and external acromial orientation and posterior acromial slope were assessed. Measurements were compared between wear patterns, glenoid erosion entities, and genders. RESULTS In the complete cohort of 68 patients (63.8 ± 10.0 years; 19 female, 49 male), a mean of 85.9° (±22.2°) was observed for the glenoid erosion orientation. Additionally, a further distinct classification of the glenoid erosion as posterior-central (PC, n = 39), posterior-inferior (PI, n = 12), and posterior-superior (PS, n = 17) wear patterns was possible. These wear patterns significantly (P < .001) distinguished by erosion orientation (PC = 86.9° ± 12.0°, PI = 116.3° ± 10.3°, PS = 62.3° ± 18.9°). The greatest depth of erosion found was 7.3 ± 2.7 mm in PC wear patterns (PC vs. PI: P = .03; PC vs. PS: n.s.; PI vs. PS: n.s.). Overall, the observed erosion divided the glenoid surface into a paleoglenoid proportion of 48% (±11%) and a neoglenoid proportion of 52% (±12%). For the complete cohort, glenoid inclination was 85.4° (±6.6°), premorbid glenoid retroversion was 80.7° (±8.1°), and current glenoid retroversion was 73.4° (±7.4°), with an estimated increase of 6.9° (±6.0°). The mean external acromial orientation was 118.2° (±8.9°), and the mean posterior acromial slope was 107.2° (±9.6°). There were no further significant differences if parameters were compared by wear patterns, entities, and gender. CONCLUSION Three significantly differently oriented wear patterns (posterior-superior, posterior-central, and posterior-inferior) were distinguished in shoulders demonstrating posterior wear on axillary imaging. No significant differences between the observed erosion patterns or any relevant correlations were found regarding the orientation of the acromion.
Collapse
|
10
|
Reahl GB, Abdul-Rassoul H, Kim RL, Ardavanis KS, Novikov D, Curry EJ, Galvin JW, Eichinger JK, Li X. Anatomic vs. reverse shoulder arthroplasty for the treatment of Walch B2 glenoid morphology: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:317-328. [PMID: 37588714 PMCID: PMC10426621 DOI: 10.1016/j.xrrt.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Walch B2 glenoid morphology with glenohumeral osteoarthritis is a difficult degenerative pattern to manage for shoulder surgeons. Anatomic total shoulder arthroplasty (TSA) in combination with eccentric reaming or bone grafting are the traditional methods of treatment. Newer approaches such as TSA with posteriorly augmented glenoid components and reverse shoulder arthroplasty (RSA) may offer better stability for the posteriorly subluxated biconcave B2 wear pattern. The aim of this systematic review is to compare mid-term surgical and functional outcomes of Walch B2 glenoids without significant rotator cuff pathology treated with TSA and RSA. Methods The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching the MEDLINE (PubMed) and Embase (Elsevier) databases. Inclusion criteria were clinical studies that evaluated the outcomes and complications of TSA or RSA in the setting of B2 glenoid morphology without significant rotator cuff pathology. Data relevant to TSA and RSA surgical outcomes were extracted and compiled, and outcomes were compared. A meta-analysis of proportions of complication and revision rates among TSA and RSA groups was performed. Results Overall, 16 articles were included with 414 TSAs and 78 RSAs. The average follow-up duration was 54.1 ± 14.8 months for patients undergoing TSA and 44.8 ± 10.1 months for patients undergoing RSA. The TSA group was further subdivided based on the use of eccentric reaming (135 TSAs), an augmented glenoid component (84 TSAs), or bone grafting (11 TSAs) or was unspecified (184 TSAs). Overall, patients undergoing TSA and RSA demonstrated mean improvements of 50.1 ± 8.5° and 64.7 ± 5.2° in active flexion, 58.5 ± 10.3° and 68.9 ± not reported° in active abduction, and 31.3 ± 5.7° and 29.0 ± 10.2° in active external rotation, respectively. In regard to functional outcome scores, patients undergoing TSA and RSA showed mean Constant score improvements of 38.8 ± 5.3 and 46.6 ± 3.1 points and American Shoulder and Elbow Surgeons score improvements of 48.2 ± 1.0 and 49.2 ± 25.3 points, respectively. Results of the meta-analysis with mid-term follow-up data demonstrated pooled complication rates of 9% (95% confidence interval [CI], 1%-22%) for TSA and 6% (95% CI, 0%-28%) for RSA and pooled revision rates of 2% (95% CI, 0%-8%) for TSA and 1% (95% CI, 0%-15%) for RSA. Conclusion In the setting of Walch B2 glenoid morphology, TSA with eccentric reaming or an augmented component yields comparable outcomes to RSA. Based on the patient's age, activity level, and expectations, both TSA and RSA can be considered a reasonable option to treat Walch B2 glenoid morphology.
