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3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence. Skeletal Radiol 2022; 51:2281-2289. [PMID: 35737085 DOI: 10.1007/s00256-022-04086-6] [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: 03/17/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. METHODS 3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. RESULTS The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). CONCLUSIONS 3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.
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Bola M, Simões J, Ramos A. Finite element analysis to predict short and medium-term performance of the anatomical Comprehensive® Total Shoulder System. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106751. [PMID: 35306286 DOI: 10.1016/j.cmpb.2022.106751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The number of Total Shoulder Arthroplasties (TSA) has increased in these last years with significant increase of clinical success. However, glenoid component loosening remains the most common cause of failure. OBJECTIVE In this study we evaluated the critical conditions to predict short and medium-term performance of the uncemented anatomical Comprehensive® Total Shoulder System using a finite element model that was validated experimentally. METHODS The finite element models of an implanted shoulder analysed included total shoulder components with pegs. The models were simulated in 3 phases of adduction: 45°, 60° and 90° to determine the most critical situation. Two different bone-implant fixation conditions were considered: post-surgery and medium term (2 years). RESULTS These show that the critical condition is for the shoulder in 90° adduction were the highest contact stress (70 MPa) was observed in the glenoid component. Relatively to the interface implant-bone strains, the maximum (-16000 µε) was observed for the short-term in the lateral region of the humerus. The highest micromotions were observed in the central fixation post of the glenoid component, ranging from 20 to 25 µm, and 325 µm in the lateral plane of the humeral component. CONCLUSION The predicted results are in accordance with clinical studies published and micromotions of the humeral component can be used to predict loosening and to differentiate shoulder implant designs.
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Affiliation(s)
- Margarida Bola
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal
| | - José Simões
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal; ESAD- College of Art and Design, Avenida Calouste Gulbenkian, Senhora da Hora, Matosinhos 4460-268, Portugal
| | - António Ramos
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal.
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Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde LF, Pouliart N. Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries. Expert Rev Med Devices 2021; 18:1189-1201. [PMID: 34903126 DOI: 10.1080/17434440.2021.2014318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.
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Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Orthopaedic Surgery and Traumatology, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Taco Gosens
- Department of Orthopaedic Surgery and Traumatology, Elisabeth Tweesteden Hospital, Tilburg/Waalwijk, The Netherlands
| | - Sara De Boey
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nicole Pouliart
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Prestat AJ, Dalili D, Rudel A, Torre F, Pavan LJ, Boileau P, Amoretti N. Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery? Eur Radiol 2020; 31:4221-4231. [PMID: 33201283 DOI: 10.1007/s00330-020-07463-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening. METHODS In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region. RESULTS All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations. CONCLUSION RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery. KEY POINTS • Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants. • Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life. • Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.
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Affiliation(s)
- A J Prestat
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.
| | - D Dalili
- Nuffield Orthopedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A Rudel
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.,Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - F Torre
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - L J Pavan
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - P Boileau
- Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - N Amoretti
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
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Chamseddine M, Breden S, Pietschmann MF, Müller PE, Chevalier Y. Periprosthetic bone quality affects the fixation of anatomic glenoids in total shoulder arthroplasty: in vitro study. J Shoulder Elbow Surg 2019; 28:e18-e28. [PMID: 30274689 DOI: 10.1016/j.jse.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid loosening, a common complication of shoulder arthroplasty, could relate to implant design and bone quality. However, the role of bone density has not been tested experimentally yet. In this study, tests on cadaveric specimens of varying bone density were performed to evaluate the effects of bone quality on loosening of typical anatomic glenoid implants. METHODS Cadaveric scapulae scanned with a quantitative computed tomography scanner to determine bone mineral density (BMD) were implanted with either pegged or keeled cemented glenoid components and tested under constant glenohumeral load while a humeral head component was moved cyclically in the inferior and superior directions. Implant superior and inferior edge lifting, defined as displacement from the underlying bone, was measured with linear variable differential transducers until we reached 23,000 test cycles, and statistical testing was performed for differences in edge lifting due to implant design and related to periprosthetic BMD. RESULTS Edge lifting was statistically significant at all time points, but on average, implant design had no effect. Lifting was highest in specimens in which BMD below the lifting edge was lower, with trends of increased displacement with decreased BMD. CONCLUSIONS Implant lifting was greater in glenoids of lower bone density for both implant designs. This finding suggests that fixation failure will most likely occur in bone of lower density and that the fixation design itself may play a secondary role.
