scholarly journals Determination of humeral inclination in stemless shoulder arthroplasty using plain radiographs

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Sascha Beck ◽  
Robert J. Martin ◽  
Theodor Patsalis ◽  
Manuel Burggraf ◽  
André Busch ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Plain Radiograph ◽  
Plain Radiographs ◽  
Neck Shaft Angle ◽  
Mathematical Algorithm ◽  
Humeral Component ◽  
Stemless Shoulder Arthroplasty ◽  
The Impact

Plain radiographs of the shoulder are routinely used to assess implant orientation after shoulder arthroplasty. Recently, humeral inclination has come into focus especially in reverse stemless shoulder arthroplasty. But, in X-ray projections not exactly parallel to the base of the humeral component, the humeral inclination angle cannot be determined precisely. Therefore, we established a mathematical algorithm to calculate the humeral neck shaft angle and counterchecked the formula using plain radiographs of a sawbone model containing a humeral head prosthesis. With increasing angles of retroversion, the base of the humeral component forms an ellipse in plain radiographs. Knowing the width and length of the ellipse as well as the inclination angle in a plain radiograph, the exact inclination angle can be determined using the equation reported below. Thus, independent from the viewing angle or angle of retroversion, the inclination angle of a stemless humeral head implant can be estimated with an accuracy of ±1.5-degree deviation. The algorithm proposed may be the basis for further research on the impact of humeral inclination in stemless shoulder arthroplasty.

scholarly journals Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty

2019 ◽  
Vol 8 (8) ◽  
pp. 378-386 ◽  
Author(s):  
Alexandre Lädermann ◽  
Eileen Tay ◽  
Philippe Collin ◽  
Sébastien Piotton ◽  
Chih-Hao Chiu ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Subacromial Space ◽  
Range Of Movement ◽  
Neck Shaft Angle ◽  
Critical Shoulder Angle ◽  
Flexion Extension ◽  
The Impact ◽  
Shoulder Angle

Objectives To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. Methods 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction. Results CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°. Conclusion Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations. Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378–386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.

scholarly journals Anatomic humeral head replacement with a press-fit prosthesis: An in vivo radiographic study

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Bryan Vopat ◽  
Jeremy Truntzer ◽  
Daniel Aaron ◽  
Jack Anavian ◽  
Joel Schwartz ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Total Shoulder Arthroplasty ◽  
Anatomic Reconstruction ◽  
Implant Design ◽  
Design Parameters ◽  
Press Fit ◽  
Humeral Component ◽  
Glenohumeral Osteoarthritis ◽  
The Mean

Successful total shoulder arthroplasty is, in part, dependent on anatomic reconstruction of the glenohumeral joint. The purpose of this study was to evaluate the post-operative anatomy of total shoulder arthroplasty with an anatomic implant design in patients with primary glenohumeral osteoarthritis and compare it to published normative anatomic measurements. Fifty-one patients (56 shoulders) with primary glenohumeral osteoarthritis were treated with a press-fit humeral component as part of a total shoulder arthroplasty (Aequalis, Tornier, Edina, Minnesota). Analysis of postoperative true anterior posterior radiographs was performed with use of a custom software algorithm. The mean humeral inclination (head-shaft angle), mean humeral implant anatomical humeral axis, mean greater tuberosity height, and mean humeral head center offset (medial offset) were 135.4±5.1°, 1.73±1.7°, 6.9±2.4 mm, and 3.8±1.8 mm, respectively. All parameters were within the ranges reported in the literature for normal shoulders except the mean humeral head center offset, which was less than reported in the literature. Anatomic parameters of a total shoulder arthroplasty can be achieved with an anatomically designed, modular adaptable press-fit design. Reduced medial humeral head center offset was likely dependent upon implant specific design parameters.

scholarly journals 3D-Analysis of the Proximal Humeral Anatomy before and after Stemless Shoulder Arthroplasty—A Prospective Case Series Study

2021 ◽  
Vol 10 (2) ◽  
pp. 259
Author(s):  
Matthias Koch ◽  
Borys Frankewycz ◽  
Andreas Voss ◽  
Max Kaeaeb ◽  
Sebastian Herrmann ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Proximal Humerus ◽  
Mapping Technique ◽  
Computer Assisted ◽  
3D Analysis ◽  
Joint Geometry ◽  
Stemless Shoulder Arthroplasty ◽  
Head Height

Background: Stemless shoulder arthroplasty (SSA) is used to anatomically reconstruct proximal humerus geometry and preserve proximal humerus bone stock. The current literature lacks 3D-analysis of pre- and postoperative proximal humeral anatomy after SSA. The aim of this study was to prospectively analyze the humeral head anatomy using a computer-assisted topography mapping technique after SSA in relation to the preoperative status and the contralateral (not affected) side. Methods: Twenty-nine patients (mean age: 63.5 ± 11.7 years) affected by primary shoulder osteoarthritis and treated with SSA were included. Preoperative and postoperative CT scans of the affected and contralateral sites were analyzed regarding joint geometry. Clinical outcome was assessed by Constant and Disabilities of the Arm, Shoulder and Hand (DASH) score shortly before and one year after surgery. Results: Clinical outcome improved significantly. No correlation between clinical outcome and the evaluated anatomical parameters was found. There was a significant decrease of the humeral head height (p < 0.01) and radius (p = 0.03) in the preoperative versus the postoperative joint geometry. The comparison to the contralateral site showed also a significant decrease of the humeral head height (p < 0.01). All other parameters showed no significant differences. Conclusion: Proximal humeral anatomy can be almost anatomically reconstructed by SSA. Solely the humeral head height differs significantly to the preoperative as well as contralateral morphology.

