Clinical and Radiographic Outcomes of a Posteriorly Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for Primary Osteoarthritis with Posterior Glenoid Bone Loss

Ho, Jason; Amini, Michael H.; Entezari, Vahid; Jun, Bong Jae; Alolabi, Bashar; Ricchetti, Eric T.; Iannotti, Joseph P.

doi:10.2106/jbjs.17.01282

Cited by 71 publications

(44 citation statements)

References 46 publications

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“…However, long-term studies analyzing the clinical outcomes are not yet available. Similar improvements were identified by Ho et al with the use of posterior augmented glenoids for correction of retroversion and humeral head subluxation [25]. These implants are more expensive, and their use may be called into question by this study.…”

Section: Discussionsupporting

confidence: 77%

“…The current data could not identify any negative correlation between glenoid component position and clinical outcomes. These findings contradict other studies that report poorer clinical outcomes with inferior glenoid version correction [1] or link better clinical outcomes to correction of glenoid retroversion and humeral head subluxation [25]. Further and longer follow-up studies on humeral head centering should explore the couple forces of the rotator cuff potentially contributing to radiolucencies around the glenoid component.…”

Section: Discussionmentioning

confidence: 57%

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Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

Simon

Crofts

Sasyniuk

et al. 2021

JCM

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Background: Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. Methods: This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior–posterior (AP) and superior–inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Results: Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (−19.4 ± 8.6° to −17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Conclusion: Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 57%

Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

Simon

Crofts

Sasyniuk

et al. 2021

JCM

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“…When addressing the posterior bone loss with an augmented implant, mixed outcomes have been reported. The original metal-backed implants have shown a 31% survivorship at 10 years, but more recently satisfactory results have been shown in 71 shoulders by Ho et al 8 at 2.4 years with no revisions.…”

Section: Discussionmentioning

confidence: 99%

Total shoulder arthroplasty outcomes after noncorrective, concentric reaming of B2 glenoids

Grantham¹,

Dekker²,

Lacheta³

et al. 2020

JSES International

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Background Total shoulder arthroplasty (TSA) is an effective procedure for the treatment of glenohumeral osteoarthritis (GHOA) delivering reliable pain relief and improved shoulder function. Abnormal glenoid morphologies are common, and biconcave glenoids are enigmas that have been associated with poor clinical outcomes and implant survivorship. Purpose To assess the clinical outcome scores of patients who underwent noncorrective, concentric reaming for TSA with biconcave glenoids (B2). We hypothesized that patients with B2 glenoids who underwent TSA with glenoid implantation using noncorrective, concentric reaming would have significant improvements in clinical outcome scores and high implant survivorship. Methods All patients who underwent anatomic TSA for GHOA with B2 glenoids, performed by a single surgeon, between July 2006 and December 2015 with minimum 2-year follow-up were reviewed. Walch classification was obtained from preoperative imaging (magnetic resonance imaging or computed tomography). Clinical outcome scores were prospectively collected and included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, 12-Item Short Form Health Survey physical component summary (PCS), and patient satisfaction. Clinical failures (revision TSA surgery or conversion to reverse TSA) and complications were reported. Paired t test and bivariate correlations level of significance was set at P = .05. Survivorship analysis with implant failure as an endpoint was done using Kaplan-Meier survival curves. Results 51 TSA in 49 patients (9 females, 40 males) with primary GHOA with B2 glenoids were performed with a mean age of 64 (range 36-81 years) at the time of surgery. The mean retroversion was 19.1° (range 5.4°-38°), and posterior decentering was 42.0% (range 19.4%-78.5%). At final evaluation, 45/51 anatomic TSAs (88% follow-up) with a mean follow-up of 4.9 years (range 2.0-10.4 years) were assessed. All clinical outcome scores improved significantly pre- to postoperatively: ASES, 52.5 to 79.6 ( P < .001); SANE, 52.4 to 74.7 ( P < .001); QuickDASH, 39.2 to 19.1 ( P = .001); and PCS, 40.9 to 48.9 ( P = .001). Median postoperative satisfaction was 9 (range 1-10). There were 2 failures and 4 that required another surgery —subscapularis repair, lysis of adhesions, irrigation and débridement, and one to explore the status of the subscapularis for persistent pain. The implant survivorship rate was 95% at a mean follow-up of 4.9 years. Conclusion Anatomic total shoulder replacement with minimally noncorrective, concentric reaming in patients with B2 glenoids had significant improvement ...

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“…They had significant correction (11.8 p < 0.001) of glenoid retroversion postoperatively. Similarly, Ho et al 26 used posterior step augmented glenoid for TSA in 71 B2 and B3 shoulders. They showed 85% had humeral head centring and 73% had post-operative retroversion less than 15%.…”

Section: Discussionmentioning

confidence: 99%

Does posterior half-wedge augmented glenoid restore version and alignment in total shoulder arthroplasty for the B2 glenoid?

Das

Wright

Singh

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Introduction: Walch type B2 has biconcave glenoid with posterior erosion, bone loss and humeral head subluxation. This leads to decreased glenohumeral contact area and increased contact pressure. During total shoulder arthroplasty(TSA), uncorrected retroversion causes eccentric loading and failure of glenoid component. It also leads to humeral head decentring with posterior rim loading, early glenoid wear and component loosening. This study aims to review anatomical restoration of glenoid version and humeral head centring in TSA with B2 glenoid using CT scans. Methods: This is a retrospective review of TSA for glenohumeral osteoarthritis with B2 Glenoid morphology. All polyethylene posterior wedge augmented glenoid component was used. All patients underwent pre and post surgery CT Scans. Glenoid version was calculated using neoglenoid line and medial scapular border as reference point. Post-operative humeral head centering was calculated using offset of centre of rotation of humeral head with plane of scapula on axial CT-Scan. Results: Study had 10 patients with 11 TSA between June 2017 and July 2018. Mean age was 59(45e80) years. Mean preoperative retroversion was 16(13e23)degrees. This was corrected to a mean of 0 retroversion postoperatively. 63% had good radiological correction (0e5 retroversion). Humeral head was well centered post-operatively with mean humeral scapula alignment offset of 2.1(0.8e4.5) mm posteriorly. All cases had well-centered humeral head postoperatively with offset less than 5 mm. Conclusions: Total shoulder replacement in B2 glenoid is technically demanding. Our radiological results show favourable outcome in terms of correction of gelenoid retroversion and eliminating posterior instability using wedge glenoid component. Level of evidence: IV.

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Clinical and Radiographic Outcomes of a Posteriorly Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for Primary Osteoarthritis with Posterior Glenoid Bone Loss

Cited by 71 publications

References 46 publications

Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

Total shoulder arthroplasty outcomes after noncorrective, concentric reaming of B2 glenoids

Does posterior half-wedge augmented glenoid restore version and alignment in total shoulder arthroplasty for the B2 glenoid?

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