Total shoulder replacement surgery with custom glenoid implants for severe bone deficiency
ABSTRACT Treatment of patients with shoulder arthritis and severe glenoid bone loss is controversial. Medial and posterior bone loss limits the size of the glenoid vault, which is the structural support of all current glenoid designs. This study presents short-term outcomes of a treatment using inset glenoid implants during shoulder replacement surgery in deficient glenoid bone.
This study presents short-term outcomes of total shoulder replacement surgery using custom inset glenoid implants in deficient glenoid bone. Seven consecutive patients (3 men, 4 women; mean age 70 years) treated with inset glenoid implants for severe bone deficiency were retrospectively evaluated at a minimum 3-year follow-up. Severely deficient bone was defined by a neutral glenoid vault depth of less than 15 mm. No bone grafts were used. All patients were evaluated before and after surgery with physical examination, radiographic studies, and outcome measures. All patients had a diagnosis of osteoarthritis. No patients had rotator cuff tears or a history of instability.
No surgical complications occurred. At an average of 4.3 years, the mean American Shoulder and Elbow Surgeon score improved 68 points. There were statistically significant improvements in range of motion (forward flexion 33°, external rotation 34°, internal rotation 6 spinal levels) and in pain (6.9 to 0.1). Independent radiographic analysis determined all implants were classified as "low risk" for glenoid loosening.
The treatment of shoulder arthritis with severe glenoid bone loss is controversial and the results are mixed. Current treatments consist of hemiarthroplasty with or without glenoid reaming, total shoulder replacement without version correction, and total shoulder replacement with bulk bone grafting and version correction. The surgical technique and clinical results described in this case series demonstrate a novel approach of inset glenoid fixation for severely deficient bone.
This study documents for the first time the possibility of safely and effectively using inset glenoid implants to reconstruct deficient bone for which standard implants are contraindicated.
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ABSTRACT: The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR. Cite this article: Bone Joint J 2014;96-B:513-18.04/2014; 96-B(4):513-8. DOI:10.1302/0301-620X.96B4.32641
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ABSTRACT: We applied shape modeling and principal component analysis (PCA) to discover glenoid bone structural relationships relevant to improving glenoid prosthesis features, fixation, and instrumentation. Knowledge of external bone morphology guides prosthesis shape and positioning, while internal bone morphology and bone density influence fixation. CT-based modeling defined nonarthritic glenoid subchondral bone surface and internal structure. First and second principal shape components were related to size and density. Reproducible structural parameters and glenoid feature relationships were discovered. Subchondral bone surface was approximated by a circle inferiorly and a triangle superiorly with the circle's center at a reproducible point along a superior-inferior line. Glenoid vault's maximum depth was at the circle's center, and the highest bone density was in posterior glenoid. Glenoid subchondral bone surface version varied from superior to inferior, but not by sex or side. Male subchondral bone surfaces were larger and more retroverted. Even if subchondral bone surfaces are deformed by arthritis, glenoid morphology can be identified by extra-articular landmarks, permitting location of the glenoid center and scapular orientation (glenoid version). Knowledge obtained from this study directs design of novel prosthesis features and instrumentation for use without pre-op CT or computer aided surgery. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop ResJournal of Orthopaedic Research 11/2014; 32(11). DOI:10.1002/jor.22696 · 2.88 Impact Factor
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ABSTRACT: Patients with skeletal dysplasia are prone to the development of degenerative shoulder disease requiring shoulder arthroplasty at a younger age than in the general population. To date there have been no published reports on the complexities or outcome of shoulder arthroplasty in this unique patient group. This is a review of 13 shoulder arthroplasties in 10 patients with skeletal dysplasia with mean follow-up of 7 years (2-17.6 years). There were 4 men and 6 women with a mean age of 53.1 years (23-76 years), mean height of 148 cm (122-177 cm), and mean weight of 60 kg (27-80 kg). The mean Oxford Shoulder Score increased from 13 (5-20) preoperatively to 28 (18-38) at final follow-up. Patients improved significantly in 2 of 8 Short Form 36 health-related quality of life domains: physical function (P = .04) and bodily pain (P = .04). Function was better in those who underwent nonconstrained total shoulder arthroplasty as opposed to hemiarthroplasty. Four (31%) required reoperation: 1 excision of heterotopic ossification, 1 relocation for anterior instability, and 2 revisions for periprosthetic fracture and glenoid erosion. Shoulder arthroplasty is effective at relieving pain, optimizing movement, and improving function for patients with skeletal dysplasia; however, compared with the general population, there is a higher complication rate and function is not as good. Furthermore, this procedure is less effective at restoring health-related quality of life than total hip arthroplasty or total shoulder arthroplasty performed for osteoarthritis in the general population. Custom implants may be required to compensate for short stature and rotator cuff and glenoid deficiency.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2014; 23(10). DOI:10.1016/j.jse.2014.01.003 · 1.93 Impact Factor