A STUDY OF MORPHOMETRIC ANALYSIS AND MEASUREMENT OF ANGLE OF TORSION OF THE HEAD OF HUMERUS AND SHOULDER ARTHROPLASTY

2021 ◽  
pp. 1-4
Author(s):  
Mithu Paul ◽  
Sarbani Das ◽  
Susmita Ghosh ◽  
Tridib Kumar Sett
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
West Bengal ◽  
Vertical Wall ◽  
Head Part ◽  
Glenoid Cavity ◽  
Plaster Of Paris ◽  
Medical College ◽  
Humeral Component ◽  
Humeral Torsion

Back ground: Humerus is the longest of the long bones of superior extremity.It”s head articulates with scapular glenoid cavity to form the gleno-humeral/Shoulder joint.The rounded head of Humerus is too weakly supported in the scapular glenoid cavity lined by glenoid labrum which makes it the most mobile and most unstable nd joint and so most commonly dislocated joint of the human body.Also the humeral head part is the 2 most important part of shoulder arthroplasty. Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: A total of 100 (Rt -58,Lt –42 ) dry human Humerus available in the Department of Anatomy of Calcutta National Medical College,Kolkata,West Bengal and Nilratan Sircar Medical College,Kolkata,West Bengal were taken for the study.The Humeral heads are measured in supero-inferior(SI) diameter, and antero-posterior diameter(AP), The width of Humeral head (Wdth),and angle of Humeral Torsion were measured. At the very beginning the both sided Humerus taken for the study are properly numbered using permanent marker pen.The width of the Humeral head(Wdth) is measured 1stly by pressing the head in modelling dough and when the mould is prepared,semisolid plaster of paris is lled into the mould. After drying the replica of humeral head is smoothened upto the mark of anatomical neck of humerus thus proper width can be measured. The superoinferior(SI) diameter, and antero-posterior diameter(AP) were measured by digital slide callipers by placing it directly onto the surface of consequently numbered humeral heads. The width of Humeral head (Wdth ) were measured from these replica(properly numbered) humeral heads, made of plaster of paris at the middle, the highest thickness was measured. The measurements are taken via spreading slide calipers in milimeters. For measuring the angle of humeral angle of torsion ,we xedly placed the humerus on to a area over the smooth part of the vertical wall which was meeting another horizontal wall at 90 degrees angle thus the line joining the two epicondyles of humerus lies parallel to the vertical wall.Now placing the straight edge of the protractor onto the upper end of humerus the angle of humeral torsion is measured. Results: Both sided Humerae were analysed separately for Morphological measurement, and angle of Humeral torsion.Mean values for SI were 41.31+3.46mm (Right side) and 40.91+3.27mm(Left side). Mean values for AP were 38.27+3.05mm (Right side) and 37.91+2.70mm(Left side). Conclusion: This study will contribute some relevant data and help the orthopaeditians in dealing with cases of shoulder pathology and shoulder arthroplasty cases.

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

2021 ◽  
pp. 175857322110193
Author(s):  
Arjun K Reddy ◽  
Jake X Checketts ◽  
B Joshua Stephens ◽  
J Michael Anderson ◽  
Craig M Cooper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Revisional Surgery ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Total Sample ◽  
Reverse Total Shoulder Arthroplasty ◽  
Common Complication ◽  
Humeral Component ◽  
Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542199712
Author(s):  
Jordan D. Walters ◽  
Stephen F. Brockmeier
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Lesser Tuberosity ◽  
Critical Elements ◽  
Implant Placement ◽  
Humeral Component ◽  
Component Loosening ◽  
Deltopectoral Approach

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

2021 ◽  
pp. 112070002110130
Author(s):  
Leigh-Anne Tu ◽  
Douglas S Weinberg ◽  
Raymond W Liu
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Hip Osteoarthritis ◽  
Volume Ratio ◽  
Femoral Head Coverage ◽  
Neck Shaft Angle ◽  
Hip Arthritis ◽  
Femoral Version ◽  
Shaft Angle ◽  
The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

scholarly journals Humeral bone grafting in stemless shoulder arthroplasty

2017 ◽  
Vol 12 (3) ◽  
pp. 183-185 ◽  
Author(s):  
Fabian Plachel ◽  
Markus Scheibel
Keyword(s):  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Stemless Shoulder Arthroplasty
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