The effects of glenoid wear patterns on patients with osteoarthritis in total shoulder arthroplasty: an assessment of outcomes and value

Hussey, Michael M.; Steen, Brandon; Cusick, Michael; Cox, Jacob L.; Marberry, Scott T.; Simon, Péter; Cottrell, Benjamin J.; Santoni, Brandon G.; Frankle, Mark A.

doi:10.1016/j.jse.2014.09.043

Cited by 51 publications

(27 citation statements)

References 31 publications

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“…In contrast to the findings in some prior studies [13,14,30,31,56,60], preoperative radiographic glenoid retroversion, glenoid biconcavity, and posterior decentering of the humeral head on the glenoid were not associated with worse outcomes in our patients. This may be because the surgical techniques used were effective in managing the potentially adverse effects of these pathoanatomic factors [29].…”

Section: Discussioncontrasting

confidence: 99%

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Matsen

Russ

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. Questions/Purposes We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? Methods Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a ''better'' outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. Results After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p \ 0.001), lower baseline Simple Shoulder Test score (OR, 1.32; 95% CI, 1.23-1.42; p \ 0.001), no prior shoulder surgery (OR, 1.79; 95% CI, 1.18-2.70; p = 0.006), humeral head not superiorly displaced on the AP radiograph (OR, 2.14; 95% CI, 1.15-4.02; p = Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. OR, 4.47; 95% CI,; p \ 0.001). Neither preoperative glenoid version nor posterior decentering of the humeral head on the glenoid were associated with the outcomes. The model predictive of a better result was driven mainly by the six factors listed above. The area under the receiver operating characteristic curve generated from the crossvalidated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as a better outcome). A cutoff probability of 0.68 yielded the best performance of the model with cross-validation predictions of better outcomes for 236 patients (80%) and worse outcomes for 58 patients (20%); sensitivity of 91% (95% CI, 88%-95%); specificity of ...

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Section: Discussioncontrasting

confidence: 99%

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Matsen

Russ

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Their clinical results were similar in both groups, but eccentric glenoids demonstrated a more than 2-fold increase in component loosening. In comparison, our study showed no clinically relevant glenoid loosening regardless of the preoperative glenoid morphology, and the mean VAS-Pain in our patients was half of those reported by Hussey et al 22 (Table IV). Greiner et al 13 studied the influence of the Walch glenoid type on the clinical and radiographic results of 113 glenoids in stemmed TSA.…”

Section: Discussioncontrasting

confidence: 46%

“…To the best of our knowledge, no glenoid stage–specific investigations have been reported using stemless or onlay resurfacing implants. Hussey et al 22 reported the clinical and radiographic results of 344 shoulders in 309 patients treated with a stemmed, modular total shoulder system for primary GH OA and assessed outcomes of concentric and eccentric preoperative glenoid wear patterns. Their clinical results were similar in both groups, but eccentric glenoids demonstrated a more than 2-fold increase in component loosening.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies reconfirmed these findings after stemmed TSA in patients with glenoid erosion reporting a periprosthetic radiolucency rate ranging from 21% to 48% 8, 33, 43Table IVLiterature comparison of concentric and eccentric glenoid morphologyHussey 2015∗Current study†ConcentricEccentricConcentricEccentricFollow-up (mo)49.252.336.744.3Age, mean (range) (yr)67.0 (37-88)66.0 (42-82)56.9 (47-68)59.0 (42-71)FF (°) (mean ± SD)Preoperative87.9 ± 36.896.6 ± 35.7118.6 ± 30.2113.2 ± 38.9Postoperative155.8 ± 31.5156.7 ± 33.0168.6 ± 9.0167.0 ± 13.9ER (°) (mean ± SD)Preoperative21.0 ± 25.522.4 ± 23.420.0 ± 24.015.3 ± 19.1Postoperative58.9 ± 37.759.0 ± 27.059.3 ± 14.855.7 ± 18.2VAS-Pain/10 (mean ± SD)1.7 ± 2.72.2 ± 2.70.3 ± 0.81.1 ± 1.3PRO (mean)ASES (80.8 ± 20.8)ASES (77.6 ± 21.2)Penn Total Score (86.9 ± 12.3)Penn Total Score (87.1 ± 12.9)Revision (%)2200Glenoid loosening (%)5.612.200 FF , forward flexion; SD , standard deviation; ER , external rotation; VAS , visual analog scale; PRO, patient-reported outcomes; ASES , American Shoulder and Elbow Surgeons.VAS-Pain and PRO = Postoperative only.Endpoint reporting was aligned according to Hussey et al 22 ∗Foundation/Turon Total Shoulder System (DJO Global, Vista, CA, USA)†Hem...…”

