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Kopriva JM, McKissack HM, Griswold BG, Hussain ZB, Cooke HL, Gottschalk MB, Wagner ER. Mixed-reality improves execution of templated glenoid component positioning in shoulder arthroplasty: a CT imaging analysis. J Shoulder Elbow Surg 2024:S1058-2746(24)00086-7. [PMID: 38320671 DOI: 10.1016/j.jse.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs). METHODS Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI. RESULTS Comparing 25 MR to 72 SI cases, MR significantly improved both inclination (P < .001) and version (P < .001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time. CONCLUSION MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.
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Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Haley M McKissack
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - B Gage Griswold
- Department of Orthopaedic Surgery, Denver Shoulder at Western Orthopaedics, Denver, CO, USA
| | - Zaamin B Hussain
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Franceschetti E, Giovannetti de Sanctis E, Gregori P, Paciotti M, Palumbo A, Franceschi F. Angled BIO-RSA leads to better inclination and clinical outcomes compared to Standard BIO-RSA and eccentric reaming: A comparative study. Shoulder Elbow 2023; 15:35-42. [PMID: 37974648 PMCID: PMC10649506 DOI: 10.1177/17585732211067156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/20/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2023]
Abstract
Background Two surgical techniques were compared : Standard BIO-RSA, performed with a glenoid eccentric reaming along with a cylindric bone graft augmentation vs. the Angled BIO-RSA, performed with a glenoid concentric reaming and a defect correction with an angled bone graft. Methods Patients undergoing RSA from January 2016 to April 2019, with one of the two techniques being performed, were retrospectively reviewed. Glenoids were classified according to Favard. Clinical (Constant-Murley, VAS and ROM) and radiographic (superior tilt correction) data were collected pre-operatively and at 12 months post-operatively. Results 141 shoulders were included. Angled BIO-RSA group showed statistically significant better outcomes in terms of forward flexion (149.9° Vs 139.3°) and abduction (136.4° Vs 126.7°). The use of an Angled BIO-RSA showed a statistically significant better superior tilt correction (1.252° Vs 4.09°). Angled BIO-RSA, leads to a better inclination correction and a mean postoperative tilt value inferior to 5° in E1 and E3 differently from standard BIO-RSA. Discussion Both techniques were able to correct glenoid superior inclination with excellent postoperative short-term results. However, angled BIO-RSA technique appears to be more effective in ensuring a correct inclination of the prosthetic glenoid component with better clinical outcomes.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | | | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Francesco Franceschi
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
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MacLean KFE, Langenderfer JE, Dickerson CR. A comparative probabilistic analysis of human and chimpanzee rotator cuff functional capacity. J Anat 2023; 243:431-447. [PMID: 37186281 PMCID: PMC10439372 DOI: 10.1111/joa.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Computational musculoskeletal modeling represents a valuable approach to examining biological systems in physical anthropology. Probabilistic modeling builds on computational musculoskeletal models by associating mathematical distributions of specific musculoskeletal features within known ranges of biological variability with functional outcomes. The purpose of this study was to determine if overlap in rotator cuff muscle force predictions would occur between species during the performance of an evolutionarily relevant horizontal bimanual arm suspension task. This necessitated creating novel probabilistic models of the human and chimpanzee glenohumeral joint through augmentation of previously published deterministic models. Glenohumeral musculoskeletal features of anthropological interest were probabilistically modeled to produce distributions of predicted human and chimpanzee rotator cuff muscle force that were representative of the specific anatomical manipulations. Musculoskeletal features modeled probabilistically included rotator cuff origins and deltoid insertion, glenoid inclination, and joint stability. Predicted human rotator cuff muscle force distributions were mostly limited to alternating between infraspinatus and teres minor, with both 100% and 0% muscle force predicted for both muscles. The chimpanzee model predicted low-to-moderate muscle force across all rotator cuff muscles. Rotator cuff muscle force predictions were most sensitive to changes of muscle origins and insertions. Results indicate that functional rotator cuff overlap is unlikely between chimpanzees and humans without greater modifications of the glenohumeral musculoskeletal phenotypes. The results also highlight the low efficacy of the human upper extremity in overhead, weight-bearing tasks, and propensity for rotator cuff injury.
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Smith GCS. A prospective observational case control study investigating the coronal plane scapular morphological differences in full-thickness posterosuperior cuff tears and primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:e223-e233. [PMID: 34875366 DOI: 10.1016/j.jse.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The critical shoulder angle (CSA) is a surrogate marker of the coronal plane morphology of the scapula. CSA differences between scapulae could be due to differences in glenoid inclination (GI) or the location of the most lateral part of the acromion relative to the inferior glenoid, or both. An understanding of the hierarchy of the scapular morphological changes associated with glenohumeral osteoarthritis (GHOA) and rotator cuff (RC) tears would allow accurate biomechanical modeling. METHODS A prospective observational case control study was undertaken in which the GI, "nonglenoid"-CSA, acromial vertical offset index, acromial horizontal offset index, acromial horizontal-vertical offset index, and coronal plane angulation of the acromion (CPAA-m) were measured on high-quality radiographs to compare coronal plane scapular anatomy in: (1) patients with asymptomatic atraumatic full-thickness RC tears, (2) patients with symptomatic primary GHOA, and (3) a control group with no RC tear or GHOA treated for glenohumeral instability or symptomatic labral pathology. Intraobserver reliability of the measurements was performed. RESULTS In the GHOA group, the GI was lower (less superiorly inclined) than the RC tear group (difference between the means: -4.8°, 95% confidence interval [CI] [-8.8°, -0.9°], P = .014) and the control group (difference between the means: -7.9°, 95% CI [-11.8°, -3.9°], P = .000); there was no difference in the acromial measurements. In the RC tear group, the nonglenoid-CSA was higher (difference between the means: 7.7°, 95% CI [3.0°, 12.3°], P = .001), the acromial vertical offset index was lower (difference between the means: -0.13, 95% CI [-0.24, -0.01], P = .026), and the acromial horizontal-vertical offset index was higher (difference between the means: 0.15, 95% CI [0.01, 0.28], P = .030) than the control group; there was no difference in the acromial horizontal offset index or the GI. The CPAA-m was lower (greater coronal plane downslope of the acromion) in both GHOA (difference between the means: -9.6°, 95% CI [-18.6°, -0.5°], P = .036) and RC tears (difference between the means: -9.9°, 95% CI [-19.0°, -0.9°], P = .029) compared with the control group. The intraclass correlation coefficients for intraobserver reliability demonstrated excellent reliability for the measurements (all >0.900). DISCUSSION Scapulae associated with GHOA have lower GI, but no spatial differences in the location of the lateral acromion compared with a normal population. Scapulae associated with RC tears have a lower vertical offset of the lateral acromion, but no difference in horizontal offset or GI compared with a normal population. The downslope of the acromion in the coronal plane is greater (lower CPAA-m) in both RC tears and GHOA than the normal population.
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Affiliation(s)
- Geoffrey C S Smith
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Orthopaedics, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Centre for Orthopaedic Research, Sydney, NSW, Australia.
