Journal article
Reduction of scapulohumeral subluxation with posterior augmented glenoid implants in anatomic total shoulder arthroplasty: Short-term 3D comparison between pre- and post-operative CT.
- Terrier A Laboratory of Biomechanical Orthopedics, École Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland. Electronic address: alexandre.terrier@epfl.ch.
- Goetti P Service of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, 4, avenue Pierre-Decker, 1005 Lausanne, Switzerland.
- Becce F Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland.
- Farron A Service of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, 4, avenue Pierre-Decker, 1005 Lausanne, Switzerland.
- 2020-04-15
Published in:
- Orthopaedics & traumatology, surgery & research : OTSR. - 2020
Anatomic total shoulder arthroplasty
Glenoid version
Patient-specific instrumentation
Posterior augmented glenoid implant
Scapulohumeral subluxation
English
BACKGROUND
Failure rates in anatomic total shoulder arthroplasty (aTSA) are higher in case of asymmetric glenoid bone loss secondary to posterior wear, and in persistent static posterior subluxation of the humeral head (PSH).
HYPOTHESIS
This study aimed to test the hypothesis that the combined use of posterior augmented glenoid (PAG) implants with three-dimensional (3D) surgical planning and patient-specific instrumentation (PSI) guides helps reduce short-term PSH after aTSA in patients with type B2-B3 glenoids.
PATIENTS AND METHODS
We included nine consecutive patients with primary glenohumeral osteoarthritis and type B2 or B3 glenoids, who underwent aTSA with cemented keeled PAG implants (posterior augments of 15, 25, or 35 degrees). All patients underwent preoperative shoulder computed tomography (CT) scans, with 3D surgical planning coupled to PSI at the time of surgery. Postoperative shoulder CT scans were performed at an average of 14 weeks (range, 10-21 weeks). Scapulohumeral subluxation and glenoid version and inclination were measured in 3D, on both pre- and post-operative CT scans, using the same reliable quantitative method.
RESULTS
There was a significant decrease in scapulohumeral subluxation from 49±12% preoperatively to 22±17% postoperatively (p=0.0039), with a large effect size (Cohen's d=1.89). Preoperative glenoid version was corrected from -17.3±9.4 degrees to -5.2±7.5 degrees postoperatively. The absolute difference between the postoperative and surgically planned version and inclination was 5.4±3.6 degrees and 3.3±2.0 degrees, respectively.
DISCUSSION
The combined use of PAG implants with 3D preoperative planning and PSI results in a significant decrease in short-term PSH and glenoid version in patients with asymmetric posterior glenoid wear. We suggest that such implants should not be limited to posterior augmentation, because glenoid deficiency can also be observed in other glenoid sectors.
LEVEL OF EVIDENCE
IV, Basic science study.
Failure rates in anatomic total shoulder arthroplasty (aTSA) are higher in case of asymmetric glenoid bone loss secondary to posterior wear, and in persistent static posterior subluxation of the humeral head (PSH).
HYPOTHESIS
This study aimed to test the hypothesis that the combined use of posterior augmented glenoid (PAG) implants with three-dimensional (3D) surgical planning and patient-specific instrumentation (PSI) guides helps reduce short-term PSH after aTSA in patients with type B2-B3 glenoids.
PATIENTS AND METHODS
We included nine consecutive patients with primary glenohumeral osteoarthritis and type B2 or B3 glenoids, who underwent aTSA with cemented keeled PAG implants (posterior augments of 15, 25, or 35 degrees). All patients underwent preoperative shoulder computed tomography (CT) scans, with 3D surgical planning coupled to PSI at the time of surgery. Postoperative shoulder CT scans were performed at an average of 14 weeks (range, 10-21 weeks). Scapulohumeral subluxation and glenoid version and inclination were measured in 3D, on both pre- and post-operative CT scans, using the same reliable quantitative method.
RESULTS
There was a significant decrease in scapulohumeral subluxation from 49±12% preoperatively to 22±17% postoperatively (p=0.0039), with a large effect size (Cohen's d=1.89). Preoperative glenoid version was corrected from -17.3±9.4 degrees to -5.2±7.5 degrees postoperatively. The absolute difference between the postoperative and surgically planned version and inclination was 5.4±3.6 degrees and 3.3±2.0 degrees, respectively.
DISCUSSION
The combined use of PAG implants with 3D preoperative planning and PSI results in a significant decrease in short-term PSH and glenoid version in patients with asymmetric posterior glenoid wear. We suggest that such implants should not be limited to posterior augmentation, because glenoid deficiency can also be observed in other glenoid sectors.
LEVEL OF EVIDENCE
IV, Basic science study.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.otsr.2020.03.007
- PMID 32284278
- Persistent URL
- https://sonar.ch/global/documents/83083
Statistics
Document views: 17
File downloads: