Precision of novel radiological methods in relation to resurfacing humeral head implants: assessment by radiostereometric analysis, DXA, and geometrical analysis

Stilling, Maiken; Mechlenburg, Inger; Amstrup, Anders; Søballé, Kjeld; Klebe, Thomas

doi:10.1007/s00402-012-1580-x

Cited by 18 publications

(19 citation statements)

References 23 publications

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“…Furthermore, the osseous integration into the implant surface and coating seems to work for all evaluated CRSA implants. Accordingly, Stilling et al, did not find a difference in a radiostereometric migration analysis after 6 month for the Copeland and Global C.U.P . However, it has to be noted that the limited number of retrievals, the different CRSA designs and the varying patient characteristics probably do not provide enough statistical power to detect a differences between the implant geometries.…”

Section: Discussionmentioning

confidence: 95%

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: Discussionmentioning

confidence: 95%

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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“…Studies on the humeral head resurfacing prosthesis showed especially poor precision values (Stilling et al. 2012, Mechlenburg et al. 2014).…”

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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“…This is similar to the preliminary results in a randomised clinical trial comparing the Copeland hemiarthroplasty with the Global CAP hemiarthroplasty. 26 The definition of a young patient is disputed, and limits of 50 or 55 years have been suggested. 3,6,27,28 We decided to use the limit of 55 years as this was used in two previous studies of resurfacing hemiarthroplasty in young patients.…”

Section: Discussionmentioning

confidence: 99%

Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

Rasmussen

Polk

Sørensen

et al. 2014

The Bone & Joint Journal

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In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7.5%) required revision; the cumulative five-year rate of revision was 9.9%. Patients aged < 55 years had a statistically significant inferior WOOS score, which exceeded the minimal clinically important difference, compared with older patients (mean difference 14.2 (8.8; 95% CI 19.6; p < 0.001), but with no increased risk of revision. There was no significant difference in the mean WOOS or the risk of revision between designs of resurfacing hemiarthroplasty.

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Precision of novel radiological methods in relation to resurfacing humeral head implants: assessment by radiostereometric analysis, DXA, and geometrical analysis

Cited by 18 publications

References 23 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

Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

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