Radiographic survival in total shoulder arthroplasty

Fox, Tyler J.; Foruria, Antonio M.; Klika, Brian J.; Sperling, John W.; Schleck, Cathy D.; Cofield, Robert H.

doi:10.1016/j.jse.2012.12.034

Cited by 74 publications

(44 citation statements)

References 21 publications

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“…Late radiographic lucency and clinical loosening of the glenoid component have been critical concerns in longterm implant survivorship in total shoulder arthroplasty [15,18,27,36]. In a review of nearly 3000 total shoulder arthroplasties, Bohsali et al [5] reported the incidence of aseptic loosening to be 39% after 5 years, with 83% of cases attributed to failure of the glenoid component.…”

Section: Introductionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Uncorrected glenoid retroversion during total shoulder arthroplasty may lead to an increased likelihood of glenoid prosthetic loosening. Augmented glenoid components seek to correct retroversion to address posterior glenoid bone loss, but few biomechanical studies have evaluated their performance. Questions/purposes We compared the use of augmented glenoid components with eccentric reaming with standard glenoid components in a posterior glenoid wear model. The primary outcome for biomechanical stability in this model was assessed by (1) implant edge displacement in superior and inferior edge loading at intervals up to 100,000 cycles, with secondary outcomes including (2) implant edge load during superior and inferior translation at intervals up to 100,000 cycles, and (3) incidence of glenoid fracture during implant preparation and after cyclic loading. Methods A 12°-posterior glenoid defect was created in 12 composite scapulae, and the specimens were divided in two equal groups. In the posterior augment group, glenoid version was corrected to 8°and an 8°-augmented polyethylene glenoid component was placed. In the eccentric reaming group, anterior glenoid reaming was performed to neutral version and a standard polyethylene glenoid component was placed. Specimens were cyclically loaded in the superoinferior direction to 100,000 cycles. Superior and inferior glenoid edge displacements were recorded. Results Surviving specimens in the posterior augment group showed greater displacement than the eccentric reaming group of superior (1.01 ± 0.02 [95% CI, 0.89-1.13] versus 0. 83 ± 0.10 [95% CI,

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Section: Introductionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…It is therefore understandable that early static images of the shoulder do not reveal gaps in the implant‐cement interface, which would manifest under dynamic movement. In a recent radiographic study, Fox et al highlighted late radiographic failure occurring after 5 years and called for the need for design innovations to improve glenoid fixations 3. The study also highlighted glenoid implants “at risk” of radiographic failure were linked with superior subluxation of the humeral head, which may indicate the problem of high vertical head displacement, a measure used in this paper.…”

Section: Discussionmentioning

confidence: 94%

Cadaveric study validating in vitro monitoring techniques to measure the failure mechanism of glenoid implants against clinical CT

Junaid

Grégory

Fetherston

et al. 2018

Journal Orthopaedic Research

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Definite glenoid implant loosening is identifiable on radiographs, however, identifying early loosening still eludes clinicians. Methods to monitor glenoid loosening in vitro have not been validated to clinical imaging. This study investigates the correlation between in vitro measures and CT images. Ten cadaveric scapulae were implanted with a pegged glenoid implant and fatigue tested to failure. Each scapulae were cyclically loaded superiorly and CT scanned every 20,000 cycles until failure to monitor progressive radiolucent lines. Superior and inferior rim displacements were also measured. A finite element (FE) model of one scapula was used to analyze the interfacial stresses at the implant/cement and cement/bone interfaces. All ten implants failed inferiorly at the implant‐cement interface, two also failed at the cement‐bone interface inferiorly, and three showed superior failure. Failure occurred at of 80,966 ± 53,729 (mean ± SD) cycles. CT scans confirmed failure of the fixation, and in most cases, was observed either before or with visual failure. Significant correlations were found between inferior rim displacement, vertical head displacement and failure of the glenoid implant. The FE model showed peak tensile stresses inferiorly and high compressive stresses superiorly, corroborating experimental findings. In vitro monitoring methods correlated to failure progression in clinical CT images possibly indicating its capacity to detect loosening earlier for earlier clinical intervention if needed. Its use in detecting failure non‐destructively for implant development and testing is also valuable. The study highlights failure at the implant‐cement interface and early signs of failure are identifiable in CT images. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2524–2532, 2018.

