Bone presence between the central peg's radial fins of a partially cemented pegged all poly glenoid component suggest few radiolucencies

Arnold, Ryan M.; High, Robin; Grosshans, Kevin T.; Walker, Craig W.; Fehringer, Edward V.

doi:10.1016/j.jse.2010.05.025

Cited by 48 publications

(37 citation statements)

References 41 publications

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“…Arnold et al [11] evaluated 35 total shoulder prosthesis at a mean follow-up of 43 months with use of computed tomography. The presence of bone between the flanges of the central peg of the glenoid was demonstrated in 32 of the 35 shoulders.…”

Section: Discussionmentioning

confidence: 99%

CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties

Vidil

Valenti

Guichoux

et al. 2012

Eur J Orthop Surg Traumatol

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BackgroundGlenoid component failure is the most common complication of total shoulder arthroplasty. It can be correlated with failure of the component itself to resist wear and deformation, failure of fixation or failure of the glenoid bone. Anchor Peg Glenoid component (Depuy®) seems to have a higher bone fixation in biomechanical canine model: it is a all-polyethylene, concave component with one circumferentially fluted, central, interference-fit peg and three small cemented peripheral pegs.Materials and methodsWe realized a prospective study of Anchor Peg total shoulder arthroplasty, included 27 patients suffering from primary arthrosis or arthritis, without rotator cuff tear. A clinical and radiographic evaluation was performed at 3 months, 1 and 2 years; a CT scan was made in postoperative and analyzed central peg’s bone integration 1 year later.ResultsImprovement of postoperative Constant score and radiographic good results were correlated with satisfactory subjective results reported by patients. We observed radiolucent lines under glenoid component in 3 cases. Twenty-six CT scans were available at 1 year: it showed complete bone integration around the central peg in 21 cases and partial peripheral bone integration in four cases. Only one patient had any tissue integration around the peg, probably because of his implantation near cortical bone of scapular spine.Discussion/conclusionLong-term result of arthroplasty is correlated with glenoid durable fixation to underlying bone: this study shows higher fixation of glenoid component with bone integration of central peg. However, these results will have to be confirmed in a later revision.

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Section: Discussionmentioning

confidence: 99%

CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties

Vidil

Valenti

Guichoux

et al. 2012

Eur J Orthop Surg Traumatol

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“…However, we have been unable to find any studies that have evaluated the efficacy of these new techniques in the context of shoulder arthroplasty. The only 2 papers that did use CT scanning (Yian et al 2005 and Arnold et al 2011) both described substantial difficulties due to metal artifacts.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Background and purposeIt is difficult to evaluate glenoid component periprosthetic radiolucencies in total shoulder arthroplasties (TSAs) using plain radiographs. This study was performed to evaluate whether computed tomography (CT) using a specific patient position in the CT scanner provides a better method for assessing radiolucencies in TSA.MethodsFollowing TSA, 11 patients were CT scanned in a lateral decubitus position with maximum forward flexion, which aligns the glenoid orientation with the axis of the CT scanner. Follow-up CT scanning is part of our routine patient care. Glenoid component periprosthetic lucency was assessed according to the Molé score and it was compared to routine plain radiographs by 5 observers.ResultsThe protocol almost completely eliminated metal artifacts in the CT images and allowed accurate assessment of periprosthetic lucency of the glenoid fixation. Positioning of the patient within the CT scanner as described was possible for all 11 patients. A radiolucent line was identified in 54 of the 55 observed CT scans and osteolysis was identified in 25 observations. The average radiolucent line Molé score was 3.4 (SD 2.7) points with plain radiographs and 9.5 (SD 0.8) points with CT scans(p = 0.001). The mean intra-observer variance was lower in the CT scan group than in the plain radiograph group (p = 0.001).InterpretationThe CT scan protocol we used is of clinical value in routine assessment of glenoid periprosthetic lucency after TSA. The technique improves the ability to detect and monitor radiolucent lines and, therefore, possibly implant loosening also.

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“…(11) Implant loosening may also be evaluated using CT, although image degradation caused by significant metal artefacts may prevent reliable analysis of implant fixation. (12,13) New CT protocols and image reconstruction techniques have been developed in an attempt to reduce these artefacts, (14,15) although further studies are required to evaluate the true efficacy of these techniques in the context of shoulder arthroplasty. Insinuation of intra-articular contrast medium into the bone-cement or implant-cement interface is also diagnostic of loosening of the glenoid component.…”

Section: A 2bmentioning

confidence: 99%

Clinics in diagnostic imaging (167)

Tan

Aljefri

Elliott

et al. 2016

smedj

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A 59-year-old woman presented with left shoulder pain and stiffness of 12 months' duration. She had previously undergone an anatomic left total shoulder arthroplasty four years ago for avascular necrosis of the humeral head with advanced secondary glenohumeral osteoarthritis. The patient had actively participated in a postoperative rehabilitation programme, with good pain relief and restoration of function of the left shoulder. However, over a period of 12 months prior to the current clinical presentation, the patient began to experience increasing left shoulder pain and stiffness, which limited her activities of daily living. A physical examination revealed significant reduction in motion of the left shoulder, which included limitation of active forward flexion of about 40°. There was also difficulty in initiating shoulder abduction. Radiographic (Fig. 1a) and arthrographic (Fig. 1b) assessments of the left shoulder were performed. These were followed by dual-energy computed tomography (DECT) of the left shoulder, which was performed without intravenous contrast immediately following the left shoulder arthrogram (Figs. 1c & d).What do these images demonstrate? What is the diagnosis?

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Bone presence between the central peg's radial fins of a partially cemented pegged all poly glenoid component suggest few radiolucencies

Cited by 48 publications

References 41 publications

CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties

CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties

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

Clinics in diagnostic imaging (167)

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