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Andrews R, Layuno-Matos JG, Frankle MA. Common Factors in Shoulder and Hip Arthroplasty Implant Failures: A Historical Review. J Clin Med 2024; 13:2370. [PMID: 38673642 PMCID: PMC11051213 DOI: 10.3390/jcm13082370] [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: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
In this era of subspecialty care in orthopedics, iterations of implant design can occur in a silo which then precludes gaining knowledge from failures of implant design that may have occurred in different subspecialties. This literature review describes the history of failures in hip and shoulder arthroplasties with the purpose of identifying similar factors that led to previous implant failures. A review of the literature was performed by two reviewers assessing articles that described failed hip and shoulder arthroplasty systems over time. We identified and analyzed 53 implant failures-23 in hip arthroplasty and 30 in shoulder arthroplasty. These failures were categorized as material, mechanical, and technical. In hip arthroplasty, 48% were material, 39% mechanical, and 13% technical failures. In shoulder arthroplasty, the distribution was 10% material, 70% mechanical, and 20% technical failures. The distribution of these failures highlights similar and sometimes repeated failure mechanisms between subspecialties. This accentuates the importance of a collaborative approach to improve future arthroplasty designs.
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Affiliation(s)
- Reed Andrews
- Department of Orthopaedics, School of Medicine, University of South Florida, Tampa, FL 33612, USA;
| | | | - Mark A. Frankle
- Foundation for Orthopaedic Research and Education, Tampa, FL 33607, USA;
- Florida Orthopaedic Institute, Tampa, FL 33637, USA
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2
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Song IS, Choi HD. The long-term results of shoulder hemiarthroplasty in irreducible four-part fracture-dislocation of the proximal humerus without rotator cuff tear arthropathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:311-317. [PMID: 37490066 DOI: 10.1007/s00590-023-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Although there are concerns about nonunion of the greater tuberosity or shoulder weakness, hemishoulder arthroplasty (HSA) is a viable treatment option for irreducible four-part proximal humerus fractures-dislocation without rotator cuff tear arthropathy. This study aims to analyze the long-term radiological and functional outcomes of HSA. METHODS This study enrolled 36 patients who underwent HSA due to irreducible four-part proximal humerus fracture-dislocation without rotator cuff tear arthropathy between March 2005 and May 2020. The exclusion group included 10 reverse total shoulder arthroplasty patients. The mean age and mean follow-up period were 68.6 years old and 48.6 months, respectively. Radiological assessments, such as vertical and horizontal greater tuberosity position, greater tuberosity healing, and implant position, were evaluated. Clinically, American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion were evaluated. RESULTS The greater tuberosity union rate was 55.6% (n = 20), with 44.4% (n = 16) experiencing nonunion, malunion, and bone resorption. The mean vertical and horizontal greater tuberosity positions showed significant difference at last follow-up compared to immediate postoperation. The retroversion of the implant was 23.8 ± 4.61°, and the acromio-humeral interval was 7.6 ± 1.34 mm. The mean last follow-up ASES and CMS were 39.5 ± 4.03 and 55.4 ± 10.41, respectively. The mean active forward flexion, abduction, internal rotation, and external rotation were 100.9 ± 15.04°, 92.5 ± 14.47°, 44.2 ± 12.83°, and 42.5 ± 15.32°, respectively. CONCLUSION In long-term follow-up, the greater tuberosity was superiorly migrated and externally rotated. Active forward flexion and abduction in the last follow-up were significantly limited. However, in terms of pain relief, a satisfactory result was seen.
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Affiliation(s)
- In-Soo Song
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea.
- Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Hyun Duck Choi
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea
- University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Lo L, Koenig S, Leong NL, Shiu BB, Hasan SA, Gilotra MN, Wang KC. Glenoid bony morphology of osteoarthritis prior to shoulder arthroplasty: what the surgeon wants to know and why. Skeletal Radiol 2021; 50:881-894. [PMID: 33095290 DOI: 10.1007/s00256-020-03647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Abstract
Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon.
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Affiliation(s)
- Lawrence Lo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 110 S. Paca Street, 6th Floor, Baltimore, MD, 21201, USA
| | - Brian B Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 2200 Kernan Drive, Suite 1154, Baltimore, MD, 21207, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 100 Penn Street, Room 540D, Baltimore, MD, 21201, USA
| | - Kenneth C Wang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA. .,Imaging Service, Baltimore VA Medical Center, 10 N. Greene St, Rm. C1-24, Baltimore, MD, 21201, USA.
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Exploring Alternative Sites for Glenoid Component Fixation Through Three-Dimensional Digitization of the Glenoid Vault: An Anatomic Analysis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00199-9. [PMID: 33278183 PMCID: PMC7714053 DOI: 10.5435/jaaosglobal-d-20-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis.