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Affiliation(s)
- Mohamad Chamseddine
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Sebastian Breden
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany.
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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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Van Vrekhem S, Vloebergh K, Asadian M, Vercruysse C, Declercq H, Van Tongel A, De Wilde L, De Geyter N, Morent R. Improving the surface properties of an UHMWPE shoulder implant with an atmospheric pressure plasma jet. Sci Rep 2018; 8:4720. [PMID: 29549270 PMCID: PMC5856771 DOI: 10.1038/s41598-018-22921-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/21/2018] [Indexed: 11/09/2022] Open
Abstract
Insufficient glenoid fixation is one of the main reasons for failure in total shoulder arthroplasty. This is predominantly caused by the inert nature of the ultra-high molecular weight polyethylene (UHMWPE) used in the glenoid component of the implant, which makes it difficult to adhesively bind to bone cement or bone. Previous studies have shown that this adhesion can be ameliorated by changing the surface chemistry using plasma technology. An atmospheric pressure plasma jet is used to treat UHMWPE substrates and to modify their surface chemistry. The modifications are investigated using several surface analysis techniques. The adhesion with bone cement is assessed using pull-out tests while osteoblast adhesion and proliferation is also tested making use of several cell viability assays. Additionally, the treated samples are put in simulated body fluid and the resulting calcium phosphate (CaP) deposition is evaluated as a measure of the in vitro bioactivity of the samples. The results show that the plasma modifications result in incorporation of oxygen in the surface, which leads to a significant improved adhesion to bone cement, an enhanced osteoblast proliferation and a more pronounced CaP deposition. The plasma-treated surfaces are therefore promising to act as a shoulder implant.
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Affiliation(s)
- S Van Vrekhem
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium.
| | - K Vloebergh
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - M Asadian
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - C Vercruysse
- Tissue Engineering Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 6B3, 9000, Ghent, Belgium
| | - H Declercq
- Tissue Engineering Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 6B3, 9000, Ghent, Belgium
| | - A Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 13K12, 9000, Ghent, Belgium
| | - L De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 13K12, 9000, Ghent, Belgium
| | - N De Geyter
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
| | - R Morent
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, B-9000, Ghent, Belgium
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Terrier A, Obrist R, Becce F, Farron A. Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality. J Shoulder Elbow Surg 2017; 26:1644-1652. [PMID: 28412104 DOI: 10.1016/j.jse.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that biomechanical parameters typically associated with glenoid implant failure after anatomic total shoulder arthroplasty (aTSA) would be correlated with preoperative glenoid bone quality. METHODS We developed an objective automated method to quantify preoperative glenoid bone quality in different volumes of interest (VOIs): cortical bone, subchondral cortical plate, subchondral bone after reaming, subchondral trabecular bone, and successive layers of trabecular bone. Average computed tomography (CT) numbers (in Hounsfield units [HU]) were measured in each VOI from preoperative CT scans. In parallel, we built patient-specific finite element models of simulated aTSAs to predict cement stress, bone-cement interfacial stress, and bone strain around the glenoid implant. CT measurements and finite element predictions were obtained for 20 patients undergoing aTSA for primary glenohumeral osteoarthritis. We tested all linear correlations between preoperative patient characteristics (age, sex, height, weight, glenoid bone quality) and biomechanical predictions (cement stress, bone-cement interfacial stress, bone strain). RESULTS Average CT numbers gradually decreased from cortical (717 HU) to subchondral and trabecular (362 HU) bone. Peak cement stress (4-10 MPa) was located within the keel hole, above the keel, or behind the glenoid implant backside. Cement stress, bone-cement interfacial stress, and bone strain were strongly negatively correlated with preoperative glenoid bone quality, particularly in VOIs behind the implant backside (subchondral trabecular bone) but also in deeper trabecular VOIs. CONCLUSION Our numerical study suggests that preoperative glenoid bone quality is an important parameter to consider in aTSA, which may be associated with aseptic loosening of the glenoid implant. These initial results should now be confronted with clinical and radiologic outcomes.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Raphaël Obrist
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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