Thermal Effects of Glenoid Reaming During Shoulder Arthroplasty in Vivo

Department of Orthopedics, University of Washington Medical Center, Seattle, WA 98195, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2011; 93(1):11-9. DOI: 10.2106/JBJS.I.01227
Source: PubMed


Glenoid component loosening is a common cause of failure of total shoulder arthroplasty. It has been proposed that the heat generated during glenoid preparation may reach temperatures capable of producing osteonecrosis at the bone-implant interface. We hypothesized that temperatures sufficient to induce thermal necrosis can be produced with routine drilling and reaming during glenoid preparation for shoulder arthroplasty in vivo. Furthermore, we hypothesized that irrigation of the glenoid during reaming can reduce this temperature increase.
Real-time, high-definition, infrared thermal video imaging was used to determine the temperatures produced by drilling and reaming during glenoid preparation in ten consecutive patients undergoing total shoulder arthroplasty. The maximum temperature and the duration of temperatures greater than the established thresholds for thermal necrosis were documented. The first five arthroplasties were performed without irrigation and were compared with the second five arthroplasties, in which continuous bulb irrigation was used during drilling and reaming. A one-dimensional finite element model was developed to estimate the depth of penetration of critical temperatures into the bone of the glenoid on the basis of recorded surface temperatures.
Our first hypothesis was supported by the recording of maximum surface temperatures above the 56°C threshold during reaming in four of the five arthroplasties done without irrigation and during drilling in two of the five arthroplasties without irrigation. The estimated depth of penetration of the critical temperature (56°C) to produce instantaneous osteonecrosis was beyond 1 mm (range, 1.97 to 5.12 mm) in four of these patients during reaming and one of these patients during drilling, and two had estimated temperatures above 56°C at 3 mm. Our second hypothesis was supported by the observation that, in the group receiving irrigation, the temperature exceeded the critical threshold in only one specimen during reaming and in two during drilling. The estimated depth of penetration for the critical temperature (56°C) did not reach a depth of 1 mm in any of these patients (range, 0.07 to 0.19 mm).
Temperatures sufficient to induce thermal necrosis of glenoid bone can be generated by glenoid preparation in shoulder arthroplasty in vivo. Frequent irrigation may be effective in preventing temperatures from reaching the threshold for bone necrosis during glenoid preparation.

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Available from: Zachary M Working, Jan 30, 2015
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    • "Glenoid loosening is a significant factor in failure of total shoulder replacement,[14] with the majority of revision arthroplasty performed to address this issue.[15] High temperatures have been noted at the implant glenoid interface[16] and glenoid reaming has been shown to generate high temperatures in vivo, beyond the physiological threshold required to induce osteonecrosis.[17] Hence reaming may contribute to resorption at the bone implant surface, resulting in prosthetic loosening. "
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    ABSTRACT: Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed to determine if humeral reaming instruments produce a thermal insult to subchondral bone during TSR. This was tested in vivo on 13 patients (8 with rheumatoid arthritis and 5 with osteoarthritis) with a single reaming system and in vitro with three different humeral reaming systems on saw bone models. Real-time infrared thermal video imaging was used to assess the temperatures generated. Synthes (Epoca) instruments generated average temperatures of 40.7°C (SD 0.9°C) in the rheumatoid group and 56.5°C (SD 0.87°C) in the osteoarthritis group (P = 0.001). Irrigation with room temperature saline cooled the humeral head to 30°C (SD 1.2°C). Saw bone analysis generated temperatures of 58.2°C (SD 0.79°C) in the Synthes (Epoca) 59.9°C (SD 0.81°C) in Biomet (Copeland) and 58.4°C (SD 0.88°C) in the Depuy Conservative Anatomic Prosthesis (CAP) reamers (P = 0.12). Humeral reaming with power driven instruments generates considerable temperatures both in vivo and in vitro. This paper demonstrates that a significant thermal effect beyond the 47°C threshold needed to induce osteonecrosis is observed with humeral reamers, with little variation seen between manufacturers. Irrigation with room temperature saline cools the reamed bone to physiological levels and should be performed regularly during this step in TSR.
    International Journal of Shoulder Surgery 07/2013; 7(3):100-4. DOI:10.4103/0973-6042.118910 · 0.65 Impact Factor
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    • "(Figure I) Until now infrared thennographic studies during bone healing have not been perfonned. We found studies that used infrared thennography as method for researching damage to the bone during bone drilling [4] [5] [6]. Also, Bendetto used it as a screening method for severity offoot injuries. "
    ELMAR, Zadar, Croatia; 09/2012
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    • "(Figure I) Until now infrared thennographic studies during bone healing have not been perfonned. We found studies that used infrared thennography as method for researching damage to the bone during bone drilling [4] [5] [6]. Also, Bendetto used it as a screening method for severity offoot injuries. "
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    ABSTRACT: Infrared thermography is a diagnostic method that could be used in follow up of patients with bone fractures. Studies on the application of thermography in traumatology are extremely scarce. The authors have tried to determine whether infrared thermography could be a diagnostic tool for different stages of bone healing progress. The basic principle is that because of metabolism increase and increase in blood flow around the fracture the temperature of surrounding tissue is increasing. The authors have examined 10 patients of mean age 67.3±8.0 (range=54-78) with fractures of distal radius in typical place. For all measurements Flir ThermaCam B2 (FLIR Systems, Inc., Oregon, USA) was used. We performed thermographic recording on the 7th day after fracture, 21st day after fracture, after the treatment with conservative immobilization had finished approximately 6 weeks after fracture. We used the other healthy hand as comparison. According to our preliminary findings on 10 patients we have found statistically significant temperature changes during different stages of bone healing. We found about 1.3°C temperature difference between fractured and healthy hand. During this research statistically significant temperature changes have been found. Infrared thermography could be a used as a good follow up method in traumatology but further investigations are needed on more patients and a longer time period.
    ELMAR, 2012 Proceedings; 01/2012
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