Quantitative Measurement of Osseous Pathology in Advanced Glenohumeral Osteoarthritis

Iannotti, Joseph P.; Jun, Bong-Jae; Patterson, Thomas E.; Ricchetti, Eric T.

doi:10.2106/jbjs.16.00869

Cited by 76 publications

(70 citation statements)

References 21 publications

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“…Most shoulders in our sample had higher retroversion and superior inclination angles. Moreover, the median version angle we found was the same as that reported by Iannotti and Bercik et al [13,14].…”

Section: Discussionsupporting

confidence: 91%

“…A normal intrinsic glenoid inclination angle, as measured on reformatted computed tomography (CT) scans, is generally between 0°and 10° [12]. Studies of the retroversion of the glenoid in osteoarthritic shoulders have reported normal values of 2°to 4°; a retroversion of 10°o r greater is commonly corrected to avoid overloading the glenoid components and to prevent early loosening of anatomical shoulder arthroplasty [13,14].…”

Section: Introductionmentioning

confidence: 99%

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The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

Özel

Hudek

Abdrabou

et al. 2020

BMC Musculoskelet Disord

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Background The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°. Methods A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group. Results The median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders. Conclusion Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

Özel

Hudek

Abdrabou

et al. 2020

BMC Musculoskelet Disord

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“…The glenoid component is generally regarded as the more problematic in both aTSA (loosening and wear) and rTSA (loosening and notching), accounting for up to 30–50% of overall complications [ 7 ]. This is due to two main parameters: inadequate glenoid bone stock and deformities [ 8 , 9 ]; and component mal-positioning [ 10 , 11 ] (excessive retroversion or inclination and glenoid vault perforation). The latter results in abnormal loading of glenoid areas [ 12 ] and may alter stress in the cement mantle [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Villatte

Müller

Pereira³

et al. 2018

PLoS ONE

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IntroductionTotal Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30–50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning.Material and methodsA search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms “Patient-Specific Instrumentation (PSI)”, “custom guide”, “shoulder”, “glenoid” and “arthroplasty”, 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies.ResultsThe final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p<0.01), inclination (p<0.01) and entry point (p = 0.02) were significantly lower with the PSI than with the STDI, but not for rotation (p = 0.49). Accuracy (deviation from planning) with PSI was about 1.88° to 4.96°, depending on the parameter. The number of component outliers (>10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)).ConclusionThis review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.

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“…The glenoid component is generally considered to be the most problematic part in both anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA), accounting for up to 30% of overall complications. 18 In some cases, glenoid bone stock could be insufficient, 19 , 20 or deformities can lead to excessive retroversion or inclination as well as glenoid vault perforation. 21 , 22 …”

Section: D Printing: How Does It Work?mentioning

confidence: 99%

3D printing in shoulder surgery

Campana¹,

Cardona²,

Vismara³

et al. 2020

Orthop Rev (Pavia)

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Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.

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Quantitative Measurement of Osseous Pathology in Advanced Glenohumeral Osteoarthritis

Abstract: The B3 and C2 patterns have qualitative and quantitative differences that may result in different clinical outcomes than classic B2 or C types; therefore, our findings suggest that these new subtypes should be included in a new or modified classification system.

Cited by 76 publications

References 21 publications

The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

3D printing in shoulder surgery

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