Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants: two-year results of a randomized controlled clinical trial

Mechlenburg, Inger; Klebe, Thomas; Døssing, Kaj; Amstrup, Anders; Søballe, Kjeld; Stilling, Maiken

doi:10.1016/j.jse.2014.05.012

Cited by 16 publications

(36 citation statements)

References 36 publications

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“…As some of the implants showed no progression, but some required revision, the functional and clinical impact of osteolysis in CRSA is unknown. In contrast, a recent CRSA study even described an increase of the periprosthetic BMD at the 2 year follow‐up, after an initial decrease in the first 6 month postoperatively . Those results support rather than contradict our findings, as the study did not measure the BMD under the implant surface but at the periprosthetic rim and stem of the implant where the stress shielding pattern lead to an increase of the bone substance.…”

Section: Discussioncontrasting

confidence: 98%

Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

Schmidutz

Sprecher

Milz

et al. 2015

Journal Orthopaedic Research

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Cementless-surface-replacement-arthroplasty (CSRA) of the shoulder aims for functional joint restoration with minimal bone loss. Good clinical results have been reported, but due to the radiopaque metal shell no data is available on the structure, osseous integration, and bone stock under the implant. 14 hemi-CSRAs (4 manufacturers) with two geometries (crown [n ¼ 7]/ stem [n ¼ 7] fixation) were retrieved from patients undergoing revision due to glenoidal erosion. Histological sections cutting through the implant centre and bone were analysed. Quantitative histomorphometry evaluated the bone-implant-contact and compared the bone-area to native humeral retrievals (n ¼ 7). The boneimplant-interface was further assessed by scanning-electron-microscopy (SEM) and energy-dispersive-x-ray (EDX). Qualitative histology revealed a reduced and inhomogeneous bone stock. Obvious signs of stress shielding were observed with bone predominantly visible at the stem and implant rim. Quantitative histomorphometry confirmed the significantly reduced bone-area (9.2 AE 3.9% [crown 9.9 AE 4.3%, stem 8.6 AE 3.6%]) compared to native humeri (21.2 AE 9.1%; p < 0.05). Bone-implant-contact was 20.5 AE 5.8% (crown 21.8 AE 6.2%, stem 19.2 AE 5.6%) which was confirmed by SEM and EDX. Altogether, CRSA shows satisfactory bone ingrowth at the interface suggesting sufficient primary stability to allow osseous integration. However, clear signs of stress shielding with an inhomogeneous and reduced bone stock were observed. The impact on the long-termresults is unclear requiring further investigation. ß

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Section: Discussioncontrasting

confidence: 98%

Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

Schmidutz

Sprecher

Milz

et al. 2015

Journal Orthopaedic Research

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“…2012, 2014, Mechlenburg et al. 2014, Streit et al. 2015), 4 studies involved the elbow (Valstar et al.…”

Section: Resultsmentioning

confidence: 99%

“…2012, Mechlenburg et al. 2014). This might be due to the symmetrical shape of the implant, which constitutes a challenge when calculating rotations.…”

Section: Discussionmentioning

confidence: 99%

The accuracy and precision of radiostereometric analysis in upper limb arthroplasty

et al. 2017

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Background and purposeRadiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb.Patients and methodsPRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSAResults23 studies were included. Precision values were in the 0.06–0.88 mm and 0.05–10.7° range for the shoulder, the 0.05–0.34 mm and 0.16–0.76° range for the elbow, and the 0.16–1.83 mm and 11–124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included.InterpretationRSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.

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“…Multiple definitions of overstuffing following RHA have been used in the literature including a medial deviation of the center of rotation [ 3 ], increased LGHO [ 19 , 20 ], and improper implant size [ 1 , 2 , 5 , 6 , 21 , 28 ], but little data exist on the reliability of these measurements. A recent study by Kadum et al investigated intra- and inter-observer agreement between four observers measuring LGHO on both computed tomography (CT) images and radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…Studies evaluating the restoration of glenohumeral joint anatomy following RHA have been conflicting. Some report that RHA restores humeral head anatomy [ 9 , 18 , 30 ] while others report increased lateral glenohumeral offset (LGHO) [ 14 , 17 – 20 , 28 ], displacement of the center of rotation [ 3 ], increased humeral head size [ 27 ], and a tendency to place the implant in varus [ 14 , 18 ]. Despite a lack of a clear definition, the term overstuffing has also been widely used in the literature as a possible cause of persistent pain or a poor functional outcome following RHA [ 1 – 3 , 6 , 18 , 19 , 21 , 25 – 27 , 29 , 30 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs

et al. 2018

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BackgroundIn a clinical setting, a visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after resurfacing hemiarthroplasty and is a part of the decision-making process, in combination with other parameters, when evaluating patients with inferior clinical results. However, the reliability of this method of visual evaluation has not been reported. The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs.MethodsSix experienced shoulder surgeons independently classified implant inclination, size of the implant and if the joint seemed overstuffed, in 219 cases of post-implant radiographs. All cases were classified twice 3 weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen’s kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement.ResultsThe overall inter-observer agreement for implant size (kappa, 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa, 0.46 and 0.44), but only a fair agreement was found concerning the evaluation for stuffing of the joint (kappa, 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial.ConclusionsOur results indicate that a visual evaluation of plain radiographs may be inadequate to evaluate overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs. Future studies may contribute to elucidate whether reliability increases if consensus on clear definitions and standardized methods of evaluation is made.

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Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants: two-year results of a randomized controlled clinical trial

Cited by 16 publications

References 36 publications

Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

The accuracy and precision of radiostereometric analysis in upper limb arthroplasty

Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs

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