Functional malcentering of the humeral head and asymmetric long-term stress on the glenoid: Potential reasons for glenoid loosening in total shoulder arthroplasty

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indications for this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

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Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001711011133 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1133-1141 ◽

Cited By ~ 5

Author(s):

T.M. Gregory ◽

B. Boukebous ◽

J. Gregory ◽

J. Pierrart ◽

E. Masemjean

Keyword(s):

Survival Rate ◽

Shoulder Arthroplasty ◽

Inflammatory Arthritis ◽

Total Shoulder Arthroplasty ◽

Dynamic Approach ◽

Term Survival ◽

The Past ◽

Clinical Conditions ◽

Glenoid Loosening

Total shoulder arthroplasty (TSA) is an effective approach for the treatment of a variety of clinical conditions affecting the shoulder, including osteoarthritis, inflammatory arthritis and osteonecrosis, and the number of TSA implanted has grown exponentially over the past decade. This review gives an update of the major complications, mainly infections, instability and loosening, encountered after TSA, based on a corpus of recent publications and a dynamic approach: The review focuses on the causes of glenoid loosening, which account for 80% of the complication, and underlines the importance of glenoid positioning in the recovery of early shouder function and in the long term survival rate of TSA.

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Humeral Head Shape in Native and Prosthetic Joint Replacement

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219848150 ◽

2019 ◽

Vol 3 ◽

pp. 247154921984815

Author(s):

Joseph P Iannotti ◽

Bong Jae Jun ◽

Jason Teplensky ◽

Eric Ricchetti

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Biomechanical Properties ◽

Head Shape ◽

Prosthetic Joint ◽

The Subject ◽

Kinematic Properties

Background Nonspherical prosthetic humeral head designs have become increasingly popular as they better approximate the native shoulder anatomy and biomechanical properties and is supported by the existing literature. It remains to be seen how this will impact postoperative outcomes for total shoulder arthroplasty providing a justification for this review. Methods A review and synthesis of the literature on the subject of joint replacement in the native and prosthetic humeral head was performed. Results Our review encompasses the anatomical, biomechanical, and finite element data present in the literature for native and prosthetic joint replacement. They describe the native humeral head as more elliptical (nonspherical) than circular (spherical) and that nonspherical prosthetics more closely approximate glenohumeral kinematic properties. Conclusion A nonspherical prosthetic may influence long-term clinical outcomes in hemiarthroplasty and anatomic total shoulder arthroplasty though further research in this area is necessary.

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Clinical and Radiological Results of Hemiarthroplasty and Total Shoulder Arthroplasty for Primary Avascular Necrosis of the Humeral Head in Patients Less Than 60 Years Old

Journal of Clinical Medicine ◽

10.3390/jcm10143081 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3081

Author(s):

Anthony Hervé ◽

Mickael Chelli ◽

Pascal Boileau ◽

Gilles Walch ◽

Luc Favard ◽

...

Keyword(s):

Clinical Outcomes ◽

Avascular Necrosis ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Revision Rate ◽

Total Shoulder Arthroplasty ◽

Young Patients ◽

Clinical And Radiological Results ◽

Glenoid Loosening

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes of shoulder arthroplasty in young patients with PANHH. Methods: One hundred and twenty-seven patients aged under 60 years old and suffering from PANHH were operated with arthroplasty. Patients were assessed clinically and radiographically before surgery with a minimum of 2 years of follow up (FU). Results: HA was performed on 108 patients (85%). Two patients were revised for painful glenoid wear after 2 and 4 years. TSA was performed on 19 patients (15%). Five TSA had to be revised for glenoid loosening (n = 4) or instability (n = 1). Revision rate was 26% with TSA and 2% with HA. There were no significant differences between HA and TSA in terms of clinical outcomes. Conclusions: With a mean FU of 8 years, HA and TSA improved clinical outcomes of patients with PANHH. HA revisions for painful glenoid wear were rare (2%). The revision rate was excessively high with TSA (26%).

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Static posterior humeral head subluxation and total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2009.03.003 ◽

2009 ◽

Vol 18 (4) ◽

pp. 505-510 ◽

Cited By ~ 106

Author(s):

Christian Gerber ◽

John G. Costouros ◽

Atul Sukthankar ◽

Sandro F. Fucentese

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty

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Journey of the glenoid in anatomic total shoulder replacement

Shoulder & Elbow ◽

10.1177/1758573218790119 ◽

2018 ◽

Vol 11 (2) ◽

pp. 140-148 ◽

Cited By ~ 4

Author(s):

Alessandro Castagna ◽

Raffaele Garofalo

Keyword(s):

Shoulder Arthroplasty ◽

Current Practice ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Patient Specific ◽

Glenoid Component ◽

Shoulder Replacement ◽

Final Destination ◽

Component Loosening

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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