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Bechtold DA, Ganapathy PK, Aleem AW, Chamberlain AM, Keener JD. The relationship between glenoid inclination and instability following primary reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e370-e377. [PMID: 33144223 DOI: 10.1016/j.jse.2020.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Despite advances in implant design and surgical technique, instability remains the most common early complication and reason for early revision after reverse shoulder arthroplasty (RSA). The purpose of this study is to evaluate the glenoid implant inclination, as measured by the β-angle, as an independent risk factor for instability after primary RSA. METHODS A retrospective case-control study was conducted matching cases with instability after primary RSA using a single implant to controls without instability. Controls were matched to age, sex, body mass index, and baseplate type (1:3 ratio of cases to controls). The preoperative, postoperative, and the change in pre- to postoperative glenoid inclination (β-angle) were compared between groups. RESULTS Thirty-four cases (mean age, 66.2 years) were matched to 102 controls (mean age, 67.0 years). There was a wide range of postoperative (63° to 100°) and pre- to postoperative change (-16.5° to +30.5°) in β-angles collectively. There was no significant difference in the postoperative β-angle (mean, 80.8° vs. 82.7°, P = .19) or the change in β-angle (mean, +1.7° vs. +3.4°, P = .35) between cases and controls, respectively. Regression analysis demonstrated no increased odds of instability with the postoperative β-angle, odds ratio 0.965 (confidence interval [CI] = 0.916-1.02, P = .19). Likewise, for the preoperative to postoperative change in β-angle, there was no significantly increased odds of instability, odds ratio 0.978 (CI = 0.934-1.03, P = .35). Finally, there was no difference in risk of instability in patients whose implant positioning resulted in a net superior increase in inclination, relative risk 0.85 (95% CI = 0.46-1.56, P = .28). CONCLUSIONS Neither the final prosthetic glenoid inclination nor the change in glenoid inclination, as measured by the β-angle, significantly influences the risk of prosthetic instability after primary RSA.
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Affiliation(s)
- Daniel A Bechtold
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Pramodh K Ganapathy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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Shah SS, Sahota S, Denard PJ, Provencher MT, Parsons BO, Hartzler RU, Dines JS. Variability in total shoulder arthroplasty planning software compared to a control CT-derived 3D printed scapula. Shoulder Elbow 2021; 13:268-275. [PMID: 34659466 PMCID: PMC8513001 DOI: 10.1177/1758573219888821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two techniques exist from which all 3D preoperative planning software for total shoulder arthroplasty are based. One technique is based on measurements constructed on the mid-glenoid and scapular landmarks (Landmark). The second is an automated system using a best-fit sphere technique (Automated). The purpose was to compare glenoid measurements from the two techniques against a control computed tomography-derived 3D printed scapula. METHODS Computed tomography scans of osteoarthritic shoulders of 20 patients undergoing primary total shoulder arthroplasty were analyzed with both 3D planning software techniques. Measurements from a 3D printed scapula (Scapula) from the true 3D computed tomography scan served as controls. Glenoid version and inclination measurements from each group were blinded and reviewed. RESULTS In 65% (Automated) and 45% (Landmark) of cases, either inclination or version varied by 5° or more versus 3D printed scapula. Significant variability in version differences compared to the scapula group existed (p = 0.007). Glenoid version from the Scapula = 13.0° ± 10.6°, Automated = 15.0° ± 13.9°, and Landmark = 12.2° ± 7.8°. Inclination from Scapula = 5.4° ± 7.9°, Automated = 6.1° ± 12.6°, and Landmark = 6.2° ± 9.1°. DISCUSSION A high percentage of cases showed discrepancies in glenoid inclination and version values from both techniques. Surgeons should be aware that regardless of software technique, there is variability compared to measurements from a control 3D computed tomography printed scapula.
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Affiliation(s)
| | | | | | | | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dixit NN, McCormick CM, Cole JH, Saul KR. Influence of Brachial Plexus Birth Injury Location on Glenohumeral Joint Morphology. J Hand Surg Am 2021; 46:512.e1-512.e9. [PMID: 33358583 PMCID: PMC8180483 DOI: 10.1016/j.jhsa.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/12/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Patient presentation after brachial plexus birth injury (BPBI) is influenced by nerve injury location; more contracture and bone deformity occur at the shoulder in postganglionic injuries. Although bone deformity after postganglionic injury is well-characterized, the extent of glenohumeral deformity after preganglionic BPBI is unclear. METHODS Twenty Sprague-Dawley rat pups received preganglionic or postganglionic neurectomy on a single forelimb at postnatal days 3 to 4. Glenohumeral joints on affected and unaffected sides were analyzed using micro-computed tomography scans after death at 8 weeks after birth. Glenoid version, glenoid inclination, glenoid and humeral head radius of curvature, and humeral head thickness and width were measured bilaterally. RESULTS The glenoid was significantly more declined in affected compared with unaffected shoulders after postganglionic (-17.7° ± 16.9°) but not preganglionic injury. Compared with the preganglionic group, the affected shoulder in the postganglionic group exhibited significantly greater declination and increased glenoid radius of curvature. In contrast, the humeral head was only affected after preganglionic but not postganglionic injury, with a significantly smaller humeral head radius of curvature (-0.2 ± 0.2 mm), thickness (-0.2 ± 0.3 mm), and width (-0.3 ± 0.4 mm) on the affected side compared with the unaffected side; changes in these metrics were significantly associated with each other. CONCLUSIONS These findings suggest that glenoid deformities occur after postganglionic BPBI but not after preganglionic BPBI, whereas the humeral head is smaller after preganglionic injury, possibly suggesting an overall decreased biological growth rate in this group. CLINICAL RELEVANCE This study expands understanding of the altered glenoid and humeral head morphologies after preganglionic BPBI and its comparisons with morphologies after postganglionic BPBI.
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Affiliation(s)
| | - Carolyn M. McCormick
- North Carolina State University, Raleigh, NC,University of North Carolina, Chapel Hill, NC
| | - Jacqueline H. Cole
- North Carolina State University, Raleigh, NC,University of North Carolina, Chapel Hill, NC
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Karahan N, Yılmaz B, Öztermeli A, Kaya M, Duman S, Çiçek ED. Evaluation of critical shoulder angle and acromion index in patients with anterior shoulder instability and rotator cuff tear. Acta Orthop Traumatol Turc 2021; 55:220-226. [PMID: 34100362 PMCID: PMC10566347 DOI: 10.5152/j.aott.2021.20072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/21/2020] [Accepted: 04/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate glenohumeral morphologic differences and their correlation between glenohumeral instability and rotator cuff pathology. METHODS Two-hundred radiographs and 100 MRI scans of 100 patients in whom the diagnosis of Anterior Shoulder Instability (Anl) or Rotator Cuff Tear (RCT) was arthroscopically verified were retrospectively identified and included in the study. All the patients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients with RCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders of patients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRI scans were examined by an orthopedic surgeon and a radiologist. The Acromial Index (AI) and the Critical Shoulder Angle (CSA) were measured on true anteroposterior shoulder radiographs; Glenoid Inclination (GI), Glenoid Version (GV), and Acromion Angulation (AA) were measured on MRI. RESULTS In the AnI group, the measurements were as followed: AI, 0.66 ± 0.03; CSA, 33 ° ± 2.85; GI, 3.4° ± 6.2; GV, 4.1 ± 4.3; and AA, 12.9 ± 8.3. In the RCT group, AI 0.71 ± 0.04; CSA, 36° ± 2.69; GI, 9.1 ± 5; GV, 6.7 ° ± 5.7; and AA, 14.3° ± 8.7. A moderate correlation was found between CSA and GI (r = 0.41, P = 0.001) and between AI and GI (r = 0.42, P = 0.014). A weak correlation was found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlation coefficients were respectively 0.81 and 0.84 for AI, 0.88 and 0.92 for CSA, 0.72 and 0.76 for GI, 0.69 and 0.73 for GV, and 0.72 and 0.77 for AA. CONCLUSION The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. Investigating CSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI. LEVEL OF EVIDENCE Level III, Diagnostic Study.