Section: Discussionmentioning

confidence: 99%

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Total shoulder arthroplasty with nonspherical humeral head and inlay glenoid replacement: clinical results comparing concentric and nonconcentric glenoid stages in primary shoulder arthritis

et al. 2019

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BackgroundGlenoid morphology can influence the outcomes of total shoulder arthroplasty. This study examines the results of a new technique according to preoperative glenoid staging. We hypothesized that there would be no statistically significant difference in outcomes between Levine concentric (Walch A) and Levine nonconcentric (Walch B) glenoids treated for primary glenohumeral arthritis using nonspherical humeral head and inlay glenoid replacement.MethodsThis retrospective case series included 31 shoulders in 29 patients (25 male, 4 female), with an average age of 58.5 years. Outcomes included the Penn Shoulder Score (PSS), visual analog scale for pain (VAS-Pain), range of motion, radiographic analysis, and complications. Inclusion criteria were primary glenohumeral arthritis, intact rotator cuff, and no prior open shoulder surgeries.ResultsMean follow-up was 42.6 months (range, 24-74 months). The study included 7 concentric and 24 nonconcentric glenoids. Outcomes comparison showed no statistically significant differences in PSS domains including Pain (P = .92), Function (P = .98), Satisfaction (P = .89), and Total (P = .98); forward flexion (P = .78); external rotation (P = .64); and VAS-Pain (P = 0.12). At the last follow-up, the mean PSS Pain was 25.3/30, Function 52.7/60, Satisfaction 8.4/10, and Total 87.0/100. The mean forward flexion was 167.3°, external rotation 56.6°, and VAS-Pain 0.9. There were no signs of periprosthetic fracture, component loosening, osteolysis, and hardware failure, and no revisions or 90-day rehospitalizations were required. One patient was prophylactically treated with oral antibiotics for a history of prior infection and 1 patient required a later open biceps tenodesis after a traumatic proximal biceps rupture postoperatively.ConclusionNonspherical shoulder arthroplasty with inlay glenoid replacement demonstrated excellent clinical benefits for both concentric and nonconcentric glenoids. The technique appears to be a promising option for glenohumeral arthritis even in the presence of posterior glenoid erosion.

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“…The complication rate among our group was 5.2%, with a component revision rate of 2.6%, in line with prior reports. 4 , 14 Further long-term follow-up is warranted to monitor if adverse outcomes are noted because of increased risk of component wear or loosening.…”

Section: Discussionmentioning

confidence: 99%

Do glenoid retroversion and humeral subluxation affect outcomes following total shoulder arthroplasty?

Benjamin¹,

Xiao²,

Salesky³

et al. 2020

JSES International

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Background Glenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). There are limited data to support this suggestion. We investigated whether preoperative glenoid retroversion and humeral head subluxation are associated with inferior outcomes after TSA and whether change of retroversion influences outcomes after TSA. Methods Patients undergoing TSA with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. Retroversion and humeral head subluxation before and after surgery were measured on axillary radiographs. Postoperative radiographs were -evaluated for glenoid component loosening and compared between groups. Spearman correlations were determined between retroversion measurements and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Patients were analyzed in groups based on retroversion and humeral head subluxation. Results There were 113 patients (50% follow-up rate) evaluated at 4.2 years postoperatively. The mean preoperative retroversion (15.3° ± 7.7°) was significantly higher than postoperative retroversion (10.0° ± 6.8°; P < .0001). There was no correlation between postoperative glenoid version or humeral head subluxation and ASES scores. For patients with preoperative retroversion of >15°, there was no difference in outcome scores based on postoperative retroversion. There were no differences in preoperative or postoperative version for patients with or without glenoid lucencies. Discussion We observed no significant relationship between postoperative glenoid retroversion or humeral head subluxation and clinical outcomes in patients following TSA. For patients with preoperative retroversion >15°, change of retroversion during TSA had no impact on their clinical outcomes at short-term follow-up.

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The effects of glenoid wear patterns on patients with osteoarthritis in total shoulder arthroplasty: an assessment of outcomes and value

Cited by 51 publications

References 31 publications

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Total shoulder arthroplasty with nonspherical humeral head and inlay glenoid replacement: clinical results comparing concentric and nonconcentric glenoid stages in primary shoulder arthritis

Do glenoid retroversion and humeral subluxation affect outcomes following total shoulder arthroplasty?

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