Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study

Cheng, Xiang; Reddy, Akhil; Kontaxis, Andreas; Choi, Daniel; Wright, Timothy M.; Dines, David M.; Warren, Russell F.; Berhouet, Julien; Gulotta, Lawrence V.

doi:10.1007/s11999-017-5510-7

Cited by 28 publications

(27 citation statements)

References 29 publications

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“…Chevalier et al used micro finite element models based on micro-CT scans of cadaveric scapulae to evaluate the influence of bone volume fraction, trabecular anisotropy and cortical thickness on stress within the periprosthetic bone and cement mantle [ 19 ]. In a further computational study, Chen et al measured the glenoid BMD in HU after simulated eccentric reaming for version correction of Walch B2 glenoids [ 18 ]. They analyzed BMD in five adjacent 1-mm layers under the reamed glenoid surface, and concluded that increased version correction resulted in gradual depletion of high-quality bone from the anterior regions of B2 glenoids.…”

Section: Discussionmentioning

confidence: 99%

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

Mariaux

Obrist

Farron

et al. 2021

BMC Musculoskelet Disord

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Background Aseptic loosening of glenoid implants is the primary revision cause in anatomic total shoulder arthroplasty (aTSA). While supported by biomechanical studies, the impact of glenoid bone quality, more specifically bone mineral density (BMD), on aseptic glenoid loosening remains unclear. We hypothesized that lower preoperative glenoid BMD was associated with aseptic glenoid implant loosening in aTSA. Methods We retrospectively included 93 patients (69 females and 24 males; mean age, 69.2 years) who underwent preoperative non-arthrographic shoulder computed tomography (CT) scans and aTSA between 2002 and 2014. Preoperative glenoid BMD (CT numbers in Hounsfield unit) was measured in 3D using a reliable semi-automated quantitative method, in the following six contiguous volumes of interest (VOI): cortical, subchondral cortical plate (SC), subchondral trabecular, and three successive adjacent layers of trabecular bone. Univariate Cox regression was used to estimate the impact of preoperative glenoid BMD on aseptic glenoid implant loosening. We further compared 26 aseptic glenoid loosening patients with 56 matched control patients. Results Glenoid implant survival rates were 89% (95% confidence interval CI, 81–96%) and 57% (41–74%) at 5 and 10 years, respectively. Hazard ratios for the different glenoid VOIs ranged between 0.998 and 1.004 (95% CI [0.996, 1.007], p≥0.121). Only the SC VOI showed significantly lower CTn in the loosening group (622±104 HU) compared with the control group (658±88 HU) (p=0.048), though with a medium effect size (d=0.42). There were no significant differences in preoperative glenoid BMD in any other VOI between patients from the loosening and control groups. Conclusions Although the preoperative glenoid BMD was statistically significantly lower in the SC region of patients with aseptic glenoid implant loosening compared with controls, this single-VOI difference was only moderate. We are thus unable to prove that lower preoperative glenoid BMD is clearly associated with aseptic glenoid implant loosening in aTSA. However, due to its proven biomechanical role in glenoid implant survival, we recommend extending this study to larger CT datasets to further assess and better understand the impact of preoperative glenoid BMD on glenoid implant loosening/survival and aTSA outcome.

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Section: Discussionmentioning

confidence: 99%

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

Mariaux

Obrist

Farron

et al. 2021

BMC Musculoskelet Disord

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“…However, 10° and higher of version correction resulted in a significant loss of quality of glenoid bone, specifically in the anterior region. 56 These results indicate that other options are needed to address bone deficiency and restore joint line in such situations. Some authors proposed use of humeral head autograft with all-poly glenoid to correct this retroversion.…”

Section: Metal-backed Glenoid (Mbg)mentioning

confidence: 98%

Journey of the glenoid in anatomic total shoulder replacement

Castagna

Garofalo

2018

Shoulder & Elbow

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Anatomic total shoulder arthroplasty (TSR) has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. Many studies have reported that the glenoid component loosening and failure remain the most common long-term complication of total shoulder arthroplasty. The approach to glenoid component is critical because a surgeon should consider patient-specific anatomy, preserving bone stock and joint line restoration, for a good and durable shoulder function. Over the years, different glenoid design and materials have been tried in various configurations. These include cemented polyethylene, uncemented metal-backed and hybrid implants. Although advances in biomechanics, design and tribology have improved our understanding of the glenoid, the journey of the glenoid component in anatomic total shoulder arthroplasty has not yet reached its final destination. This article attempts to describe the evolution of the glenoid component in anatomic TSR and current practice.

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“…To our knowledge, our study is the rst to quantitatively assess the impact of preoperative glenoid BMD in 3D on glenoid implant survivalmore speci cally aseptic glenoid looseningin aTSA. Most previous studies have evaluated the quality of the glenoid bone support using CT datasets (either micro-or conventional CT), but only few have correlated their ndings with clinical and radiological outcomes [17][18][19]22]. Our semi-automated quantitative measurement method based on a computerized 3D scapular reconstruction model has proven its reliability and already helped improving glenoid implant positioning [43].…”

Section: Discussionmentioning

confidence: 99%

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

Mariaux

Obrist

Farron

et al. 2020

Preprint

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Background: Aseptic loosening of glenoid implants is the primary revision cause in anatomic total shoulder arthroplasty (aTSA). While supported by biomechanical studies, the impact of glenoid bone quality, more specifically bone mineral density (BMD), on aseptic glenoid loosening remains unclear. We hypothesized that lower preoperative glenoid BMD was associated with aseptic glenoid implant loosening in aTSA.Methods: We retrospectively included 93 patients (69 females and 24 males; mean age, 69.2 years) who underwent preoperative non-arthrographic shoulder computed tomography (CT) scans and aTSA between 2002 and 2014. Preoperative glenoid BMD (CT numbers in Hounsfield unit) was measured in 3D using a reliable semi-automated quantitative method, in the following six contiguous volumes of interest (VOI): cortical, subchondral cortical plate (SC), subchondral trabecular, and three successive adjacent layers of trabecular bone. Univariate Cox regression was used to estimate the impact of preoperative glenoid BMD on aseptic glenoid implant loosening. We further compared 26 aseptic glenoid loosening patients with 56 matched control patients.Results: Glenoid implant survival rates were 89% (95% confidence interval CI, 81%-96%) and 57% (41%-74%) at 5 and 10 years, respectively. Hazard ratios for the different glenoid VOIs ranged between 0.998 and 1.004 (95% CI [0.996, 1.007], p≥0.121). Only the SC VOI showed significantly lower CTn in the loosening group (622±104 HU) compared with the control group (658±88 HU) (p=0.048), though with a medium effect size (d=0.42). There were no significant differences in preoperative glenoid BMD in any other VOI between patients from the loosening and control groups.Conclusions: Although the preoperative glenoid BMD was statistically significantly lower in the SC region of patients with aseptic glenoid implant loosening compared with controls, this single-VOI difference was only moderate. We are thus unable to prove that lower preoperative glenoid BMD is clearly associated with aseptic glenoid implant loosening in aTSA. However, due to its proven biomechanical role in glenoid implant survival, we recommend extending this study to larger CT datasets to further assess and better understand the impact of preoperative glenoid BMD on glenoid implant loosening/survival and aTSA outcome.Trial registration: Retrospectively registered

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Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study

Cited by 28 publications

References 29 publications

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

Journey of the glenoid in anatomic total shoulder replacement

Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

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