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Joseph P Iannotti - One of the best experts on this subject based on the ideXlab platform.

  • clinical and radiographic outcomes of a posteriorly augmented Glenoid Component in anatomic total shoulder arthroplasty for primary osteoarthritis with posterior Glenoid bone loss
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Michael H Amini, Eric T Ricchetti, Vahid Entezari, Bong Jae Jun, Bashar Alolabi, Joseph P Iannotti
    Abstract:

    BACKGROUND The primary objectives of this study were to evaluate the ability of a posteriorly stepped augmented Glenoid Component, used in patients with primary glenohumeral osteoarthritis with B2 or B3 Glenoid morphology, to correct preoperative retroversion and humeral head subluxation and to identify factors associated with radiographic radiolucency and patient-reported clinical outcomes. METHODS We identified 71 shoulders with B2 or B3 Glenoid morphology that underwent anatomic total shoulder arthroplasty with use of a posteriorly stepped augmented Glenoid Component and with a preoperative 3-dimensional computed tomography (3D-CT) scan and a minimum of 2 years of clinical and radiographic follow-up. The Penn Shoulder Score (PSS), shoulder range of motion, Glenoid center-peg osteolysis, and postoperative version and humeral head subluxation were the main outcome variables of interest. RESULTS Follow-up was a median of 2.4 years (range, 1.9 to 5.7 years); the mean patient age at treatment was 65 ± 7 years (range, 51 to 80 years). PSS, range of motion, humeral head centering, and Glenoid version were significantly improved among all patients (p < 0.0001). Patients with persistent posterior subluxation of the humeral head postoperatively had worse preoperative fatty infiltration of the teres minor and greater postoperative Component retroversion (p < 0.05). Patients with center-peg osteolysis had more preoperative joint-line medialization and posterior Glenoid bone loss (p < 0.05). Patients with more preoperative humeral head posterior subluxation had a lower PSS, adjusting for confounders (p < 0.05). CONCLUSIONS Posteriorly stepped augmented Glenoid Components can improve pathologic retroversion and posterior subluxation of the humeral head in B2 and B3 Glenoids, with significant improvements found in clinical outcome scores at a minimum of 2 years of follow-up in the vast majority of patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • correction of acquired Glenoid bone loss in osteoarthritis with a standard versus an augmented Glenoid Component
    Journal of Shoulder and Elbow Surgery, 2014
    Co-Authors: Vani J Sabesan, Mark Callanan, Vinay Sharma, Joseph P Iannotti
    Abstract:

    Background The magnitude and anatomic consequences of pathologic acquired Glenoid retroversion and posterior bone loss that can be surgically corrected with a standard versus an augmented Glenoid Component have not been studied extensively in a surgical patient population. Materials and methods Twenty-nine patients with glenohumeral osteoarthritis, acquired posterior bone loss, and increased retroversion were studied by use of a three-dimensional computer surgical simulation. For each case, amount of medialization was measured as the linear distance from the lateral aspect of the Glenoid vault model to the center of the articular implant surface. Simulation of implant placement at 0° or 6° was performed with use of a standard Glenoid having a uniform thickness and an asymmetric thickness augmented Component. Results An increased amount of medialization was seen with the standard Glenoid, 8.3 ± 4.1 mm, compared with 3.8 ± 3.3 mm with use of the augmented Glenoid implant ( P R 2 = 0.825) and augmented ( R 2 = −0.68) Glenoid implant. There was an increased ability to correct greater amounts of pathologic version with less medialization by use of an augmented step Glenoid compared with a standard anchor peg Glenoid. Discussion Correction of moderate to severe Glenoid retroversion by asymmetric reaming cannot always be done with use of a standard Component, and if it is done, it will result in greater medialization of the joint line. Use of an augmented Component can allow complete correction of retroversion and minimize the effect of medialization.