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Affiliation(s)
- Nazım Karahan
- Clinic of Orthopaedics and Traumatology, Çorlu State Hospital, Tekirdağ,
Turkey
| | - Barış Yılmaz
- Department of Orthopaedic and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul,
Turkey
| | - Ahmet Öztermeli
- Clinic of Orthopaedic and Traumatology, Gebze State Hospital, Gebze,
Turkey
| | - Murat Kaya
- Department of Orthopaedic and Traumatology, Marmara University, School of Medicine, İstanbul,
Turkey
| | - Serda Duman
- Department of Orthopaedic and Traumatology, Selahattin Eyyubi State Hospital, Diyarbakır,
Turkey
| | - Esin Derin Çiçek
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul,
Turkey
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Hartzler RU, Denard PJ, Griffin JW, Werner BC, Romeo AA. Surgeon acceptance of an initial 3D glenoid preoperative plan: rates and risk factors. J Shoulder Elbow Surg 2021; 30:787-794. [PMID: 32650080 DOI: 10.1016/j.jse.2020.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the effect of 3-dimensional (3D) planning for total shoulder arthroplasty (TSA) on component positioning and patient outcomes has been increasingly studied, the effect of 3D planning on surgeon decision making has not been well studied. METHODS A retrospective review was performed of a database containing TSA cases for which the glenoid component was planned with a commercially available 3D computed tomography software program (Virtual Implant Positioning; Arthrex, Inc.) from 2016 to 2019. A total of 6483 cases planned by 417 surgeons were included. The glenoid version (Vtech) and inclination (Itech) of the Virtual Implant Positioning technician plan as well as the surgeon's final plan for version (Vsurg) and inclination (Isurg) were extracted. When the version and/or inclination of the surgeon plan matched that of the technician, that variable was defined as "accepted." The rates of acceptance of Vtech and Itech were calculated and analyzed for association with implant type, native version and inclination, and running case count. A subgroup analysis of high-volume users (n > 30 cases) was analyzed to determine if any of the variables independently was associated with surgeon acceptance. RESULTS There was a very high rate of matching of version (66%), inclination (72%), or both (55%) and a low rate (18%) where neither parameter of the glenoid plan matched that of the technician. In univariate analysis, as the case count and retroversion increased the rate of accepting of version dropped noticeably (70%-50% and 47%, respectively [ P< .0001]). The rate of accepting the plan for inclination did not vary much as case count changed. In the multivariate analysis, 23 of 56 high-volume surgeons had at least 1 independent factor associated with accepting the technician-planned glenoid version, and 5 surgeons had 2 independent factors. In the multivariate analysis of matching glenoid inclination, 27 of 56 high-volume surgeons had at least 1 independent factor associated with accepting the technician-planned glenoid version, and 9 surgeons had 2 or more independent factors. CONCLUSIONS In a large database of TSAs with 3D-planned glenoids, there were high rates of cases with surgeon agreement with an initial plan provided by an industry technician: 66% in version, 72% in inclination, 55% for both version and inclination. Surgeon acceptance of the initial plan decreased as pathoanatomy increased and case count increased. Shoulder surgeons should be aware that an initial 3D preoperative plan provided by industry represents a potential source of cognitive bias in shoulder arthroplasty planning.
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Affiliation(s)
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Justin W Griffin
- Jordan-Young Institute, Virginia Beach, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Anthony A Romeo
- Musculoskeletal Institute, Dupage Medical Group, Downers Grove, IL, USA
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Parsons M, Greene A, Polakovic S, Rohrs E, Byram I, Cheung E, Jones R, Papandrea R, Youderian A, Wright T, Flurin PH, Zuckerman J. Intersurgeon and intrasurgeon variability in preoperative planning of anatomic total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons. J Shoulder Elbow Surg 2020; 29:2610-8. [PMID: 33190760 DOI: 10.1016/j.jse.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning software is widely available for most anatomic total shoulder arthroplasty (ATSA) systems. It can be most useful in determining implant selection and placement with advanced glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning of a series of ATSA cases. METHODS Forty-nine computed tomography scans were planned for ATSA by 9 fellowship-trained shoulder surgeons using the ExactechGPS platform (Exactech Inc., Gainesville, FL, USA). Each case was planned a second time between 4 and 12 weeks later. Variability within and between surgeons was measured for implant type, size, version and inclination correction, and implant face position. Interclass correlation coefficients, Pearson, and Light's kappa coefficients were used for statistical analysis. RESULTS There was considerable variation in the frequency of augment use between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability were 0.37 for version, 0.80 for inclination, 0.36 for implant type, and 0.36 for implant size. Pearson coefficients for intrasurgeon variability were 0.17 for version and 0.53 for inclination. Light's kappa coefficient for implant type was 0.64. CONCLUSIONS This study demonstrates substantial inter- and intrasurgeon variability in preoperative planning of ATSA. Although the magnitude of differences in correction was small, surgeons differed significantly in the use of augments to achieve the resultant plan. Surgeons differed from each other on thresholds for augment use and maximum allowable residual retroversion. This suggests that there may a range of acceptable corrections for each shoulder rather than a single optimal plan.
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Parsons M, Greene A, Polakovic S, Byram I, Cheung E, Jones R, Papandrea R, Youderian A, Wright T, Flurin PH, Zuckerman J. Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons. J Shoulder Elbow Surg 2020; 29:2080-8. [PMID: 32471752 DOI: 10.1016/j.jse.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning software is gaining utility in reverse total shoulder arthroplasty (RTSA), particularly when addressing pathologic glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning a series of RTSA cases to identify differences in how surgeons consider optimal implant placement. This may help identify opportunities to establish consensus when correlating plan differences with clinical data. METHODS A total of 49 computed tomography scans from actual RTSA cases were planned for RTSA by 9 fellowship-trained shoulder surgeons using the same platform (Exactech GPS, Exactech Inc., Gainesville, FL, USA). Each case was planned a second time 6-12 weeks later. Variability within and between surgeons was measured for implant selection, version correction, inclination correction, and implant face position. Interclass correlation coefficients, and Pearson and Light's kappa coefficient were used for statistical analysis. RESULTS There was considerable variation in the frequency of augmented baseplate selection between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability ranged from 0.43 for version, 0.42 for inclination, and 0.25 for baseplate type. Pearson coefficients for intrasurgeon variability were 0.34 for version and 0.30 for inclination. Light's kappa coefficient for baseplate type was 0.61. CONCLUSIONS This study demonstrates substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. Although average differences between plans were relatively small, there were large differences in specific cases suggesting little consensus on optimal planning parameters and opportunities to establish guidelines based on glenoid pathoanatomy. The correlation of preoperative planning with clinical outcomes will help to establish such guidelines.