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Abstract
As imaging techniques are ever-evolving, this article aims to provide a brief overview of the various modalities including their limitations. The ability of imaging for evaluation of implant osseo-integration will be addressed and also the role of imaging in assessing septic and aseptic loosening, with a particular focus on adverse tissue reactions, will be discussed. Specific features when imaging the big joints such as shoulder, hip, knee and ankle joint will also be outlined.Overall, a lack of standardisation and validity was noted and despite the gross variety of imaging modalities, there is no technique covering all aspects required for evaluation of implant fixation and septic and aseptic loosening. Each imaging modality has a role, depending on the information required and anticipated. The choice of imaging technique should not be primarily based on medical considerations but also on availability, accessibility, expertise and costs. Plain radiographs alone have been recommended in cases of suspected peri-prosthetic joint infections, given the lack of evidence for additional imaging techniques in this context. For aseptic loosening, ultrasound and plain radiographs may serve as initial screening tools. Metal artefact reducing sequences (MARS) MRI are advancing cross-sectional imaging and are likely to promote their role in patient evaluation.We conclude that imaging is one essential part in the work-up of patients with total joint replacements, within a specific clinical context. Close teamwork between experienced radiologists and orthopaedic surgeons is required for optimal patient care. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160058. Originally published online at www.efortopenreviews.org.
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Affiliation(s)
- Christoph H Lohmann
- Department of Orthopeadic Surgery, Otto-von-Guericke University, Leipziger Str. 44,39120 Magdeburg, Germany
| | - Sanjiv Rampal
- Department of Orthopeadic Surgery, Otto-von-Guericke University, Leipziger Str. 44,39120 Magdeburg, Germany
| | - Martin Lohrengel
- Department of Orthopeadic Surgery, Otto-von-Guericke University, Leipziger Str. 44,39120 Magdeburg, Germany
| | - Gurpal Singh
- Division of Musculoskeletal Oncology, University Orthopaedics Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, 119228 Singapore
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Letter HP, Limback J, Wasyliw C, Bancroft L, Scherer K. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty. Radiol Case Rep 2016; 11:98-101. [PMID: 27257460 PMCID: PMC4878934 DOI: 10.1016/j.radcr.2016.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/28/2016] [Indexed: 11/29/2022] Open
Abstract
Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware.
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Affiliation(s)
- Haley P. Letter
- Department of Radiology, Florida Hospital, 601 E. Rollins St, Orlando, FL 32803, USA
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Tan TJ, Aljefri AM, Elliott MB, Nicolaou S. Clinics in diagnostic imaging (167). Total shoulder arthroplasty glenoid component loosening with secondary rotator cuff failure. Singapore Med J 2016; 57:172-6; quiz 177. [PMID: 27075207 DOI: 10.11622/smedj.2016070] [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: 11/18/2022]
Abstract
A 59-year-old woman who had previously undergone an anatomic left total shoulder arthroplasty presented with increasing left shoulder pain and significant reduction in motion of the left shoulder joint. No evidence of prosthetic loosening or periprosthetic fracture was detected on the radiographs or fluoroscopic arthrogram images. Dual-energy computed tomography (DECT) images revealed evidence of loosening of the glenoid component and secondary rotator cuff failure. This case illustrates how a combination of detailed clinical history, careful physical examination and DECT arthrogram evaluation may be used to identify complications of an anatomic total shoulder arthroplasty.
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Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ahmad Mohammad Aljefri
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marc Bruce Elliott
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Abstract
Shoulder replacement surgery is a common elective surgical procedure for those with progressive osteoarthritis and rheumatoid arthritis. This review explores the history of shoulder replacements, the different types of replacements and their advantages or disadvantages.
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Affiliation(s)
- Ahmed Mehmood
- 5th year Medical Student, UCL Medical School, University College London, London WC1E 6BT
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Lin DJ, Wong TT, Kazam JK. Shoulder Arthroplasty, from Indications to Complications: What the Radiologist Needs to Know. Radiographics 2016; 36:192-208. [DOI: 10.1148/rg.2016150055] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Nwawka OK, Konin GP, Sneag DB, Gulotta LV, Potter HG. Magnetic resonance imaging of shoulder arthroplasty: review article. HSS J 2014; 10:213-24. [PMID: 25264437 PMCID: PMC4171449 DOI: 10.1007/s11420-014-9399-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnetic resonance (MR) imaging evaluation of the painful failed shoulder arthroplasty is a useful imaging modality due to advancements in metal artifact reduction techniques, which allow assessment of the integrity of the supporting soft-tissue envelope and the implant. QUESTIONS/PURPOSES The focus of this pictorial review is to illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process. METHODS A PubMed (MEDLINE) search focusing on the complications and imaging assessment of shoulder arthroplasty was performed. Articles were selected for review based on their pertinence to the aforementioned topics. RESULTS We discuss the ability of MR imaging to identify why a patient's arthroplasty may have failed. Specific causes including component loosening and implant failure, rotator cuff and deltoid integrity, infection, subtle fractures, and nerve pathology are reviewed, with illustrative sample images. CONCLUSION MRI is a valuable tool in the assessment for pathology in the shoulder following arthroplasty.
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Affiliation(s)
- O. Kenechi Nwawka
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Gabrielle P. Konin
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Darryl B. Sneag
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Lawrence V. Gulotta
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Hollis G. Potter
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
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Rasmussen JV. Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis. Acta Orthop 2014; 85:1-23. [PMID: 24930800 DOI: 10.3109/17453674.2014.922007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopedic Surgery Herlev University Hospital Herlev Ringvej 75, 2730 Herlev Denmark Phone: +45 38381926
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