Effect of RSA glenoid baseplate central fixation on micromotion and bone stress

Bonnevialle, Nicolas; Geais, Laurent; Müller, Jacobus H.; Berhouet, Julien

doi:10.1016/j.jseint.2020.07.004

Cited by 18 publications

(17 citation statements)

References 38 publications

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“…The minimal central peg length proposed in the literature that should be inserted in the native bone stock to avoid loosening varies between 8 to 10 mm [21,39]. However, we did not observe signs of glenoid loosening or migration when using a central screw after two years, confirming sufficient stability and the biomechanical findings of Bonnevialle et al [40]. This observation can be explained by the tremendous compression obtained at the insertion of screw devices and the additional inferior tilt provided by the full wedge baseplate.…”

Section: Discussionsupporting

confidence: 81%

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Nabergoj

Neyton

Bothorel

et al. 2021

JCM

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There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p < 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017; ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient.

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Section: Discussionsupporting

confidence: 81%

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Nabergoj

Neyton

Bothorel

et al. 2021

JCM

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“… 137 Regarding baseplate design, the central screw does not seem superior to the post regarding load to failure compared to the central post. 138 Lastly, Gutiérrez et al investigated optimal baseplate position using a computer model. According to their work, which focused on uniform force distribution, a 15-degree inferior tilt is best suited for a concentric or lateral eccentric glenosphere, and for an inferior eccentric glenosphere a neutral inclination (0 degrees) is the preferred orientation.…”

Section: Reverse Shoulder Arthroplastymentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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“…Micromotions and stresses within bone and cement were compared among glenoid components that were virtually implanted in scapulae of three men and two women scheduled for shoulder arthroplasty (Table 1 ) [ 10 ]. The patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (IRB reference number: COS-RGDS-2021–05-004-GODENECHE-A).…”

Section: Methodsmentioning

confidence: 99%

“…3.2, Kitware, Clifton Park, NY, USA), by manually separating the scapula from the clavicle along the acromioclavicular joint. For all scapulae, the boundary between cortical and trabecular bone was differentiated in each slice, using the thresholding (trabecular bone < 20% of the maximum density [ 10 ]) and manual selection tools of the segmentation software. The bone density in each voxel was estimated by applying the method described by Pomwenger et al [ 11 ] (Additional file 1 ).…”

Section: Methodsmentioning

confidence: 99%

Mechanical behavior of hybrid glenoid components compared to all-PE components: a finite element analysis

Bonnevialle

Berhouet²,

Pôtel³

et al. 2022

J EXP ORTOP

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Purpose The purpose of this finite element study was to compare bone and cement stresses and implant micromotions among all-polyethylene (PE) and hybrid glenoid components. The hypothesis was that, compared to all-PE components, hybrid components yield lower bone and cement stresses with smaller micromotions. Methods Implant micromotions and cement and bone stresses were compared among 4 all PE (U-PG, U-KG, A-KG, I-KG) and 2 hybrid (E-hCG, I-hPG) virtually implanted glenoid components. Glenohumeral joint reaction forces were applied at five loading regions (central, anterior, posterior, superior and inferior). Implant failure was assumed if glenoid micromotion exceeded 75 µm or cement stresses exceeded 4 MPa. The critical cement volume (CCV) was based on the percentage of cement volume that exceeded 4 MPa. Results were pooled and summarized in boxplots, and differences evaluated using pairwise Wilcoxon Rank Sum tests. Results Differences in cement stress were found only between the I-hPG hybrid component (2.9 ± 1.0 MPa) and all-PE keeled-components (U-KG: 3.8 ± 0.9 MPa, p = 0.017; A-KG: 3.6 ± 0.5 MPa, p = 0.014; I-KG: 3.6 ± 0.6 MPa, p = 0.040). There were no differences in cortical and trabecular bone stresses among glenoid components. The E-hCG hybrid component exceeded micromotions of 75 µm in 2 patients. There were no differences in %CCV among glenoid components. Conclusions Finite element analyses reveal that compared to all-PE glenoid components, hybrid components yield similar average stresses within bone and cement. Finally, risk of fatigue failure of the cement mantle is equal for hybrid and all-PE components, as no difference in %CCV was observed. Level of evidence IV, in-silico.

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Effect of RSA glenoid baseplate central fixation on micromotion and bone stress

Cited by 18 publications

References 38 publications

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Biomechanics of anatomic and reverse shoulder arthroplasty

Mechanical behavior of hybrid glenoid components compared to all-PE components: a finite element analysis

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