  • three dimensional preoperative planning software and a novel information transfer technology improve Glenoid Component positioning
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Joseph P Iannotti, Justi J Ake, Eric Rodriguez, Joh J Ems, Eric T Ricchetti, Mena Mesiha
    Abstract:

    Background: We hypothesized that a novel surgical method, in which three-dimensional (3-D) preoperative planning software is generated to create a patient-specific surgical model that is used with a reusable and adjustable tool, could substantially improve the positioning accuracy of the Glenoid guide pin used in total shoulder arthroplasty. We tested this method using bone models from patients with shoulder pathology and compared the results with those achieved using surgical methods representing the current standard of care. Methods: Three surgeons with a variety of surgical experience placed a guide pin in nine bone models from patients with a variety of glenohumeral arthritis severity using (1) standard instrumentation alone, (2) standard instrumentation and 3-D preoperative surgical planning, and (3) the reusable transfer device and 3-D preoperative surgical planning. A postoperative 3-D computed tomography scan of the bone model was made and registered to the preoperative plan, and the differences between the actual and planned pin locations and trajectories were measured. Results: Use of the standard instrumentation combined with 3-D preoperative planning software improved guide pin positioning compared with standard instrumentation and preoperative planning using 2-D imaging. The accuracy of pin positioning increased by 4.5° ± 1.0° in version (p < 0.001), 3.3° ± 1.3° in inclination (p = 0.013), and 0.4 ± 0.2 mm in location (p = 0.042). Use of the adjustable and reusable device and the 3-D software improved pin positioning by a further 3.7° ± 0.9° in version, 8.1° ± 1.2° in inclination, and 1.2 ± 0.2 mm in location (p < 0.001 for all) compared with standard instrumentation and the 3-D software; the improvement compared with use of standard instrumentation with 2-D imaging was 8.2° ± 0.9° in version, 11.4° ± 1.2° in inclination, and 1.7 ± 0.2 mm in location (p < 0.001 for all). Conclusions: Use of 3-D preoperative planning and use of the patient-specific bone model and transfer device both improved the positioning accuracy of the pin used to guide placement of the Glenoid Component in total shoulder arthroplasty. Clinical Relevance: Proper positioning of the Glenoid Component would be expected to improve the function and durability of the joint replacement.

  • Glenoid Component retroversion is associated with osteolysis
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Vani J Sabesan, Joseph P Iannotti
    Abstract:

    Background: It has been suggested that Glenoid Component retroversion and eccentric loading are an important mechanism leading to Glenoid Component loosening, but little clinical data have been published to support this concept. Methods: Sixty-six shoulders underwent total shoulder replacement with an all-polyethylene press-fit pegged Glenoid Component designed for osseous ingrowth for treatment of osteoarthritis. These shoulders were followed clinically and with radiographs for an average (and standard deviation) of 3.8 ± 1.8 years (range, two to seven years). Preclinical radiographic loosening was defined as osteolysis around the central peg of the Glenoid Component. Results: Of the sixty-six shoulders, twenty (30%) had osteolysis around the center peg. The length of time after replacement (p = 0.0006), preoperative Glenoid retroversion (p = 0.036), and postoperative Glenoid Component retroversion (p = 0.041) were correlated with osteolysis around the Glenoid center peg and an increase in the Lazarus Component loosening grade. Postoperative retroversion correlated with preoperative retroversion (Pearson correlation coefficient = 0.44, 95% confidence interval [CI] = 0.19 to 0.64, p = 0.0011). The presence of osteolysis around the center peg was not correlated with a worse clinical outcome defined by shoulder scores or a reoperation due to Glenoid loosening. After adjustment for follow-up time, excessive postoperative Glenoid retroversion (≥15°) was associated with an increased odds of osteolysis (odds ratio = 5.23, 95% CI = 1.31 to 20.9]), whereas preoperative Glenoid retroversion was associated with no change in the odds of osteolysis. Conclusions: Osteolysis around the center peg of a Glenoid Component is correlated with Component retroversion of ≥15°. This finding suggests that there should be additional investigation into the effects of correcting preoperative Glenoid retroversion to prevent osteolysis around the center peg. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • total shoulder arthroplasty with an all polyethylene pegged bone ingrowth Glenoid Component a clinical and radiographic outcome study
    Journal of Bone and Joint Surgery - Series A, 2012
    Co-Authors: Michael A Wirth, Rebecca A Loredo, Glenn M Garcia, Charles A Rockwood, Carleton Southworth, Joseph P Iannotti
    Abstract:

