Revision of Humeral Head and Total Shoulder Arthroplasties

1982 ◽  
Vol &NA; (170) ◽  
pp. 189???195 ◽  
Author(s):  
CHARLES S. NEER ◽  
RICHARD M. KIRBY
Author(s):  
Jingzhou Zhang ◽  
Charlie Yongpravat ◽  
Marc D. Dyrszka ◽  
William N. Levine ◽  
Thomas R. Gardner ◽  
...  

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.


2020 ◽  
pp. 175857322091765
Author(s):  
Betty Zhang ◽  
Gavinn Niroopan ◽  
Chetan Gohal ◽  
Bashar Alolabi ◽  
Timothy Leroux ◽  
...  

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV


2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.


2014 ◽  
Vol 23 (2) ◽  
pp. 166-172 ◽  
Author(s):  
David Walker ◽  
Thomas W. Wright ◽  
Scott A. Banks ◽  
Aimee M. Struk

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Johannes A. Eckert ◽  
Ulrike Mueller ◽  
Sebastian Jaeger ◽  
Benjamin Panzram ◽  
J. Philippe Kretzer

Tribocorrosion in taper junctions of retrieved anatomic shoulder arthroplasty implants was evaluated. A comparison of the tribocorrosion between cobalt-chromium and titanium alloy stems was conducted and the observations were correlated with the individual’s clinical data. Adverse effects caused by metal debris and subsequent elevated serum metal ion levels are frequently reported in total hip arthroplasty. In total shoulder arthroplasty, to date only a small number of retrieval analyses are available and even fewer address the issue of tribocorrosion at the taper junctions. A total of 36 retrieved hemiarthroplasties and total shoulder arthroplasties were assessed using the modified Goldberg score. The prevalence of fretting and corrosion was confirmed in this cohort. Titanium stems seem to be more susceptible to damage caused by tribocorrosion than cobalt-chromium stems. Furthermore, stemless designs offered less tribocorrosion at the taper junction than stemmed designs. A weak correlation between time to revision and increased levels of tribocorrosion was seen. Whether or not tribocorrosion can lead to adverse clinical reactions and causes failure of shoulder arthroplasties remains to be examined.


2019 ◽  
Vol 11 (3) ◽  
pp. 316 ◽  
Author(s):  
Ryan Matthew Cox ◽  
Tyler James Brolin ◽  
Eric Michael Padegimas ◽  
Mark David Lazarus ◽  
Charles Lonnie Getz ◽  
...  

2018 ◽  
Vol 2 ◽  
pp. 247154921775047
Author(s):  
Joaquin Sanchez-Sotelo ◽  
Ngoc Tram V Nguyen ◽  
Mark Morrey

Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.


2019 ◽  
Vol 3 ◽  
pp. 247154921984483
Author(s):  
Eric S Baranek ◽  
David P Trofa ◽  
William N Levine ◽  
Steven S Goldberg

Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.


2021 ◽  
Vol 3 ◽  
pp. 24-29
Author(s):  
Matthew Sarvesvaran ◽  
Siddharth Thaker ◽  
Suresh Srinivasan ◽  
Rahatdeep Singh Brar ◽  
Raj Bhatt ◽  
...  

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.


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