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Boileau P, Morin-Salvo N, Bessière C, Chelli M, Gauci MO, Lemmex DB. Bony increased-offset-reverse shoulder arthroplasty: 5 to 10 years' follow-up. J Shoulder Elbow Surg 2020; 29:2111-2122. [PMID: 32505414 DOI: 10.1016/j.jse.2020.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid lateralization has been shown to be the most imortant factor in maximizing passive range of motion and shoulder stability while preventing scapular impingement and notching. We aimed to evaluate mid- to long-term functional and radiologic outcomes after bony increased-offset-reverse shoulder arthroplasty (BIO-RSA) using a Grammont-style (medialized) humeral implant. METHODS The study included 143 consecutive shoulders (140 patients; mean age, 72 years) treated with a BIO-RSA for rotator cuff deficiency. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate; fixation was achieved using a long central peg (25 mm) and 4 screws. A large baseplate (29 mm) with a small baseplate sphere (36 mm) was used in 77% of cases, and a Grammont-style (medialized) humeral implant with 155° of inclination was used in all cases. All patients underwent clinical and radiographic assessment at a minimum of 5 years after surgery; in addition, 86 cases (60%) underwent computed tomography scan assessment. RESULTS At a mean follow-up of 75 months (range, 60-126 months), the survivorship of the BIO-RSA using revision as an endpoint was 96%. No cases of dislocation or humeral loosening were observed. Overall, 118 patients (83%) were either very satisfied (61%) or satisfied (22%). The adjusted Constant score improved from 40% ± 18% to 93% ± 23%, and the Subjective Shoulder Value improved from 31% ± 15% to 77% ± 18% (P < .001). The humeral bone graft incorporated completely in 96% of cases (137 of 143). Severe inferior scapular notching (grade 3 or 4) occurred in 18% (24 of 136). The risk of postoperative notching correlated to a lower body mass index (P < .05), superior glenosphere inclination (P = .02), and high or flush glenosphere positioning (P = .035). CONCLUSIONS BIO-RSA is a safe and effective technique to lateralize the glenoid, providing consistent bone graft healing, excellent functional outcomes, a low revision rate, and a high rate of patient satisfaction. Thin patients (with a low body mass index) and glenosphere malposition (with persistent superior inclination and/or insufficient lowering of the baseplate and sphere) are associated with higher risk of scapular notching.Our data confirm the importance of implanting the baseplate with a neutral inclination (reverse shoulder arthroplasty angle < 5°) and with sufficient glenosphere inferior overhang (>5 mm) in preventing scapular notching. The use of a less medialized humeral implant (135° or 145° inclined) and smaller (25-mm) baseplate (when using a small, 36-mm sphere) should allow reduction in the incidence of scapular notching.
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Affiliation(s)
- Pascal Boileau
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France.
| | | | | | - Mikaël Chelli
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France
| | - Marc-Olivier Gauci
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France
| | - Devin B Lemmex
- PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
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Chalmers PN, Beck L, Miller M, Stertz I, Henninger HB, Tashjian RZ. Glenoid Retroversion Associates With Asymmetric Rotator Cuff Muscle Atrophy in Those With Walch B-type Glenohumeral Osteoarthritis. J Am Acad Orthop Surg 2020; 28:547-55. [PMID: 31517880 DOI: 10.5435/JAAOS-D-18-00830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our purpose was to determine whether glenoid retroversion associates with asymmetric rotator cuff muscle atrophy in eccentric glenohumeral osteoarthritis (GHOA) and if this asymmetry is worsening of GHOA-related atrophy. METHODS Two groups of shoulder magnetic resonance images were studied: patients older than 50 years without a rotator cuff tear or GHOA (control group) and patients preoperative to anatomic total shoulder arthroplasty (GHOA group). Retroversion and rotator cuff muscle cross-sectional areas were measured using reliable and accurate techniques. Proportional muscle areas were created by dividing by total cuff area to correct for differences in overall patient size. Walch grades were assigned via consensus. RESULTS The control group consisted of 102 patients and the GHOA cohort consisted of 141 patients. Within the eccentric GHOA group, retroversion associated with relative increasing supraspinatus (r = 0.268, P = 0.035), increasing infraspinatus (r = 0.273, P = 0.032), and decreasing subscapularis areas (r = -0.343, P = 0.006). However, the combined GHOA group had a significantly higher relative subscapularis area than the control group (P = 0.026). CONCLUSION In the eccentric GHOA, increasing retroversion is associated with increasing volume of the posterior cuff relative to the anterior cuff muscles, which is a reversal of the asymmetric increasing volume of the anterior cuff relative to the posterior cuff muscles seen with concentric GHOA. LEVEL OF EVIDENCE Diagnostic, level III.
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14
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Shukla DR, McLaughlin RJ, Lee J, Nguyen NTV, Sanchez-Sotelo J. Automated three-dimensional measurements of version, inclination, and subluxation. Shoulder Elbow 2020; 12:31-37. [PMID: 32010231 PMCID: PMC6974883 DOI: 10.1177/1758573218825480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/03/2018] [Accepted: 12/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preoperative planning software has been developed to measure glenoid version, glenoid inclination, and humeral head subluxation on computed tomography (CT) for shoulder arthroplasty. However, most studies analyzing the effect of glenoid positioning on outcome were done prior to the introduction of planning software. Thus, measurements obtained from the software can only be extrapolated to predict failure provided they are similar to classic measurements. The purpose of this study was to compare measurements obtained using classic manual measuring techniques and measurements generated from automated image analysis software. METHODS Ninety-five two-dimensional computed tomography scans of shoulders with primary glenohumeral osteoarthritis were measured for version according to Friedman method, inclination according to Maurer method, and subluxation according to Walch method. DICOM files were loaded into an image analysis software (Blueprint, Wright Medical) and the output was compared with values obtained manually using a paired sample t-test. RESULTS Average manual measurements included 13.8° version, 13.2° inclination, and 56.2% subluxation. Average image analysis software values included 17.4° version (3.5° difference, p < 0.0001), 9.2° inclination (3.9° difference, p < 0.001), and 74.2% for subluxation (18% difference, p < 0.0001). CONCLUSIONS Glenoid version and inclination values from the software and manual measurement on two-dimensional computed tomography were relatively similar, within approximately 4°. However, subluxation measurements differed by approximately 20%.