Collapse
Affiliation(s)
- G. Bradley Reahl
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Ryan L. Kim
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Kyle S. Ardavanis
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - David Novikov
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Emily J. Curry
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Joseph W. Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Josef K. Eichinger
- Medical University of South Carolina, Department of Orthopaedics, Charleston, SC, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage. Sci Rep 2021; 11:18596. [PMID: 34545141 PMCID: PMC8452695 DOI: 10.1038/s41598-021-98040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P < 0.05); Disordered alignment and proportion of collagen I/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P < 0.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.
Collapse
|
13
|
Verhaegen F, Meynen A, Debeer P, Scheys L. Determination of predisposing scapular anatomy with a statistical shape model-Part II: shoulder osteoarthritis. J Shoulder Elbow Surg 2021; 30:e558-e571. [PMID: 33600897 DOI: 10.1016/j.jse.2021.01.018] [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: 09/08/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Shoulder osteoarthritis can be divided into different glenoid types (A, B, C, and D) and subtypes. The aim of this study was to investigate if there is an association between the prearthropathy scapular anatomy, shoulder osteoarthritis, and different glenoid types and subtypes. METHODS Using principal components analysis, a statistical shape model (SSM) of the scapula was constructed from a data set of 110 computed tomographic (CT) scans. These subjects formed the control group. Next, CT scan images of 117 patients with osteoarthritis were classified according to the modified Walch classification. A complete 3-dimensional (3D) scapular bone model was created for every patient, and using the SSM, a reconstruction of their prearthropathy scapular anatomy was performed. Automated 3D measurements were performed in both the patient and control group to obtain glenoid version and inclination, critical shoulder angle (CSA), posterior acromial slope (PAS), lateral acromion angle, scapular offset, and the rotational alignment of the coracoacromial complex. These parameters were compared between controls, patients with osteoarthritis, and glenoid types and subtypes. RESULTS Mean version and inclination for the control group was 6° retroversion and 8° superior inclination (both SD 4°). The mean CSA, PAS, coracoid-posterior acromion angle, posterior acromion-scapular plane angle, and fulcrum axis ratio were 30° (SD 4°), 64° (SD 8°), 116° (SD 9°), 55° (SD 7°), and 46% (SD 4%), respectively. Patients with osteoarthritis had a significant lower CSA, posterior acromion-scapular plane angle, coracoid-posterior acromion angle, and fulcrum axis ratio (27°, 50°, 111°, and 44%, all P < .001). We found a significant difference between the control group and the respective glenoid types for the following parameters: mean CSA and coracoid-posterior acromion angle for A glenoids (27°, P = .001, and 111°, P = .007); mean version, CSA, PAS, coracoid-posterior acromion angle, posterior acromion-scapular plane angle, and fulcrum axis ratio for B glenoids (11°, 27°, 71°, 111°, 49°, and 43%, all P < .001); and mean version, CSA, and posterior acromion-scapular plane angle for D glenoids (2°, P = .002, 26°, P = .003, and 48°, P = .007). DISCUSSION There seems to be an association between prearthropathy scapular anatomy and shoulder osteoarthritis. A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology. Furthermore, B and D glenoids are associated with, respectively, a more and less pronounced prearthropathy glenoid retroversion.
