Reporting of glenoid bone loss measurement in clinical studies and the need for standardization

Weil, Simon; Arnander, Magnus; Pearse, Yemi; Tennent, Duncan

doi:10.1302/0301-620x.104b1.bjj-2021-0751.r1

Cited by 8 publications

(10 citation statements)

References 54 publications

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“…Furthermore, studies used different classification systems for glenoid deficiency and there was marked variability in how this was detected, with some studies using radiograph and others using ct. there was variation in mathematical analysis as well, a problem acknowledged in the literature on glenoid bone loss. 60,61 This may limit the generalizability of our results. Finally, several of the included studies were retrospectively conducted, and may therefore be subject to bias.…”

Section: Resultsmentioning

confidence: 87%

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Management of glenoid bone loss in primary reverse shoulder arthroplasty

Wilcox

Campbell

Low

et al. 2022

The Bone & Joint Journal

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Aims Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. Methods This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates. Results A total of 13 studies (919 shoulders) were included in the analysis. The mean age of patients at initial evaluation was 72.2 years (42 to 87), with a mean follow-up time of 40.7 months (24 to 120). Nine studies with 292 rTSAs evaluated the use of bone graft and five studies with 627 rTSAs evaluated the use of augmented glenoid baseplates. One study was analyzed in both groups. Both techniques demonstrated improvement in patient-reported outcome measures and ROM assessment, with augmented prostheses outperforming bone grafting on improvements in the American Shoulder and Elbow Surgeons Score. There was a higher complication rate (8.9% vs 3.5%; p < 0.001) and revision rate among the bone grafting group compared with the patients who were treated with augmented prostheses (2.4% vs 0.6%; p = 0.022). Conclusion This review provides strong evidence that both bone graft and augmented glenoid baseplate techniques to address glenoid bone loss give excellent ROM and functional outcomes in primary rTSA. The use of augmented base plates may confer fewer complications and revisions. Cite this article: Bone Joint J 2022;104-B(12):1334–1342.

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Section: Resultsmentioning

confidence: 87%

“…There was variation in mathematical analysis as well, a problem acknowledged in the literature on glenoid bone loss. 60,61 This may limit the generalizability of our results. Finally, several of the included studies were retrospectively conducted, and may therefore be subject to bias.…”

Section: Discussionmentioning

confidence: 86%

Management of glenoid bone loss in primary reverse shoulder arthroplasty

Wilcox

Campbell

Low

et al. 2022

The Bone & Joint Journal

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“…As no consensus exists regarding drawing an accurate best-fit circle, previous studies have used differing methods. 26,28 When referencing the inferior glenoid for the best-fit circle, some studies used ambiguous terms, such as the inferior or posteroinferior glenoid, whereas others used 9- to 3-o’clock or 9- to 5-o’clock, which is difficult to specify when making a circle. 13,14,20,26 Also, the position of the best-fit circle itself considerably affects the circle size and defect measurements.…”

Section: Discussionmentioning

confidence: 99%

“…7,12,24 Nevertheless, in many studies, the best-fit circle was created in affected glenoids with bone defects, not in the normal glenoids. 26,28 However, no study has confirmed whether best-fit circles drawn in this manner truly represent native glenoids before injury. While some investigators used best-fit circles created from unaffected contralateral glenoids instead, 28 our clinical experience has revealed that best-fit circles of affected and unaffected contralateral glenoids do not match in many patients.…”

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confidence: 99%

Disagreement Between the Accepted Best-Fit Circle Method to Calculate Bone Loss Between Injured and Uninjured Shoulders