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Affiliation(s)
| | | | | | | | - Joaquin Sanchez-Sotelo
- Joaquin Sanchez-Sotelo, Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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15
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Zaid MB, Young NM, Pedoia V, Feeley BT, Ma CB, Lansdown DA. Anatomic shoulder parameters and their relationship to the presence of degenerative rotator cuff tears and glenohumeral osteoarthritis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28:2457-2466. [PMID: 31353303 DOI: 10.1016/j.jse.2019.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Scapular anatomy, as measured by the acromial index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), and glenoid inclination (GI), has emerged as a possible contributor to the development of degenerative shoulder conditions such as rotator cuff tears and glenohumeral osteoarthritis. The purpose of this study was to investigate the published literature on influences of scapular morphology on the development of degenerative shoulder conditions. METHODS A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology on the development of degenerative rotator cuff tears and glenohumeral osteoarthritis. The studies were reviewed by 2 authors. The findings were summarized for various anatomic parameters. A meta-analysis was completed for parameters reported in more than 5 related publications. RESULTS A total of 660 unique titles and 55 potentially relevant abstracts were reviewed with 30 published articles identified for inclusion. The AI, CSA, LAA, and GI were the most commonly reported bony measurements. Increased CSA and AI correlated with rotator cuff tears, whereas lower CSA appeared to be related to the presence of glenohumeral osteoarthritis. Decreased LAA correlated with degenerative rotator cuff tears. Five articles reported on the GI with mixed results on shoulder pathology. DISCUSSION Degenerative rotator cuff tears appear to be significantly associated with the AI, CSA, and LAA. There does not appear to be a significant relationship between the included shoulder parameters and the development of osteoarthritis.
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Affiliation(s)
- Musa B Zaid
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Nathan M Young
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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16
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Kahn TL, Granger EK, Henninger HB, Tashjian RZ, Chalmers PN. Reverse total shoulder arthroplasty and resting radiographic scapular rotation. J Shoulder Elbow Surg 2019; 28:e265-e270. [PMID: 30992246 PMCID: PMC6646096 DOI: 10.1016/j.jse.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/26/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND It remains unclear whether changes in scapular rotation influence the surgeon's ability to achieve resting radiographic neutral or inferior baseplate tilt at final follow-up. The purposes of this study were (1) to determine whether reverse total shoulder arthroplasty (RTSA) changes the resting scapular rotation, (2) to determine the association between glenoid inclination with respect to the scapula (β angle) and resting scapular rotation, and (3) to determine the β angle threshold that will most likely lead to resting radiographic neutral or inferior baseplate tilt relative to the thorax. METHODS This was a retrospective radiographic study. Patients with adequate-quality standing anteroposterior and Grashey radiographs obtained preoperatively and after primary RTSA at a minimum of 1 year were included. Glenoid inclination (β angle) was measured between the supraspinatus fossa and the glenoid. Resting scapular rotation was measured between the supraspinatus fossa and a vertical line. Baseplate tilt was then calculated as the angle between the glenoid and a vertical line. RESULTS The study included 74 patients with a mean follow-up period of 3 years (range, 1-9 years). Scapular rotation changed 2° ± 12° (mean ± standard deviation) into upward rotation (P = .048). No association was found between the β angle and scapular rotation. In 71% of patients with a neutral or inferior baseplate tilt, a postoperative β angle greater than 85° was found. CONCLUSIONS Resting radiographic scapular rotation changed 2° into upward rotation with RTSA and was not associated with the β angle. If the β angle is greater than 85°, resting radiographic baseplate tilt will most likely be inferior or neutral.
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Affiliation(s)
- Timothy L Kahn
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, Salt Lake City, UT, USA
| | - Erin K Granger
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, Salt Lake City, UT, USA.
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17
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Chalmers PN, Suter T, Jacxsens M, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. Influence of Radiographic Viewing Perspective on Glenoid Inclination Measurement. J Shoulder Elb Arthroplast 2019; 3. [PMID: 33437911 PMCID: PMC7799437 DOI: 10.1177/2471549218824986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction The purposes of this study were to determine (1) whether glenoid inclination
(GI) could be accurately measured on plain radiographs as compared to a
gold-standard 3-dimensional (3D) measure and (2) whether GI could be
reliably measured on plain radiographs. Materials and Methods Digitally reconstructed radiographs (DRRs) were made from 3D computed
tomography reconstructions of 68 normal cadaver scapulae. DRRs were made in
a variety of viewing angles. Inclination was measured on these DRRs. These
measurements were also made using a gold-standard 3D method. Measurements
were made by 2 orthopedic surgeons and 1 surgeon twice, to calculate
interrater and intrarater intraclass correlation coefficients (ICCs). Results The gold-standard 3D β was 83 ± 5° (72°–98°). On neutral plain radiographs,
the mean ± standard deviation 2D β angle was 80 ± 6° (range, 66°–99°). With
regard to accuracy, the 2D β angle was significantly different from the 3D β
angle, with the 2D β underestimating the 3D β by 5° (95% confidence
intervals −1 to 12). With regard to reliability, interrater ICCs for 2D β
with a neutral viewing angle was 0.79. Two-dimensional β varied widely with
viewing angle from 0.24 to 0.88. Interrater ICCs for the 3D method was 0.83
(0.60–0.92). Intrarater ICCs for all 3 techniques were high (>0.91). Conclusions Two-dimensional radiographic GI measurement is not accurate, as it
underestimates the 3D value by an average of 5° when compared to the
gold-standard 3D measurement. GI 2D measurement reliability varies with
viewing angle on plain radiographs and thus to accurately and reliably
measure inclination 3D imaging is necessary.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Thomas Suter
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Matthijs Jacxsens
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Heath B Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Matsumura N, Oki S, Suzuki T, Iwamoto T, Sato K, Nakamura M, Matsumoto M, Nagura T. A computed tomography analysis of three-dimensional glenoid orientation modified by glenoid torsion. JSES Open Access 2019; 2:194-199. [PMID: 30675594 PMCID: PMC6334855 DOI: 10.1016/j.jses.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The longitudinal axis of the glenoid is not always parallel to the scapular body, and glenoid torsion could affect the values of glenoid orientation. The purpose of this study was to evaluate 3-dimensional glenoid version and inclination modified by glenoid torsion and to clarify the differences between the values of conventional and of modified glenoid orientations. Methods Computed tomography scans of 30 shoulders without shoulder pathology, 30 shoulders with primary osteoarthritis, and 30 shoulders with a massive rotator cuff tear or cuff tear arthropathy were retrospectively evaluated. After determining the glenoid axis and the scapular planes and calculating conventional glenoid version and inclination, modified glenoid version and inclination, and glenoid torsion, the values of conventional glenoid orientation and those of modified glenoid orientation were compared statistically. Results All shoulders showed anterior torsion of the glenoid with an average of 16° ± 5°. The values of modified glenoid retroversion were significantly smaller than those of conventional glenoid retroversion in all groups (P < .033), and the values of the modified glenoid inferior inclination were significantly larger than those of conventional glenoid inferior inclination in all groups (P < .001). Conclusions The present study showed that the glenoid twists with respect to the scapular body and that modification by glenoid torsion could affect the values of glenoid orientation. These results indicated that glenoid orientation with respect to the glenoid longitudinal axis will help surgeons determine proper placement of the glenoid component during shoulder arthroplasty.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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19