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“…The images were reviewed by two orthopaedic surgeons (LVG and KLC). Radiolucencies were graded according to a system described by Lazarus et al [20] for the pegged components, and a modification of that system for the hybrid components (Table 2) [10]. Discrepancies between reviewers were settled by consensus.…”

Section: Methodsmentioning

confidence: 99%

“…Total shoulder replacements have been shown to improve function and diminish pain for patients with end-stage osteoarthritis [2,10,16,26]. However, glenoid component loosening remains one of the most common causes of medium and long-term failures [5, 9-12, 15, 18, 22, 23, 25, 27-30, 33].…”

Section: Introductionmentioning

confidence: 99%

“…However, glenoid component loosening remains one of the most common causes of medium and long-term failures [5, 9-12, 15, 18, 22, 23, 25, 27-30, 33]. Attempts to improve glenoid fixation with metal-backed components have been problematic because of accelerated wear, implant loosening, component fracture, screw breakage, and polyethylene dissociation [10,13,27,29]. These findings have led to the conclusion that cemented all-polyethylene pegged and keeled components offer the best chance at prolonged implant longevity and survival.…”

Section: Introductionmentioning

confidence: 99%

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No Differences in Early Results of a Hybrid Glenoid Compared With a Pegged Implant

Gulotta

Chambers

Warren

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Glenoid component loosening after total shoulder arthroplasty is one of the most common causes of failure. A hybrid glenoid that uses peripherally cemented pegs and a central press-fit post may improve implant longevity. Questions/purposes We asked, compared with polyethylene pegged glenoid implants, do hybrid glenoid implants with a titanium post provide (1) better ingrowth with fewer radiolucencies, (2) better outcome and pain scores, and (3) lower risk of complications and revisions? Methods Between 2009 and 2010, 126 patients underwent primary total shoulder arthroplasty for osteoarthritis.Patients were included in this retrospective study if they consented for inclusion in a shoulder arthroplasty registry, had complete baseline and 2-year data, and had complete radiographs. Eighty-three (67%) were available at an average followup of 3.2 years (range, 24-45 months). Forty received a conventional all-polyethylene pegged glenoid and 43 received a hybrid component. During the period in question, four of the participating surgeons used only one implant, and four used only the other; there was one highvolume surgeon in each of the study groups. Radiographs were taken at the 2-year followup and analyzed for radiolucent lines. CT scans were obtained randomly for 10 patients with hybrid glenoid implants to assess bone ongrowth. American Shoulder and Elbow Surgeons score, VAS score, complications and revisions were recorded. Results At final followup, radiolucent lines between the two study groups were not different (hybrid, 1.0 ± 0.4; pegged, 1.6 ± 0.3; mean difference, 0.6; 95% CI, 0.85-1.72; p = 0.323). Final VAS pain scores were not different (hybrid, 1.2 ± 0.2; pegged, 1.5 ± 0.3; p = 0.056). Change in American Shoulder and Elbow Surgeons scores were not different (hybrid, 33.7 ± 7.3; pegged, 35.5 ± 8.2; p = 0.283). There were no differences in complication risk (hybrid, one of 43 [2.3%]; pegged, three of 40 [7.5%]; relative risk, 2.3; 95% CI, 0.82-3.12; p = 0.061). Conclusions With the numbers available and at early followup, there were no differences between the hybrid and pegged glenoids in terms of fixation, functional outcome, pain scores, and complications. CT scans confirmed bone ongrowth on the porous titanium post in a small subcohort of patients. Further studies are needed to determine how this new implant will perform with time. Until then, its use should be initiated with caution.

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Radiographic survival in total shoulder arthroplasty

Cited by 74 publications

References 21 publications

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Cadaveric study validating in vitro monitoring techniques to measure the failure mechanism of glenoid implants against clinical CT

No Differences in Early Results of a Hybrid Glenoid Compared With a Pegged Implant

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