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Mueller U, Harzi A, Loescher R, Buelhoff M, Eckert JA, Kretzer JP. Wear and damage in retrieved humeral inlays of reverse total shoulder arthroplasty-where, how much, and why? J Shoulder Elbow Surg 2021; 30:e517-e530. [PMID: 33220411 DOI: 10.1016/j.jse.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Polyethylene (PE) wear and material degradation have been reported as complications in reverse total shoulder replacements (rTSAs). In this regard, scapular notching is associated with more clinical complications. Therefore, the purposes of the study were to quantify the linear and volumetric wear, as a measure for the amount of removed material, and to qualitatively assess the PE damage modes to describe the material degradation in retrieved rTSA humeral PE inlays that contribute to failure of shoulder replacements. Furthermore, this study aimed to evaluate the effect of scapular notching on PE wear and rim damage of the humeral components. METHODS The total study population of 39 humeral inlays contains 2 cohorts that were used for the damage mode analysis and for the wear analysis, respectively. The extent and presence of wear damage modes in 5 defined zones were assessed by a grading system for all PE joint replacements. For quantitative wear analysis the most frequent design (n = 17) was chosen. Using a coordinate-measuring machine and postprocessing software, volumetric wear measurements for the retrieved humeral PE inlays were undertaken. Furthermore, prerevision radiographs were analyzed for scapular notching. Finally, retrieval findings were correlated with clinical and radiographic data to consider the effect of notching and to identify risk of failures for these prostheses. RESULTS Damage on the rim of the humeral PE inlays was more frequent and severe than on the intended articulation surface. Irrespective of the damage mode, the inferior rim zone sustained the greatest amount of wear damage followed by the posterior zone. Burnishing, scratching, pitting, and embedded particles are most likely to occur in the articular surface area, whereas surface deformation, abrasion, delamination and gross material degradation are predominantly present in the inferior and posterior rim zones. The retrieved inlays exhibited a mean volumetric wear rate of 296.9 mm³/yr ± 87.0 mm³/yr. However, if the notched and non-notched components were compared, a significant higher volumetric wear rate (296.5 ± 106.1 mm³/yr) was found for the notched components compared to the non-notched group (65.7 ± 7.4 mm³/yr). Generally, there was a significantly greater incidence of damage and greater amount of wear if scapular notching occurred. CONCLUSION The notched components showed a 5-fold increase in PE wear rate. Therefore, scapular notching has a strong effect on PE damage and wear. If scapular notching can be clinically avoided, the PE wear performance is in a similar magnitude as found for hip and knee replacements.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Amal Harzi
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raphael Loescher
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Buelhoff
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes A Eckert
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Van de Kleut ML, Athwal GS, Faber KJ, Teeter MG. In vivo volumetric and linear wear measurement of reverse shoulder arthroplasty at minimum 5-year follow-up. J Shoulder Elbow Surg 2020; 29:1695-1702. [PMID: 32192882 DOI: 10.1016/j.jse.2019.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/11/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty is quickly becoming the most frequently performed glenohumeral joint replacement. The purpose of this study was to evaluate the volumetric and linear wear rates of ultrahigh-molecular-weight polyethylene humeral liners in vivo at a minimum 5-year follow-up. METHODS Radiostereometric analysis was used to image 15 patients at terminal range of motion in forward flexion, abduction, external rotation, and internal rotation and with the arm at the side. The relative position and orientation of the glenosphere and polyethylene were identified for each arm position. The apparent intersection of the glenosphere into the polyethylene was recorded as wear. Mean volumetric and linear wear rates were recorded, and Pearson correlation coefficients were applied to the 36-mm liners to assess the relationship between the wear rate and term of service. RESULTS The mean reverse shoulder arthroplasty term of service at the time of imaging was 8 ± 1 years (range, 6-11 years). The mean volumetric and linear wear rates for the 36-mm liners (n = 13) were 42 ± 22 mm3/yr (r = 0.688, P = .009) and 0.11 ± 0.03 mm/yr (r = 0.767, P = .002), respectively. The mean volumetric and linear wear rates for the 42-mm liners (n = 2) were 114 ± 44 mm3/yr and 0.17 ± 0.01 mm/yr, respectively. No single arm position was able to capture all recorded wear individually. CONCLUSION This study showed volumetric and linear wear rates of approximately 40 mm3/yr and 0.1 mm/yr, respectively, for the 36-mm polyethylene liners. The 42-mm liners showed higher wear rates, although a greater number of subjects is required for conclusive results. In vivo wear of reverse total shoulder arthroplasty is multidirectional and perceptible.
