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Pak T, Ardebol J, Kilic AI, Sears BW, Lederman E, Werner BC, Moroder P, Denard PJ. Posteroinferior glenosphere positioning is associated with improved range of motion following reverse shoulder arthroplasty with a 135° inlay humeral component and lateralized glenoid. J Shoulder Elbow Surg 2024; 33:2171-2177. [PMID: 38537768 DOI: 10.1016/j.jse.2024.02.019] [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: 11/11/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135° inlay stem with a lateralized glenoid. METHODS A retrospective review was performed on a prospectively maintained multicenter database on patients who underwent primary RSA from 2015 to 2021 with a 135° inlay stem. The COR was measured on minimum 2-year postoperative sagittal plain radiographs using a best-fit circle fit method. A best-fit circle was made on the glenosphere and the center was marked. From there, 4 measurements were made: (1) center to the inner cortex of the coracoid, (2) center to the inner cortex of the anterior acromion, (3) center to the inner cortex of the middle acromion, and (4) center to the inner cortex of the posterior acromion. Regression analysis was performed to evaluate any association between the position of the COR relative to bony landmarks with functional outcomes. RESULTS A total of 136 RSAs met the study criteria. There was no relation with any of the distances with outcome scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale). In regard to range of motion (ROM), each distance had an effect on at least 1 parameter. The COR to coracoid distance had the broadest association with ROM, with improvements in forward flexion (FF), external rotation (ER0), and internal rotation with the arm at 90° (IR90) (P < .001, P = .031, and P < .001, respectively). The COR to coracoid distance was also the only distance to affect the final FF and IR90. For every 1-mm increase in this distance, there was a 1.8° increase in FF and 1.5° increase in IR90 (β = 1.78, 95% confidence interval [CI] 0.85-2.72, P < .001, and β = 1.53, 95% CI 0.65-2.41, P < .001; respectively). CONCLUSION Evaluation of the COR following RSA in the sagittal plane suggests that a posteroinferior glenosphere position may improve ROM when using a 135° inlay humeral component and a lateralized glenoid.
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Affiliation(s)
- Theresa Pak
- Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | | | - Ali I Kilic
- Oregon Shoulder Institute, Medford, OR, USA; Department of Orthopaedics and Traumatology, Izmir Bakircay University, Izmir, Turkey
| | | | - Evan Lederman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Brian C Werner
- University of Virginia Health System, Charlottesville, VA, USA
| | - Philipp Moroder
- Department for Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
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Shah AA, Sheth M, McKee M, Lederman E. Evolution of Reverse Shoulder Arthroplasty Design Rationales and Where We Are Now. J Am Acad Orthop Surg 2024:00124635-990000000-01069. [PMID: 39168092 DOI: 10.5435/jaaos-d-23-01265] [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: 12/30/2023] [Accepted: 06/29/2024] [Indexed: 08/23/2024] Open
Abstract
Reverse shoulder arthroplasty (RSA) will soon reach its 20-year anniversary in the United States and has now become the most performed shoulder arthroplasty in the United States. The evolution from Grammont style implants to lateralized designs continues to generate debate as comparable outcomes have been reported with both types of systems. While early literature focused on fixation and expanded indications, recent studies have evaluated component design and position and their effect on functional outcomes and complications. The purpose of this article was to provide a synopsis of design rationales of current RSA prostheses and review outcomes related to RSA design and position.
