Glenoid component loosening associated with increased critical shoulder angle at midterm follow-up

Watling, Jonathan P.; Sanchez, Javier E.; Heilbroner, Samuel P.; Levine, William N.; Bigliani, Louis U.; Jobin, Charles M.

doi:10.1016/j.jse.2017.10.002

Cited by 17 publications

(5 citation statements)

References 16 publications

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“…This leads to higher risk of rotator cuff failure [35–37]. Additionally, Watling et al [38] found a high CSA being associated with glenoid component loosening and failure. In our series, however, we did not find a significant association between CSA angles and revision.…”

Section: Discussionmentioning

confidence: 99%

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

et al. 2019

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PurposeLiterature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure.MethodsPre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients.ResultsThe inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19–3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure.ConclusionThe CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm.Trial registrationInstitutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

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Section: Discussionmentioning

confidence: 99%

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

et al. 2019

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“… 52 , 53 A CSA > 35 degrees is, on the other hand, related to an increased incidence of rotator cuff tears secondary to increased supraspinatus loading to compensate for increased joint instability as a consequence of increased glenohumeral joint shear forces. 51 , 54 , 55 In the setting of ATSA, an increased CSA has been related to an increased incidence of glenoid radiolucencies. 55 …”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

“… 51 , 54 , 55 In the setting of ATSA, an increased CSA has been related to an increased incidence of glenoid radiolucencies. 55 …”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

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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“…5,6 Recently, Watling et al reported that higher CSA values was associated with a higher incidence of glenoid loosening following anatomic total shoulder replacement. 16 Measuring the CSA with a plain radiograph provides a simple and useful tool to screen for possible rotator cuff pathology in patients with osteoarthritis, and may serve as a means with which to predict the development of glenohumeral arthritis.…”

Section: Discussionmentioning

confidence: 99%