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Chalmers PN, Beck L, Granger E, Henninger H, Tashjian RZ. Superior glenoid inclination and rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1444-1450. [PMID: 29576340 DOI: 10.1016/j.jse.2018.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/19/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. METHODS In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. RESULTS (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, -1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P < .001) in the rotator cuff tear group of 192 patients than in the control cohort of 107 patients. CONCLUSIONS Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lindsay Beck
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Erin Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Heath Henninger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Boileau P, Morin-Salvo N, Gauci MO, Seeto BL, Chalmers PN, Holzer N, Walch G. Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management of glenoid bone loss and erosion. J Shoulder Elbow Surg 2017; 26:2133-2142. [PMID: 28735842 DOI: 10.1016/j.jse.2017.05.024] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/15/2017] [Accepted: 05/21/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid deficiency and erosion (excessive retroversion/inclination) must be corrected in reverse shoulder arthroplasty (RSA) to avoid prosthetic notching or instability and to maximize function, range of motion, and prosthesis longevity. This study reports the results of RSA with an angled, autologous glenoid graft harvested from the humerus (angled BIO-RSA). METHODS A trapezoidal bone graft, harvested from the humeral head and fixed with a long-post baseplate and screws, was used to compensate for residual glenoid bone loss/erosion. For simple to moderate (<25°) glenoid defects, standardized instrumentation combined with some eccentric reaming (<15°) was used to reconstruct the glenoid and obtain neutral implant alignment. For severe (>25°) and complex (multiplanar) glenoid bone defects, patient-specific grafts and guides were used after 3-dimensional planning. Patients were reviewed with minimum 2 years of follow-up. Mean follow-up was 36 months (range, 24-81 months). Preoperative and postoperative measurements of inclination and version were performed in the plane of the scapula on computed tomography images. RESULTS The study included 54 patients (41 women, 13 men; mean 73 years old). Fifteen patients had combined vertical and horizontal glenoid bone deficiency. Among E2/E3 glenoids, inclination improved from 37° (range, 14° to 84°) to 10.2° (range -28° to 36°, P < .001). Among B2/C glenoids, retroversion improved from -21° (range, -49° to 0°) to -10.6° (-32° to 4°, P = .06). Complete radiographic incorporation of the graft occurred in 94% (51 of 54). Complications included infection in 1 and clinical aseptic baseplate loosening in 2. Mild notching occurred in 25% (13 of 51) of patients. Constant-Murley and Subjective Shoulder Value assessments increased from 31 to 68 and from 30% to 83%, respectively (P < .001). CONCLUSION Angled BIO-RSA predictably corrects glenoid deficiency, including severe (>25°) multiplanar deformity. Graft incorporation is predictable. Advantages of using an autograftharvested in situ include bone stock augmentation, lateralization, low donor-site morbidity, low relative cost, and flexibility needed to simultaneously correct posterior and superior glenoid defects.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, University of Côte d'Azur, Nice, France.
| | - Nicolas Morin-Salvo
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Marc-Olivier Gauci
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Brian L Seeto
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nicolas Holzer
- Department of Orthopaedic Surgery, Hôpital Universitaire de Genève, Geneva, Switzerland
| | - Gilles Walch
- Department of Orthopaedic Surgery, Centre Orthopédique Santy, Lyon, France
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Frich LH, Schmidt PH, Torfing T. Glenoid morphology in obstetrical brachial plexus lesion: a three-dimensional computed tomography study. J Shoulder Elbow Surg 2017; 26:1374-1382. [PMID: 28412107 DOI: 10.1016/j.jse.2017.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obstetric brachial plexus lesion (OBPL) frequently leads to glenohumeral dysplasia, and excessive retroversion of the glenoid is among the best known developmental disturbances. Most analyses of the glenoid are based on 2-dimensional (D) imaging and do not address glenoid inclination or provide information on the glenoid in the sagittal plane. We aim to describe the 3-D deformity of the glenoid in children with OBPL. METHODS Preoperative computed tomography (CT) scans of the nonaffected and the affected scapula of 24 children (aged 5 to 12 years) with developmental disturbances after OBPL years were analyzed. The dimensions of the scapula and the deformation of the glenoid were visualized in 3-D. RESULTS The retroversion of the glenoid fossa was greater in all affected shoulders, and 2-D measurements significantly overestimated retroversion compared with angles measured in 3-D. The inclination of the glenoid fossa was altered, and a distal bony edge loss was observed on 3-D reformations in the sagittal plane. The reliability of the measured angles was excellent, and the κ agreement for the description of the glenoid form was substantial. Furthermore, the dimensions of the scapula were significantly smaller on the affected shoulders. CONCLUSION OBPL is indeed a 3-D disorder. Our measurements revealed excessive retroversion of the glenoid fossa, and the reliability of the 3-D CT measurements was superior to their 2-D counterparts. 3-D CT reformations of the glenoid in the coronal and the sagittal plane added further to 3-D understanding of glenoid morphology in OBPL. These new findings legitimatize a 3-D CT-based description of the glenoid deformities connected with OPBL.
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Affiliation(s)
- Lars H Frich
- Department of Orthopaedics, Odense University Hospital, Odense, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense, Denmark
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Werner BS, Hudek R, Burkhart KJ, Gohlke F. The influence of three-dimensional planning on decision-making in total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1477-83. [PMID: 28162884 DOI: 10.1016/j.jse.2017.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term results and complication rates in shoulder arthroplasty are related to implant positioning. Current literature reports increased precision in glenoid component positioning using 3-dimensional (3D) computed tomography (CT) planning tools. This study evaluated the accuracy of glenoid version and inclination measurements using 2D CT scans compared with a validated 3D software program and its influence on decision making on implant selection. METHODS Preoperative CT scans were obtained from 50 patients undergoing total shoulder arthroplasty. Glenoid version and inclination measurements were performed in random order by 3 independent qualified orthopedic surgeons on reformatted 2D CT scans. Indication for anatomic or reverse shoulder arthroplasty was based on glenoid deformity and on rotator cuff conditions. Results were compared with those from a validated 3D computer software program, and the final decision was made according to the 3D planning. RESULTS Mean preoperative glenoid retroversion on reformatted 2D CT scans was 11.9° ± 9.6° and mean superior inclination was 10.7° ± 8.6°. When the 3D software was used, glenoid retroversion averaged 15.1° ± 10.6° and superior inclination averaged 8.9° ± 9.9°. The 2D CT demonstrated good interobserver and intraobserver reliability for glenoid version and inclination. Decision on the choice of implant was adjusted in 7 patients after the 3D planning. CONCLUSIONS Our findings show that measurements of glenoid version and inclination on reformatted 2D CT scans are less accurate compared with 3D measurements. A preoperative 3D planning software allows for improvement of virtual glenoid positioning and influences the decision making process.