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Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; School of Biomedical Engineering, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - George S Athwal
- Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kenneth J Faber
- Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Griffiths MW, Athwal GS, Medley JB, Johnson JA, Langohr GDG. Wear of humeral polyethylene cups in reverse total shoulder arthroplasty with simulated rim damage from scapular notching. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.biotri.2020.100123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Validation of In Vivo Linear and Volumetric Wear Measurement for Reverse Total Shoulder Arthroplasty Using Model-Based Radiostereometric Analysis. J Orthop Res 2019; 37:1620-1627. [PMID: 30977541 DOI: 10.1002/jor.24294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Presently, polyethylene wear measurement of reverse total shoulder arthroplasty (rTSA) is restricted to in vitro, in silico, and retrieval analysis, with no method for the quantification of in vivo wear of well-functioning implants. The purpose of this study was to validate the use of model-based radiostereometric analysis (MBRSA) as a measurement tool for in vivo rTSA wear using a phantom setup. Six additively manufactured polyethylene inserts were fabricated, one unworn control and five to represent known wear patterns, and individually fit within the rTSA components. Each insert was imaged using standard radiostereometric techniques and analyzed using MBRSA. From the position and orientation estimation provided by MBRSA, a micro-computed tomography model of the control insert was virtually placed within the metaphyseal tray. The apparent intersection of the glenosphere into the insert was recorded as wear. This method enables wear measurements with a linear precision of 0.21 mm and a bias of 0.36 ± 0.13 mm, and a volumetric precision of 49.3 mm3 , with a bias of 48.9 ± 24.3 mm3 . This technique allows for the in vivo measurement of polyethylene wear without the requirement of marker beads or baseline radiographs, expanding the potential for in vivo wear measurements to larger populations and retrospective analysis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1620-1627, 2019.
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Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Biomedical Engineering, Western University, London, Ontario, Canada.,Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George S Athwal
- Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Biomedical Engineering, Western University, London, Ontario, Canada.,Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Ramírez-Martínez I, Smith SL, Joyce TJ. The effect of combined loading cycles on the wear of reverse shoulder joint replacements. J Mech Behav Biomed Mater 2019; 94:201-206. [PMID: 30903864 DOI: 10.1016/j.jmbbm.2019.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 12/23/2022]
Abstract
Wear of polyethylene is a current limitation in the long-term survival of reverse shoulder arthroplasties (RSAs). The purpose of this study was to investigate, for the first time, the influence of a combination of clinically relevant activities of daily living (ADLs) as patterns of motion and loading on the wear of ultra-high molecular-weight polyethylene (UHMWPE) in RSA. This physiological combined cycle, termed "repeated-motion-load", was applied on four new samples of a commercially available reverse shoulder prosthesis for five million cycles using the unique Newcastle Shoulder Wear Simulator. This resulted in a mean wear rate of 12.0 ± 3.9 mm3/million cycles for the UHMWPE components in combination with metallic glenospheres, while the average articulating UHMWPE surface roughness reduced from 692 ± 132 nm Sa to 42 ± 29 nm Sa.
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Affiliation(s)
- Israel Ramírez-Martínez
- Bioengineering Group, School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, England, UK.
| | - Simon L Smith
- Bioengineering Group, School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, England, UK
| | - Thomas J Joyce
- Bioengineering Group, School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, England, UK
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Kurdziel MD, Newton MD, Hartner S, Baker KC, Wiater JM. Quantitative evaluation of retrieved reverse total shoulder arthroplasty liner surface deviation and volumetric wear. J Orthop Res 2018; 36:2007-2014. [PMID: 29314184 DOI: 10.1002/jor.23849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/02/2018] [Indexed: 02/04/2023]
Abstract
Polyethylene wear is a known complication in total joint arthroplasty, however, in vivo wear rates in reverse total shoulder arthroplasty (RTSA) remain largely unknown. This study aimed to quantify volumetric and surface deviation changes in retrieved RTSA humeral liners using a novel micro-computed tomography (μCT)-based technique. After IRB-approval, 32 humeral liners (single manufacturer and model) with term-of-service greater than 90 days were analyzed. Clinical demographics and surgical data were collected via chart review. Unworn liners were used as geometric controls. Retrieved and unworn liners underwent μCT scanning. Retrieved liner volumes were isolated, co-registered to controls of matching geometry, and surface deviations of the articulation surface and rim were computed. Differences in total volume loss (TVL), volumetric wear rate (VWR), and surface deviation were reported. Semi-quantitative grading evaluated rim damage presence and severity. Mean term-of-service for all liners was 2.07 ± 1.33 years (range: 0.30-4.73). Mean TVL and VWR were 181.3 ± 208.2 mm3 and 114.5 ± 160.3 mm3 /year, respectively. Mean articulation and rim surface deviations were 0.084 ± 0.065 and 0.177 ± 0.159 mm, respectively. Articulation surface deviation was positively correlated to term-of-service. Rim damage was present on 63% of liners and correlated significantly to rim surface deviation. This study reports in vivo wear rates of retrieved RTSA implants. Our results demonstrate volumetric and articulation surface wear in select RTSA liners that is correlated to term-of-service. Calculation of in vivo wear rates can help bridge the gap between clinical outcomes and experimental models such as wear simulations and computational models. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2007-2014, 2018.
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Affiliation(s)
- Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan.,Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, Michigan
| | - Michael D Newton
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan
| | - Samantha Hartner
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan.,Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, Michigan
| | - Jerome Michael Wiater
- Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, Michigan.,Department of Orthopaedic Surgery, Beaumont Health System, 3535 W. 13 Mile Rd., Suite 744, Royal Oak, Michigan, 48073
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Reply to the Letter to the Editor: The Weight-Bearing Shoulder. J Am Acad Orthop Surg 2018; 26:e259-e260. [PMID: 29781823 DOI: 10.5435/jaaos-d-18-00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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