Kim

Lim

et al. 2023

Am J Sports Med

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Background: No study has evaluated whether best-fit circles based on glenoids with defects accurately represent normal inferior glenoids before injury. Purpose: To investigate whether the best-fit circles on the affected side with a glenoid defect can accurately represent native glenoids before injury. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This retrospective study included 58 patients with unilateral recurrent anterior shoulder instability. First, we compared the diameter of best-fit circles based on affected and unaffected glenoids. Glenoid defect sizes based on each best-fit circle were then calculated and compared. Second, we created serial virtual glenoid defects (10%, 15%, 20%, 25%) on unaffected glenoids and compared diameters of best-fit circles on the glenoids before and after virtual defects. We also analyzed and compared the size of virtual and calculated glenoid defects. Bland-Altman plots and intraclass coefficients (ICCs) were used to compare and analyze agreement of measurements. After categorization of glenoid defects based on clinical cutoff values, Cohen κ and percentage agreement were calculated. Results: The diameter of 55.2% (32/58) of best-fit circles from affected glenoids over- or underestimated the diameter on the unaffected side by >5%. In 28 of the 32 patients, the diameter of the affected side circle was overestimated. Consequently, 41.4% (24/58) of glenoid defects were over- or underestimated by >5%. In 19 of the 24 patients, the glenoid defect from the affected side was >5% larger. ICCs between sides for best-fit circle diameters and defect sizes were 0.632 and 0.800, respectively. Agreement of glenoid defect size between sides was 58.6% (34/58) overall, but when the defect was ≥10%, agreement decreased to 32.3% (10/31). Among 232 glenoids with virtual defects created from 58 normal glenoids, the diameter of 31.0% (72/232) of best-fit circles and the size of 11.6% (27/232) of defects were over- or underestimated by >5%. Conclusion: When assessing glenoid defects in anterior shoulder instability, best-fit circles based on affected glenoids do not always represent the native glenoid and may thus lead to inaccurate circle sizes and defect estimates.

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“…Various measurements have been introduced to measure the glenoid bone loss based on an en face sagittal oblique view [4][5][6] using computed tomography (CT) or magnetic resonance images, considering the inferior aspect of the intact glenoid shaped as a circle [7][8][9][10][11]. However, consensus regarding the gold standard for measurements in the clinical practice is lacking [5,12,13], as scapula position and best-fit circle placement could potentially alter the measurement results [14]. Although Zhang et al [15] provided a quantitative definition and a practical method for en face view generation with a maximal glenoid projection area, such method would be too complicated to practice routinely with no specific software.…”

Section: Introductionmentioning

confidence: 99%

Glenoid Bone Loss Determination: Validity and Reliability of the Constellation Technique Versus the Sagittal Best Fit Circle Technique

Chen

Fang

Cai

et al. 2022

JOIO

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Objective To propose a new method for glenoid bone loss measurement, the constellation technique (CST); determine its reliability and accuracy; and compare the validity of CST with that of the conventional technique (CVT) and standard measurements for ratio calculation. Materials and Methods Sixty shoulders with intact glenoids and no glenohumeral instability and arthritis underwent CT scans. Simulated osteotomies were conducted on the 3D models of glenoids at two cutting locations, expressed as clock face times (2:30–4:20; 1:30–5:00). Two experienced surgeons compared three methods for glenoid bone loss measurement; CVT (best-fit circle), CST (‘5S’ steps), and standard measurement. Eight undergraduates remeasured five randomly chosen shoulders with moderate to severe bone loss. Intraclass correlation coefficients (ICCs) were calculated for raters. Results With a defect range between 2:30 and 4:20, all 60 glenoids demonstrated minimal bone loss (< 15%); while between 1:30 and 5:00, 42 shoulders were with moderate bone loss (15–20%), and 18 shoulders with severe bone loss (≥ 20%). For experienced raters, no significant differences were noted between protocos for all categories of bone loss ( p ≥ 0.051), with good inter- and intraobserver reliability indicated by ICC. For novice raters, post hoc Tukey analysis found that CST was more accurate in one patient with a standard mean bone loss of 23.2% ± 1.9% compared with CVT. Conclusion The CST turned the key step of glenoid defect evaluation from deciding an en face view to determining the glenoid inferior rim. The protocol is simple, accurate, and reproducible, especially for novice raters.

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Reporting of glenoid bone loss measurement in clinical studies and the need for standardization

Cited by 8 publications

References 54 publications

Management of glenoid bone loss in primary reverse shoulder arthroplasty

Management of glenoid bone loss in primary reverse shoulder arthroplasty

Disagreement Between the Accepted Best-Fit Circle Method to Calculate Bone Loss Between Injured and Uninjured Shoulders

Glenoid Bone Loss Determination: Validity and Reliability of the Constellation Technique Versus the Sagittal Best Fit Circle Technique

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