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Bouacida S, Gauci MO, Coulet B, Lazerges C, Cyteval C, Boileau P, Chammas M. Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2017; 26:1128-1136. [PMID: 28372968 DOI: 10.1016/j.jse.2017.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/02/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior humeral subluxation is the main cause of failure of total shoulder arthroplasty. We aimed to compare humeral head subluxation in various reference planes and to search for a correlation with retroversion, inclination, and glenoid wear. MATERIALS AND METHODS We included 109 computed tomography scans of primary glenohumeral osteoarthritis and 97 of shoulder problems unrelated to shoulder osteoarthritis (controls); all computed tomography scans were reconstructed in the anatomic scapular plane and the glenoid hull plane that we defined. In both planes, we measured retroversion, inclination, glenohumeral offset (Walch index), and scapulohumeral offset. RESULTS Retroversion in the scapular plane (Friedman method) was lower than that in the glenoid hull plane for controls and for arthritic shoulders. The threshold of scapulohumeral subluxation was 60% and 65% in the scapular plane and glenoid hull plane, respectively. The mean upward inclination was lower in the scapular plane (Churchill method) than in the glenoid hull plane (Maurer method). In the glenoid hull plane, 35% of type A2 glenoids showed glenohumeral offset greater than 75%, with mean retroversion of 25.6° ± 6° as compared with 7.5° ± 7.2° for the "centered" type A2 glenoids (P < .0001) and an upward inclination of -1.4° ± 8° and 6.3° ± 7° (P = .03), respectively. The correlation between retroversion and scapulohumeral offset was r = 0.64 in the glenoid hull plane and r = 0.59 in the scapular plane (P < .05). CONCLUSION Measurement in the glenoid hull plane may be more accurate than in the scapular plane. Thus, the glenoid hull method allows for better understanding type B3 of the modified Walch classification.
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Affiliation(s)
- Soufyane Bouacida
- Department of Orthopedic Surgery of the Upper Limb, Hand Surgery and Peripheral Nerves Surgery, Lapeyronie Hospital, Montpellier, France.
| | - Marc-Olivier Gauci
- Department of Orthopedic Surgery and Traumatology, Larchet 2 Hospital, Nice, France
| | - Bertrand Coulet
- Department of Orthopedic Surgery of the Upper Limb, Hand Surgery and Peripheral Nerves Surgery, Lapeyronie Hospital, Montpellier, France
| | - Cyril Lazerges
- Department of Orthopedic Surgery of the Upper Limb, Hand Surgery and Peripheral Nerves Surgery, Lapeyronie Hospital, Montpellier, France
| | - Catherine Cyteval
- Department of Medical Imaging, Lapeyronie Hospital, Montpellier, France
| | - Pascal Boileau
- Department of Orthopedic Surgery and Traumatology, Larchet 2 Hospital, Nice, France
| | - Michel Chammas
- Department of Orthopedic Surgery of the Upper Limb, Hand Surgery and Peripheral Nerves Surgery, Lapeyronie Hospital, Montpellier, France
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Chalmers PN, Salazar D, Chamberlain A, Keener JD. Radiographic characterization of the B2 glenoid: is inclusion of the entirety of the scapula necessary? J Shoulder Elbow Surg 2017; 26:855-860. [PMID: 28131692 DOI: 10.1016/j.jse.2016.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/19/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computed tomography (CT) scans are often obtained before total shoulder arthroplasty to assess glenoid deformity. To allow correction of the slice axis into the plane of the scapula, these scans have typically required inclusion of the entirety of the scapula. The purpose of this study was to determine whether inclusion of the medial border and inferior angle is necessary for accurate measurement of scapular version, inclination, and humeral subluxation. METHODS Fourteen CT scans in preoperative total shoulder arthroplasty patients with Walch B2 type glenoids underwent a standardized measurement protocol. Glenoid version, inclination, depth, and humeral subluxation were measured on 2-dimensional CT images corrected to the plane of the scapula. These measurements were then repeated in randomized, blinded fashion after subtracting 12.5%, 25%, and 50% of the scapula from the medial border and 12.5%, 25%, and 50% of the scapula from the inferior angle. RESULTS Measurement of retroversion did not significantly differ between measurement of the full scapula and measurement of any of the incomplete scapulas, with the exception of the subtraction of 50% of the scapular width, which caused retroversion to be overestimated by 4.7° (P = .006) and led to inaccurate measurement of subluxation and glenoid depth. CONCLUSION If at least 8 cm of scapular width is imaged on a CT scan, accurate glenoid measurements can be made. Even if 50% of scapular height is not imaged, accurate measurements can be made. Failure to include the medial border or inferior angle does not preclude accurate glenoid measurement.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA.
| | - Dane Salazar
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Aaron Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
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Garcia GH, Liu JN, Degen RM, Johnson CC, Wong AC, Dines DM, Gulotta LV, Dines JS. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elbow Surg 2017; 26:241-245. [PMID: 27594085 DOI: 10.1016/j.jse.2016.07.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND No evaluation has been done on the relationship of the critical shoulder angle (CSA) with retear after rotator cuff repair. Our purpose was to evaluate whether a higher CSA is associated with retear after rotator cuff repair. METHODS This was a retrospective review of 76 patients who had undergone rotator cuff repair with postoperative ultrasound examination. Ultrasound findings were graded no retear (NT), partial-thickness (PT) retear, or full-thickness (FT) retear. Preoperative radiographs were used to measure CSA, glenoid inclination, lateral acromion angle, and acromion index. RESULTS Average age was 61.9 years (45.3-74.9 years). On ultrasound examination, 57 shoulders (74.0%) had NT, 11 (14.2%) had PT retears, and 8 (10.3%) had FT retears. There was no significant difference in retear rate by age, gender, or tension of repair. Average CSA was significantly lower for the NT group at 34.3° ± 2.9° than for the FT group at 38.6° ± 3.5° (P < .01). If CSA was >38°, the odds ratio of having an FT retear was 14.8 (P < .01). In addition, higher CSA inversely correlated with postoperative American Shoulder and Elbow Surgeons scores (P < .03). Average glenoid inclination was significantly lower in the NT group at 12.3° ± 2.7° compared with 17.3° ± 2.6° in the FT group (P < .01). If glenoid inclination was >14, the odds ratio of having a FT retear was 15.0 (P < .01). CONCLUSION At short-term follow-up, higher CSA significantly increased the risk of an FT retear after rotator cuff repair. Also, increasing CSA correlated with worse postoperative American Shoulder and Elbow Surgeons scores. This radiographic marker may help manage expectations for rotator cuff tear patients.
