The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement

Williams, Gerald R.; Wong, Kirk L.; Pepe, Matthew D.; Tan, Virak; Silverberg, David; Ramsey, Matthew L.; Karduna, Andrew R.; Iannotti, Joseph P.

doi:10.1067/mse.2001.116871

Cited by 144 publications

(73 citation statements)

References 20 publications

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“…Therefore the centre of rotation is within 4 mm; the maximum range of tolerance defined by other groups [17,24]. When comparing postoperative centre of rotation to the original position, Pearl et al reported values of 14.7 mm and 2.1 mm for second-and third-generation prostheses, respectively [17,19,20].…”

Section: Discussionmentioning

confidence: 91%

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Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis

Irlenbusch

End

Kılıç

2010

International Orthopaedics (SICOT)

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Reconstruction of the anatomy of the proximal humerus is a prerequisite to achieving good long-term clinical results after shoulder arthroplasty. Modern, adjustable prostheses have greater flexibility of inclination, retroversion, and medial and dorsal offset in comparison with older prostheses. Such improvements should allow for better reconstruction of the centre of rotation compared to older prostheses. Reconstruction of the humeral head centre was assessed in 106 modern adjustable (Affinis) and 47 second-generation prostheses. All reconstructions were compared both to the preoperative state and the unoperated shoulder. To describe the pre-and postoperative states, the geometry and position of the humeral head in relation to the glenoid were analysed on patient radiographs. Applying the defined parameters, modern adjustable prostheses showed better reconstruction than second generation prostheses. Parameter values measured in reconstructions using fourth generation prostheses were comparable to those of the unoperated shoulder, but differed significantly from the preoperative state. Second generation prostheses, in contrast, only show non-specific differences in parameter values. This suggests that an approximate reconstruction of normal anatomy can be achieved using a modern fourth generation prosthesis. Reconstruction of the complex anatomy of the proximal humerus is significantly better with modern adjustable prostheses compared to second generation prostheses. Improved clinical outcome can therefore be predicted in a functional and intact rotator cuff. The advantage of using modern prostheses systems over older models is clearly demonstrated in this study. IntroductionThe anatomy of the proximal humerus can vary with respect to inclination, retrotorsion and the medial and dorsal offsets (the offset of the centre of rotation in relation to the humeral axis) [1,6,9,14,17,20,21]. Due to this, many groups call for this anatomy to be repaired as precisely as possible when implanting a humeral prosthesis in order to achieve optimal postoperative joint function [1,4,5,7,8,10,13,15,16,18,20,22,23]. Others go further and insist on reconstruction of the centre of rotation specifically [17].In many cases of osteoarthritis, flattening of the humeral head can be identified (Fig. 1a, b), resulting in conditional lateral displacement of the centre of rotation in relation to shaft axis but causing a medial shift of the of the rotational centre in relation to the glenoid. Other patients show a primary osteoarthritis with no significant deformation of the humeral head (Fig. 1c). The technical demands for reconstruction of the rotational centre differ considerably in both cases.Modern prostheses allow adaptation to both the primary and also pathologically altered secondary anatomy. These prostheses generally allow eccentric adjustment of the prosthesis head in relation to the shaft. Some also feature variable, adjustable inclination.In order to reconstruct a shoulder as closely as possible to the contralateral side...

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Section: Discussionmentioning

confidence: 91%

“…It is not yet clear if better adaptation leads to longer prosthesis survival [17,18]. It has however been shown that range of movement can be improved and the danger of subacromial impingement is reduced [15,24,25]. Exact reconstruction of the centre of rotation is also important for normal function of the rotator cuff muscles [15,16].…”

Section: Discussionmentioning

confidence: 99%

Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis

Irlenbusch

End

Kılıç

2010

International Orthopaedics (SICOT)

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“…23 In order to minimise glenoid erosion, it is suggested that one should not overstuff the joint and that the rotator cuff integrity and the humeral centre of rotation should be restored. 7 In a biomechanical cadaver study, Hammond et al 24 compared resurfacing with third generation stemmed hemiarthroplasty in various functional positions.…”

Section: Component Offset and Versionmentioning

confidence: 99%

Technical difficulty in component sizing and positioning in humeral resurfacing: Relationship to clinical outcomes

et al. 2015

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Introduction: Resurfacing of the glenohumeral joint has gained popularity since its first introduction. Among other advantages, it is reported to allow closer replication of individual anatomy -failure of which may produce inferior clinical results. We review a cohort of patients who had undergone proximal humeral resurfacing, to evaluate certain radiological parameters of component sizing and positioning, and to correlate these with the clinical outcomes.

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“…However, replacement of the glenoid component remains the weak link in total shoulder arthroplasty and is a common cause of revision surgery [1]. Positioning of the glenoid component is challenging due to the difficult surgical exposure and intra-operative visualization (Figure 1), as well as the lack of accessible anatomical reference landmarks [2]. Other challenges include the poor bone stock and the high variability in orientation secondary to eccentric wear from arthritis.…”

Section: Introductionmentioning

confidence: 99%

Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery

Nguyen

Ferreira

Brownhill

et al. 2007

Computer Aided Surgery

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Objective: Replacement of the diseased shoulder joint with implants is a procedure whose frequency is rapidly increasing. However, glenoid replacement remains challenging due to the difficult joint exposure and visualization of anatomical reference landmarks during the procedure. Improper positioning of the glenoid component can lead to early failure. The objective of this study was to develop and evaluate a Computer Assisted Glenoid Implantation (CAGI) technique to achieve a more accurate and reliable placement of the glenoid component. Materials and Methods: Twenty cadaveric scapulae were imaged with CT. The accuracy of an electromagnetic tracking system and 3D surface modeling for the measurement of glenoid position was compared to that of the standard CT-based method. Custom jigs were then developed to track instruments and to correct for scapular motion during in vitro trials. A standardized protocol for determining, in real time, the glenoid position and placement was developed and validated. Results: The version angles measured by the tracking system, CT, and the 3D modeling software were 0.0 AE 1.2 , -1.3 AE 1.0 , and -1.1 AE 1.1 , respectively. The magnitudes for inclination angles were 0.7 AE 0.7 , 0.9 AE 0.8 , and 1.0 AE 0.7 , respectively. A statistically significant difference was found only between measurements made with the tracking system and with CT (p < 0.05). Testing of the CAGI system in a cadaveric trial resulted in an accuracy of 1.17 of version and 0.60 of inclination. The procedure was readily performed with excellent feedback and guidance for the surgeon. Conclusions: Preoperative planning using CT imaging with 3D modeling and intraoperative tracking were combined to produce improved accuracy and reliability of glenoid implantation in the setting of total shoulder arthroplasty.

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The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement

Cited by 144 publications

References 20 publications

Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis

Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis

Technical difficulty in component sizing and positioning in humeral resurfacing: Relationship to clinical outcomes

Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery

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