Radiographic assessment of prosthetic humeral head size after anatomic shoulder arthroplasty

Alolabi, Bashar; Youderian, Ari R.; Napolitano, Larry A.; Szerlip, Benjamin W.; Evans, Peter; Nowinski, Robert J.; Ricchetti, Eric T.; Iannotti, Joseph P.

doi:10.1016/j.jse.2014.02.013

Cited by 83 publications

(86 citation statements)

References 17 publications

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“…This study demonstrated no deviation or a deviation of less than 3 mm with lower rates lying between 34.9% and 68.8%. The mean deviation between the premorbid CoR and the center of the prosthesis measured between 2.5 and 3.8 mm which is two to four times higher compared to our study[ 12 ]. However, even if our results are relatively good, we have to notice that we were not able to demonstrate a 100% rate of an exact restoration of the CoR.…”

Section: Discussioncontrasting

confidence: 78%

“…We used this best-ﬁt circle to measure the deviation of the center of the prosthesis to the premorbid CoR. Previous studies demonstrated that a malpositioning of 3 to 4 mm can affect the clinical outcome[ 5 , 12 , 29 - 31 ]. According to Alolabi et al[ 12 ] and Kadum et al[ 31 ], we defined a deviation of 3 mm as clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

“…This way, the deviation of the CoR of the implanted humeral head can be assessed in comparison to the native anatomic one. As described by Alolabio et al[ 12 ], a deviation of more than 3 mm was considered as being clinically significant. A medial deviation compared to the premorbid CoR was deﬁned as an overstufﬁng (Figure 3 ), whereas a lateral deviation was defined as an understuffing (Figure 4 ).…”

Section: Methodsmentioning

confidence: 99%

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Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

Engelhardt

Manzke

Breil-Wirth

et al. 2017

WJO

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AIMTo evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODSTwenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.RESULTSBoth, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.CONCLUSIONTESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

Engelhardt

Manzke

Breil-Wirth

et al. 2017

WJO

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“…The circle size could then be readily adjusted using the computer “mouse”. This method resembles the methods of several prior studies that have considered the articular surface of the humeral head as essentially circular in standard A–P view …”

Section: Methodsmentioning

confidence: 99%

“…This method resembles the methods of HUMERAL HEAD CIRCLE-FIT METHOD several prior studies that have considered the articular surface of the humeral head as essentially circular in standard A-P view. 17,19,[22][23][24][25][26][27][28][29] The observers used each of the following methods on each radiograph:…”

Section: Methodsmentioning

confidence: 99%

Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Mears

Langston

Phippen

et al. 2017

Journal Orthopaedic Research

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Measurements made on routine A-P radiographs can predict strength/quality of the proximal humerus, as shown in terms of two easy-to-measure parameters: Cortical index (CI) and mean-combined cortical thickness (MCCT). Because of high variability inherent when using established methods to measure these parameters, we describe a new orientation system. Using digitized radiographs of 33 adult proximal humeri, five observers measured anatomical reference locations in accordance with: (i) Tingart et al. (2003) method, (ii) Mather et al. (2013) method, and (iii) our new humeral head Circle-Fit method (CFM). The Tingart and Mather methods measure CI and MCCT with respect to upper and lower edges of 20 mm tall rectangles fit to a proximal diaphyseal location where endosteal (Tingart) or periosteal (Mather) cortical margins become parallel. But high intra- and inter-observer variability occurs when placing the rectangles because of uncertainty in identifying cortical parallelism. With the CFM an adjustable circle is fit to the humeral head articular surface, which reliably and easily establishes a proximal metaphyseal landmark (M1) at the surgical neck. Distal locations are then designated at successive 10 mm increments below M1, including a second metaphyseal landmark (M2) followed by diaphyseal (D) locations (D1, D2 ⋯D6). D1 corresponds most closely to the proximal edges of the rectangles used in the other methods. Results showed minimal inter-observer variations (mean error, 1.5 ± 1.1 mm) when the CFM is used to establish diaphyseal locations for making CI and MCCT measurements when compared to each of the other methods (mean error range, 10.7 ± 5.9 to 13.3 ± 6.7 mm) (p < 0.001). © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2313-2322, 2017.

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Early offset‐increasing migration predicts later revision for humeral head resurfacing implants. A randomized controlled radiostereometry trial with 10‐year clinical follow‐up

Tøttrup

Thillemann

et al. 2022

Journal Orthopaedic Research

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In a randomized controlled setting, medium‐term implant migration and long‐term clinical outcomes were compared for the Copeland and the Global C.A.P. humeral head resurfacing implants (HHRI). Thirty‐two patients (mean age 63 years) were randomly allocated to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were followed for 5 years with radiostereometry, Constant Shoulder Score, and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). WOOS and revision status were also obtained cross‐sectionally at a mean 10‐year follow‐up. At the 5‐year follow‐up, total translation (TT) was 0.75 mm (95% confidence interval [CI]: 0.53–0.97) for the Copeland HHRIs and 1.15 mm (95% CI: 0.85–1.46) for the Global C.A.P. HHRIs (p = 0.04), but the clinical scores were similar at all follow‐ups. The cumulative risks of revision at 5 and 10 years were 29% and 43% for Copeland and 35% and 41% for Global C.A.P HHRIs (p > 0.7). No implants were loose at revision, but HHRIs that were later revised followed an early offset‐increasing migration pattern with medial translation and lift‐off resulting in a mean 0.53 mm (95% CI: 0.18–0.88) higher TT at the 1‐year follow‐up compared to non‐revised HHRIs. In conclusion, the Global C.A.P. HHRI had higher TT compared with the Copeland HHRI, but clinical scores and revision rates were similar. Nonetheless, revision rates were high and challenge the use of HHRIs. Interestingly, an early radiostereometry evaluated HHRI migration pattern with increased off‐set predicted later implant revision.

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Radiographic assessment of prosthetic humeral head size after anatomic shoulder arthroplasty

Cited by 83 publications

References 17 publications

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Early offset‐increasing migration predicts later revision for humeral head resurfacing implants. A randomized controlled radiostereometry trial with 10‐year clinical follow‐up

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