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Affiliation(s)
- Anup A Shah
- From the Banner University Medical Group, University of Arizona - College of Medicine, Phoenix, AZ (Shah, McKee and Lederman); University of Washington, Seattle, WA (Sheth)
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Schippers P, Gercek E, Schneidmüller D, Strohm PC, Ruckes C, Wegner E, Baranowski A, Dietz SO. Proximal humeral fractures in children - controversies in decision making. Eur J Trauma Emerg Surg 2024; 50:1831-1837. [PMID: 38689019 PMCID: PMC11458729 DOI: 10.1007/s00068-024-02534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Proximal humeral fractures in children are rare and usually treated non-operatively, especially in children younger than ten. The decision between operative and non-operative treatment is mostly based on age and fracture angulation. In the current literature, diverging recommendations regarding fracture angulation that is still tolerable for non-operative treatment can be found. Besides, there is no consensus on how fracture angulation should be determined. This study aimed to determine whether leading experts in pediatric trauma surgery in Germany showed agreement concerning the measurement of fracture angulation, deciding between operative and non-operative treatment, and choosing a treatment modality. METHODS Twenty radiographs showing a proximal humeral fracture and the patient's age were assessed twice by twenty-two senior members of the "Section of Pediatric Traumatology of the German Association for Trauma Surgery". Experts determined the fracture angulation and chose between several operative and non-operative treatment modalities. The mean of individual standard deviations was calculated to estimate the accuracy of single measurements for fracture angulation. Besides Intra-Class Correlation and Fleiss' Kappa coefficients were determined. RESULTS For fracture angulation, experts showed moderate (ICC = 0.60) interobserver and excellent (ICC = 0.90) intraobserver agreement. For the treatment decision, there was fair (Kappa = 0.38) interobserver and substantial (Kappa = 0.77) intraobserver agreement. Finally, experts preferred ESIN over K-wires for operative and a Gilchrist over a Cuff/Collar for non-operative treatment. CONCLUSIONS Firstly, there is a need for consensus among experts on how fracture angulation in PHFs in children should be reliably determined. Our data indicate that choosing one method everybody agrees to use could be more helpful than using the most sophisticated. However, the overall importance of fracture angulation should also be critically discussed. Finally, experts should agree on treatment algorithms that could translate into guidelines to standardize the care and perform reliable outcome studies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Erol Gercek
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | | | - Peter C Strohm
- Clinic of Orthopedics and Trauma Surgery, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center, Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Erik Wegner
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas Baranowski
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sven-Oliver Dietz
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Pak T, Menendez ME, Gobezie R, Sears BW, Lederman E, Werner BC, Denard PJ. Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid. JSES Int 2024; 8:522-527. [PMID: 38707585 PMCID: PMC11064686 DOI: 10.1016/j.jseint.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of subacromial notching (SaN). The purpose of this study was to evaluate the presence of SaN following RSA and its relationship with lateralization with a 135° inlay humeral component. The secondary purpose was to assess the association of SaN with functional outcomes. Methods A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. SaN was defined as bony erosion with sclerotic margins on the undersurface of the acromion on final follow-up radiographs not present preoperatively. Postoperative implant positioning (inclination, distalization, and lateralization) were evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on implant and clinical variables to assess for risk factors. A separate analysis was performed to determine the association of SaN with clinical outcomes. Results SaN was identified in 13 out of 442 shoulders (2.9%). Age, sex, body mass index, smoking status, diabetes mellitus, arm dominance had no relationship with SaN. Neither glenoid sided lateralization nor humeral offset were associated with SaN risk. Other implant characteristics such as distalization, glenosphere size, and postoperative inclination did not influence SaN risk. The presence of SaN did not affect patient-reported outcomes (American Shoulder and Elbow Surgeons: P = .357, Visual Analog Scale: P = .210) or range of motion. Conclusion The rate of SaN is low and not associated with glenoid or humeral prosthetic lateralization when using a 135° inlay humeral component. When SaN occurs, it is not associated with functional outcomes or range of motion at short-term follow-up.
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Affiliation(s)
- Theresa Pak
- Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Brian C. Werner
- University of Virginia Health System, Charlottesville, VA, USA
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Schippers P, Rösch G, Sohn R, Holzapfel M, Junker M, Rapp AE, Jenei-Lanzl Z, Drees P, Zaucke F, Meurer A. A Lightweight Browser-Based Tool for Collaborative and Blinded Image Analysis. J Imaging 2024; 10:33. [PMID: 38392082 PMCID: PMC10889326 DOI: 10.3390/jimaging10020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Collaborative manual image analysis by multiple experts in different locations is an essential workflow in biomedical science. However, sharing the images and writing down results by hand or merging results from separate spreadsheets can be error-prone. Moreover, blinding and anonymization are essential to address subjectivity and bias. Here, we propose a new workflow for collaborative image analysis using a lightweight online tool named Tyche. The new workflow allows experts to access images via temporarily valid URLs and analyze them blind in a random order inside a web browser with the means to store the results in the same window. The results are then immediately computed and visible to the project master. The new workflow could be used for multi-center studies, inter- and intraobserver studies, and score validations.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Gundula Rösch
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Rebecca Sohn
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Matthias Holzapfel
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Marius Junker
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
- Department of Orthopedics, Tabea Hospital Hamburg, 22587 Hamburg, Germany
| | - Anna E Rapp
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Zsuzsa Jenei-Lanzl
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Frank Zaucke
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Andrea Meurer
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
- Medical Park St. Hubertus Klinik, 83707 Bad Wiessee, Germany
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