A CT scan protocol for the detection of radiographic loosening of the glenoid component after total shoulder arthroplasty

Grégory, Thomas; Hansen, Ulrich; Khanna, Monica; Mutchler, Céline; Urien, Saı̈k; Amis, Andrew A.; Augereau, B; Emery, Roger

doi:10.3109/17453674.2013.869653

Cited by 35 publications

(23 citation statements)

References 19 publications

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“…Nevertheless, radiographic imaging is still widely used in shoulder instability to assess the presence or absence of bony abnormalities, fractures, Hill-Sachs lesion or any other pathologic changes in the joint [13][14][15][16]. Additionally, roentgenographic examination is used in the following: post-operative assessment of changes in the implant position after total shoulder arthroplasty (TSA) [7,17,18], measuring glenoid version [19], detection of scapular fractures [20], or evaluation of reverse shoulder arthroplasty (RSA) [21]. However, due to certain limitations of this method several research projects focus on comparing the reliability of radiographic imaging, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability

Kubicka

Stefaniak

Lubiatowski

et al. 2016

International Orthopaedics (SICOT)

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Purpose The main purpose of this study is to establish which of two methods is more reliable in glenoid assessment for instability in pre-operative planning. Accordingly, we have studied the intra-and inter-observer reliability of glenoid parameters with the use of two-dimensional (2D) and three-dimensional (3D) reconstructed computed tomography (CT) images. Methods One hundred glenoids were measured with the use of 2D-CT and 3D-CT (in 3D orientation) by two independent observers (one experienced and one inexperienced). Measurements were repeated after one week for 30 randomly selected glenoids. Results The intra-class correlation coefficient (ICC) for interobserver reliability was significantly greater for 3D-CT (0.811 to 0.915) than for 2D-CT (0.523 to 0.925). All intra-observer reliability values for 3D-CT were near perfect (0.835 to 0.997), while those for 2D-CT were less reliable (0.704 to 0.960). A dependent t-test showed that, for both observers, almost all glenoid parameters (except R and d) differed significantly (p < 0.05) between 2D and 3D measurement methods. Conclusions Therefore, it can be concluded that 3D glenoid reconstructions are more reliable for glenoid bone loss assessment than 2D-CT. The results suggest that quantifying a glenoid defect with the use of 2D image only-even if performed by an experienced orthopaedic surgeon-is prone to errors. Differences in measurements between and within observers can be explained by plane setting and identifying glenoid rim in 2D -C T. Accordingly, we recommend that glenoid measurements should be performed in 3D orientation using 3D reconstruction obtained from CT images for pre-operative assessments, which are crucial for surgical planning.

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Section: Introductionmentioning

confidence: 99%

Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability

Kubicka

Stefaniak

Lubiatowski

et al. 2016

International Orthopaedics (SICOT)

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“…We therefore believe that our findings are valid and generalizable to patients with greater tuberosity fractures and that there is no additional value of CT scanning in the majority of these cases. One also should consider the extra resources and radiation of CT scanning: the mean radiation dose for a CT scan of the shoulder (2.1 mSv) corresponds to approximately 26 conventional posteroanterior chest radiographs or plain shoulder radiographs (both 0.08 mSv) [2,12,20] and the costs for a shoulder CT scan (unadjusted Medicare fee $180) is approximately six times the costs of plain shoulder radiographs (unadjusted Medicare fee $29) [8]. The additional value of CT imaging might be different for other fractures and our results therefore are not generalizable to other anatomic locations [14].…”

Section: Discussionmentioning

confidence: 99%

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Janssen

Hermanussen

Guitton

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background For greater tuberosity fractures, 5-mm displacement is a commonly used threshold for recommending surgery; however, it is unclear if displacement can be assessed with this degree of precision and reliability using plain radiographs. It also is unclear if CT images provide additional information that might change decision making. Question/Purposes We asked: (1) Does interobserver agreement for assessment of the amount and direction of fracture-fragment displacement vary based on imaging modality (radiographs only; 2-dimensional [2-D] CT images and radiographs; and 3-dimensional [3-D] and 2-D CT images and radiographs)? (2) Does the likelihood of recommending surgery vary based on imaging modality? (3) Does the level of confidence regarding the decision for treatment vary based on imaging modality? Methods We invited 791 orthopaedic surgeons to complete a survey on greater tuberosity fractures. One hundred eighty (23%) responded and were randomized on a 1:1:1 basis in one of the three imaging modality groups and evaluated the same set of 22 fractures. We described age, sex, mechanism of injury, days between injury and imaging, and that patients had no comorbidities or signs of neurovascular damage for every case. One hundred sixty-four of the 180 respondents completed the study and there was an imbalance in noncompletion between the three groups (two of 67 [3.0%] in the radiograph only group; nine of 57 [16%] in the 2-D CT and radiograph group; and five of 56 [8.9%] in the 3-D CT, 2-D CT, and radiograph group; p = 0.043 by Fisher's exact test). Participants assessed amount (in millimeters) and direction (posterosuperior/posteroinferior/ anterosuperior/anteroinferior/no displacement) of displacement; recommended treatment (surgical or nonoperative); and indicated their level of confidence regarding the recommended treatment on a scale from 0 to 10 for every case. Overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the amount of cases they would operate on by the total number of cases (n = 22) and presented as a percentage. Confidence regarding the One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland). One of the authors (HHH) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from the Anna Foundation (The Netherlands); an amount less than USD 10,000 from the Marco Polo Fund (The Netherlands); and an amount less than USD 10,000 from the Groningen University Fund (The Netherlands). All ICMJE Conflict of Interest...

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“…The mean rate of radiolucent lines in series with more than 10 years of follow-up is reported to be 80% [ 26 ]. However, the reported occurrence of radiolucent lines varies greatly between the published series (from 0 to 100%) and has proven to be inconsistent.…”

Section: Postoperative Imagingmentioning

confidence: 99%

“…It is widely admitted that only progressive radiolucent lines are associated with loosening of the glenoid implant. This criteria of “progression” is questionable, since the value of one observation of a radiolucent line is questionable: it is observer dependant, and even a slight change in the incidence of the radiograph can interfere with the RL analyses [ 26 , 27 ]. Beyond that, X-rays underestimate radiolucent lines.…”

Section: Postoperative Imagingmentioning

confidence: 99%

Shoulder Arthroplasty Imaging: What’s New

Grégory

Nicolas

et al. 2017

TOORTHJ

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Background:Shoulder arthroplasty, in its different forms (hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty) has transformed the clinical outcomes of shoulder disorders. Improvement of general clinical outcome is the result of stronger adequacy of the treatment to the diagnosis, enhanced surgical techniques, specific implanted materials, and more accurate follow up. Imaging is an important tool in each step of these processes.Method:This article is a review article declining recent imaging processes for shoulder arthroplasty.Results:Shoulder imaging is important for shoulder arthroplasty pre-operative planning but also for post-operative monitoring of the prosthesis and this article has a focus on the validity of plain radiographs for detecting radiolucent line and on new Computed Tomography scan method established to eliminate the prosthesis metallic artefacts that obscure the component fixation visualisation.Conclusion:Number of shoulder arthroplasties implanted have grown up rapidly for the past decade, leading to an increase in the number of complications. In parallel, new imaging system have been established to monitor these complications, especially component loosening

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A CT scan protocol for the detection of radiographic loosening of the glenoid component after total shoulder arthroplasty

Cited by 35 publications

References 19 publications

Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability

Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Shoulder Arthroplasty Imaging: What’s New

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