The effect of radial mismatch on radiographic glenoid loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

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Effect of Implant Shape and Material Properties on Stresses in the Glenoid Components of Total Shoulder Arthroplasties: A Finite Element Analysis

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19494 ◽

2010 ◽

Cited By ~ 2

Author(s):

Jingzhou Zhang ◽

Charlie Yongpravat ◽

Marc D. Dyrszka ◽

William N. Levine ◽

Thomas R. Gardner ◽

...

Keyword(s):

Humeral Head ◽

Glenohumeral Joint ◽

Total Shoulder Arthroplasty ◽

Peak Stress ◽

Glenoid Component ◽

Joint Stability ◽

Element Analysis ◽

Total Shoulder Arthroplasties ◽

Shoulder Arthroplasties ◽

Glenoid Loosening

The geometry of the glenohumeral joint is osseous, naturally nonconforming and minimally constrained, thus the essential requirement of a glenohumeral prosthesis in total shoulder arthroplasty (TSA) is prevention of joint degeneration and glenoid loosening. A variety of glenoid prostheses have been developed. Nonconforming glenohumeral implants are common for TSA. However, the nonconforming shape increases the instability when the humeral head is in the central region, where motion frequently occurs. Conforming implants can increase joint stability, but the “rocking-horse” effect [1] caused by the conforming shape is thought to lead to high stresses and moments at the glenoid rim when the humeral head approaches the periphery during its range of motion. The hybrid design, with a conforming center and a nonconforming periphery, combines the advantages of both nonconforming and conforming implant geometries. It has been shown [2] that the peak stress generated in glenoid components during activities of daily living can be as high as 25 MPa, which exceeds the polyethylene yield strength of the glenoid component and can lead to wear and cold flow of the component. Polyethylene has also been shown to be viscoelastic [3]. Therefore, both elastic-plastic and viscoelastic-plastic models of the glenoid implant were used to determine how viscoelasticity affected stress in the implant. The effects of implant shape on the stresses in the center, transition, and superior zones for the three different glenoid implant shapes, as well as on the stress in the underlying cement and bone, were determined in this study.

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Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.05.021 ◽

2012 ◽

Vol 21 (3) ◽

pp. 342-349 ◽

Cited By ~ 116

Author(s):

Barbara Melis ◽

Nicolas Bonnevialle ◽

Lionel Neyton ◽

Christophe Lévigne ◽

Luc Favard ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Loosening

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Test Methods for Dynamic Evaluation of Glenoid Loosening or Disassociation

10.1520/f2028-02 ◽

2002 ◽

Author(s):

Keyword(s):

Test Methods ◽

Dynamic Evaluation ◽

Glenoid Loosening

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Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-022-00625-y ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Hyojune Kim ◽

Chul-Ho Kim ◽

Minsoo Kim ◽

Wonsun Lee ◽

In-Ho Jeon ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Revision Rate ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Functional Scores ◽

Reverse Total Shoulder ◽

Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

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