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Chalmers PN, Salazar D, Chamberlain A, Keener JD. Radiographic characterization of the B2 glenoid: the effect of computed tomographic axis orientation. J Shoulder Elbow Surg 2017; 26:258-64. [PMID: 27592372 DOI: 10.1016/j.jse.2016.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/18/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid retroversion may accelerate glenoid loosening after total shoulder arthroplasty. Accurate measurement of preoperative glenoid deformity is critical for decision-making and prognostication. The purpose of this study was to determine whether glenoid version, inclination, and depth and humeral subluxation measurements on computed tomography (CT) scan slices oriented in the plane of the body differ from those oriented in the scapular plane and those obtained by automated 3-dimensional reconstruction software in the setting of a biconcave B2-type glenoid. METHODS Thirty-one preoperative CT scans in patients undergoing total shoulder arthroplasty with Walch B2-type glenoids underwent a standardized measurement protocol by 3 observers. Glenoid version, inclination, and depth and humeral subluxation were measured on 2-dimensional CT images in the plane of the body, on 2-dimensional images in the plane of the scapula, and by a validated, automated 3-dimensional software program. RESULTS Correction of CT slice axis into the plane of the scapula decreased measured retroversion by 2.4° to 4.7° (P < .004) and inclination by 21° (P < .001). Whereas uncorrected version measurements do not differ from automated software measurements, corrected measurements do (P < .001). Whereas corrected inclination measurements do not differ from automated measurements, uncorrected measurements do (P < .001). Automated measurements differed from both corrected and uncorrected subluxation (P < .001 in both cases). CONCLUSION If CT images are not reoriented into the plane of the scapula, version and inclination will be significantly overestimated. In the setting of a retroverted, deformed glenoid, automated software may produce similar inclination measurements to corrected 2-dimensional CT, but it produces significantly altered measurements of version and subluxation.
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Van Haver A, Heylen S, Vuylsteke K, Declercq G, Verborgt O. Reliability analysis of glenoid component inclination measurements on postoperative radiographs and computed tomography-based 3D models in total and reversed shoulder arthroplasty patients. J Shoulder Elbow Surg 2016; 25:632-40. [PMID: 26652701 DOI: 10.1016/j.jse.2015.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Only a few articles describe the reproducibility and clinical feasibility of glenoid inclination measurements on conventional radiographs, and none of them validated their method in shoulder arthroplasty cases. From a clinical point of view, the angle measured between the supraspinatus fossa and the glenoid fossa line (angle β) appears to be the most interesting angle to assess glenoid inclination. This study aimed to validate the angle β in shoulder arthroplasty patients to facilitate the assessment of glenoid component inclination. MATERIALS AND METHODS Seventeen patients who underwent total or reverse shoulder arthroplasty were evaluated. The angle β was measured by 2 independent observers on postoperative radiographs and 3-dimensional (3D) models. The interobserver variability and accuracy of angle β were analyzed by calculating the intraclass correlation coefficient (ICC) and by generating Bland-Altman plots. RESULTS The angle β showed a good interobserver variability (ICC = 0.971 for radiographs, ICC = 0.980 for 3D models) and a good agreement between the radiographic and 3D measurements (ICC = 0.904 for observer 1 and ICC = 0.908 for observer 2). Bland-Altman plots demonstrated that in 95% of the measurements on radiographs, the error will be <10. In the investigated population, 85% showed an error <6. CONCLUSION This study demonstrates that angle β can be measured on radiographs to assess glenoid component inclination in total and reverse shoulder arthroplasty, but clinicians and researchers should keep in mind that measurement errors of 10° may occur in a minority of cases.
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28
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Daggett M, Werner B, Collin P, Gauci MO, Chaoui J, Walch G. Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study. J Shoulder Elbow Surg 2015; 24:1948-53. [PMID: 26350880 DOI: 10.1016/j.jse.2015.07.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased critical shoulder angles consist of both the acromial cover and glenoid inclination and have been found in patients with rotator cuff pathology. The purpose of this study was to determine the correlation of the critical shoulder angle and glenoid inclination and to determine the difference in glenoid inclination between patients with osteoarthritis and massive rotator cuff tears. METHODS The critical shoulder angle and glenoid inclination were measured on anteroposterior radiographs, and glenoid inclination was also measured on a validated 3-dimensional computer software program of 50 shoulders undergoing primary total shoulder arthroplasty. Twenty-five shoulders had osteoarthritis and A1 glenoids, as defined by the Walch classification, and were undergoing anatomic shoulder arthroplasty. The other 25 shoulders had massive rotator cuff tears and E0 glenoids, as defined by the Favard classification. The 2 groups were compared. RESULTS Critical shoulder angle and glenoid inclination were significantly correlated (R(2) = 0.7426, P < .001). Shoulders with massive rotator cuff tears (E0) demonstrated increased glenoid inclination measurements than shoulders with osteoarthritis (A1). As measured by the 3-dimensional software, the massive rotator cuff group had a glenoid inclination of 13.6° ± 4.3° and the osteoarthritis group had a glenoid inclination of 4.7° ± 5.6°. When measured by anteroposterior radiographs, the average glenoid inclination was 13.6° ± 4.6° in the massive rotator cuff group and was 7.6° ± 5.01° in the osteoarthritic group . CONCLUSION Glenoid inclination is linearly correlated with the critical shoulder angle and is significantly increased in patients with massive rotator cuff tears.
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Affiliation(s)
- Matthew Daggett
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France.
| | - Birgit Werner
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Philipp Collin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jean Chaoui
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
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Hohmann E, Tetsworth K. Glenoid version and inclination are risk factors for anterior shoulder dislocation. J Shoulder Elbow Surg 2015; 24:1268-73. [PMID: 25958217 DOI: 10.1016/j.jse.2015.03.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Although the contribution of the capsuloligamentous structures and dynamic muscle balance to shoulder stability has been well documented, the role of the osseous anatomy of the glenoid has not been thoroughly evaluated. This study investigated glenoid version and inclination in patients with a documented anterior shoulder dislocation and compared it with a control group. We hypothesized that patients with a prior anterior dislocation would have more anterior version and increased inferior inclination of the glenoid. MATERIALS AND METHODS Patients aged younger than 40 years who underwent arthroscopic shoulder stabilization (study group) were compared with patients (control group) who had previously undergone magnetic resonance imaging (MRI) for a different shoulder condition. Version was measured on axial images, and inclination was measured on coronal images of a T2-weighted spin-echo scan. The MRIs of 128 study group patients (mean age, 24.5 ± 8.6 years) with a confirmed traumatic anterior shoulder dislocation were compared with the MRIs of 130 control group patients (mean age, 30.9 ± 7 years). RESULTS The mean version in the study group was -1.7° ± 4.5° (retroversion); the mean inclination was 1.6° ± 5.9° (inferior). The mean version in the control group was -5.8° ± 4.6° (retroversion); the mean inclination was -4.0° ± 6.8° (superior). The between-group differences were significant for version (P = .00001) and inclination (P = .00001). CONCLUSIONS The results of this study strongly suggest that glenoid version and inclination are significantly increased in patients with established anterior shoulder instability compared with a matched control group.
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Affiliation(s)
- Erik Hohmann
- Department of Orthopaedic Surgery, Clinical Medical School, University of Queensland, Brisbane, QLD, Australia; Musculoskeletal Research Unit, Central Queensland University, Rockhampton, QLD, Australia.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, QLD, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia
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