Collapse
Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
| | - Alexander Meynen
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
14
|
Determination of pre-arthropathy scapular anatomy with a statistical shape model: part I-rotator cuff tear arthropathy. J Shoulder Elbow Surg 2021; 30:1095-1106. [PMID: 32822879 DOI: 10.1016/j.jse.2020.07.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Rotator cuff tear arthropathy (RCTA) is a pathology characterized by a massive rotator cuff tear combined with acromiohumeral and/or glenohumeral arthritis. The severity of RCTA can be staged according to the Hamada classification. Why RCTA develops in some patients is unknown. Furthermore, in RCTA patients, distinctly different articular damage patterns can develop on the glenoid side as categorized by the Sirveaux classification (glenoid erosion). The goal of this study was to determine whether an association exists between scapular anatomy and RCTA and different severity stages of RCTA, as well as the associated glenoid erosion types. METHODS A statistical shape model of the scapula was constructed from a data set of 110 computed tomography scans using principal component analysis. Sixty-six patients with degenerative rotator cuff pathology formed the control group. The computed tomography scan images of 89 patients with RCTA were included and grouped according to the Hamada and Sirveaux classifications. A complete 3-dimensional scapular bone model was created, and statistical shape model reconstruction was performed. Next, automated 3-dimensional measurements of glenoid version and inclination, scapular offset, the critical shoulder angle (CSA), the posterior acromial slope (PAS), and the lateral acromial angle (LAA) were performed. All measurements were then compared between controls and RCTA patients. RESULTS The control group had a median of 7° of retroversion (variance, 16°), 8° of superior inclination (variance, 19°), and 106 mm of scapular offset (variance, 58 mm). The median CSA, PAS, and LAA were 30° (variance, 14°), 65° (variance, 60°), and 90° (variance, 17°), respectively. In terms of inclination, version, scapular offset, and the PAS, we found no statistically significant differences between the RCTA and control groups. For RCTA patients, the median CSA and median LAA were 32° (P ≤ .01) and 86° (P ≤ .01), respectively. For all investigated parameters, we did not find any significant difference between the different stages of RCTA. Patients with type E3 erosion had a different pre-arthropathy anatomy with increased retroversion (12°, P = .006), an increased CSA (40°, P ≤ .001), and a reduced LAA (79°, P ≤ .001). DISCUSSION Our results seem to indicate that a 4° more inferiorly tilted and 2° more laterally extended acromion is associated with RCTA. RCTA patients in whom type E3 erosion develops have a distinct pre-arthropathy scapular anatomy with a more laterally extended and more inferiorly tilted acromion and a more retroverted glenoid in comparison with RCTA patients with no erosion. The pre-arthropathy scapular anatomy does not seem to differ between patients with different stages of RCTA.
Collapse
|
15
|
Matache BA, Alnusif N, Chaoui J, Walch G, Athwal GS. Humeral head subluxation in Walch type B shoulders varies across imaging modalities. JSES Int 2021; 5:98-101. [PMID: 33554173 PMCID: PMC7846694 DOI: 10.1016/j.jseint.2020.08.016] [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] [Indexed: 11/26/2022] Open
Abstract
Background The Walch type B pattern of glenohumeral osteoarthritis is characterized by posterior humeral head subluxation (PHHS). At present, it is unknown whether the percentage of subluxation measured on axillary radiographs is consistent with measurements on 2-dimensional (2D) axial or 3-dimensional (3D) volumetric computed tomography (CT). The purpose of this study was to evaluate PHHS across imaging modalities (radiographs, 2D CT, and 3D CT). Methods A cohort of 30 patients with Walch type B shoulders underwent radiography and standardized CT scans. The cohort comprised 10 type B1, 10 type B2, and 10 type B3 glenoids. PHHS was measured using the scapulohumeral subluxation method on axillary radiographs and 2D CT. On 3D CT, PHHS was measured volumetrically. PHHS was statistically compared between imaging modalities, with P ≤ .05 considered significant. Results The mean PHHS value for the entire group was 69% ± 24% on radiographs, 65% ± 23% with 2D CT, and 74% ± 24% with 3D volumetric CT. PHHS as measured on complete axillary radiographs was not significantly different than that measured on 2D CT (P = .941). Additionally, PHHS on 3D volumetric CT was 9.5% greater than that on 2D CT (P < .001). There were no significant differences in PHHS between the type B1, B2, and B3 groups with 2D or 3D CT measurement techniques (P > .102). Conclusion Significant differences in PHHS were found between measurement techniques (P < .035). A 9.5% difference in PHHS between 2D and 3D CT can be mostly accounted for by the linear (2D) vs. volumetric (3D) measurement techniques (a linear 80% PHHS value is mathematically equivalent to a volumetric PHHS value of 89.6%). Surgeons should be aware that subluxation values and therefore thresholds vary across different imaging modalities and measurement techniques.
Collapse
Affiliation(s)
| | - Naser Alnusif
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
| | | | | | - George S Athwal
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
| |
Collapse
|
16
|
Abstract
Background There is evidence that specific variants of scapular morphology are associated with dynamic and static posterior shoulder instability. To this date, observations regarding glenoid and/or acromial variants were analyzed independently, with two-dimensional imaging or without comparison with a healthy control group. Therefore, the purpose of this study was to analyze and describe the three-dimensional (3D) shape of the scapula in healthy and in shoulders with static or dynamic posterior instability using 3D surface models and 3D measurement methods. Methods In this study, 30 patients with unidirectional posterior instability and 20 patients with static posterior humeral head subluxation (static posterior instability, Walch B1) were analyzed. Both cohorts were compared with a control group of 40 patients with stable, centered shoulders and without any clinical symptoms. 3D surface models were obtained through segmentation of computed tomography images and 3D measurements were performed for glenoid (version and inclination) and acromion (tilt, coverage, height). Results Overall, the scapulae of patients with dynamic and static instability differed only marginally among themselves. Compared with the control group, the glenoid was 2.5° (P = .032), respectively, 5.7° (P = .001) more retroverted and 2.9° (P = .025), respectively, 3.7° (P = .014) more downward tilted in dynamic, respectively, static instability. The acromial roof of dynamic instability was significantly higher and on average 6.2° (P = .007) less posterior covering with an increased posterior acromial height of +4.8mm (P = .001). The acromial roof of static instability was on average 4.8° (P = .041) more externally rotated (axial tilt), 7.3° (P = .004) flatter (sagittal tilt), 8.3° (P = .001) less posterior covered with an increased posterior acromial height of +5.8 mm (0.001). Conclusion The scapula of shoulders with dynamic and static posterior instability is characterized by an increased glenoid retroversion and an acromion that is shorter posterolaterally, higher, and more horizontal in the sagittal plane. All these deviations from the normal scapula values were more pronounced in static posterior instability.
Collapse
|
17
|
Holt AM, Throckmorton TW. Reverse Shoulder Arthroplasty for B2 Glenoid Deformity. J Shoulder Elb Arthroplast 2019; 3:2471549219897661. [PMID: 34497958 PMCID: PMC8282141 DOI: 10.1177/2471549219897661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/27/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
Abstract
In shoulder osteoarthritis, the B2 glenoid presents challenges in treatment
because of the excessive retroversion and posterior deficiency of the glenoid.
Correction of retroversion and maintenance of a stable joint line with
well-fixed implants are essential for the successful treatment of this deformity
with arthroplasty. Reverse shoulder arthroplasty offers several key advantages
in achieving this goal, including favorable biomechanics, a well-fixed
baseplate, and proven success in other applications. Techniques such as
eccentric reaming, bone grafting, and baseplate augmentation allow surgeons to
tailor treatment to the patient’s altered anatomy. Eccentric reaming is favored
for correction of small defects or mild version anomalies. Current trends favor
bone grafting for larger corrections, though augmented components have shown
early promise with the potential for expanded use. With overall promising
results reported in the literature, reverse shoulder arthroplasty is a useful
tool for treating older patients with B2 glenoid deformities.
Collapse
Affiliation(s)
- Andrew M Holt
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, Tennesse
| | - Thomas W Throckmorton
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, Tennesse
| |
Collapse
|