    Background: Loosening of the Glenoid Component continues to be the foremost cause of medium and long-term failure of shoulder replacements. The purpose of this study was to evaluate the clinical and radiographic results of a minimally cemented all-polyethylene pegged Glenoid Component designed for biologic fixation. Methods: Forty-four shoulders in forty-one patients with a mean age of sixty-six years underwent total shoulder arthroplasty with a pegged bone-ingrowth Glenoid Component. Outcome data included the American Shoulder and Elbow Surgeons questionnaire, the Simple Shoulder Test, and visual analog scales. A detailed radiographic analysis was performed by two board-certified musculoskeletal radiologists who were blinded to clinical and patient-reported outcomes. The radiographs were evaluated with regard to the presence of radiolucent lines at the bone-cement interface, implant seating, and the radiodensity between the flanges of the central peg. Results: The mean duration of clinical follow-up was four years and the mean duration of radiographic follow-up was three years. Twenty shoulders had perfect seating and radiolucency grades, thirty had increased radiodensity between the flanges of the central peg, and three demonstrated osteolysis. Radiodensity about the uncemented central peg at the time of the latest follow-up was positively associated with perfect seating and radiolucency grades on the initial postoperative radiographs (p = 0.03, Fisher exact test). The Simple Shoulder Test score, the American Shoulder and Elbow Surgeons score, and all visual analog scale scores had improved significantly (p < 0.01) at the time of the latest follow-up. Conclusions: Total shoulder arthroplasty with a minimally cemented, all-polyethylene, pegged Glenoid implant can yield stable and durable fixation at short to medium-term follow-up (mean, four years). Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Frederick A Matsen - One of the best experts on this subject based on the ideXlab platform.

  • Failure of the Glenoid Component in Anatomic Total Shoulder Arthroplasty A Systematic Review of the English-Language Literature Between 2006 and 2012
    2016
    Co-Authors: Anastasios Papadonikolakis, Moni B Neradilek, Frederick A Matsen
    Abstract:

    Background: Although Glenoid Component failure is one of the most common complications of anatomic total shoulder arthroplasty, substantial evidence from the recent published literature is lacking regarding the temporal trend in the rate of this complication and the risk factors for its occurrence. Methods: We conducted a systematic review and identified twenty-seven articles presenting data on Glenoid Component failure rates that met the inclusion criteria. These articles represented data from 3853 total shoulder arthroplasties performed from 1976 to 2007. Results: Asymptomatic radiolucent lines occurred at a rate of 7.3 % per year after the primary shoulder replacement. Symptomatic Glenoid loosening occurred at 1.2 % per year, and surgical revision occurred at 0.8 % per year. There was no significant evidence that the rate of symptomatic loosening has diminished over time. Keeled Components had greater rates of asymptomatic radiolucent lines compared with pegged Components in side-by-side comparison studies. However, as a result of wide variability in outcomes reporting, only sex, Walch class, and diagnosis were significantly associated with the risk of Glenoid Component failure in the overall analysis. Conclusions: This is the first systematic review of the published evidence on Glenoid Component failure. Although the authors of individual articles proposed various risk factors for Glenoid Component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve th

  • failure of the Glenoid Component in anatomic total shoulder arthroplasty
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Anastasios Papadonikolakis, Moni B Neradilek, Frederick A Matsen
    Abstract:

    Background: Although Glenoid Component failure is one of the most common complications of anatomic total shoulder arthroplasty, substantial evidence from the recent published literature is lacking regarding the temporal trend in the rate of this complication and the risk factors for its occurrence. Methods: We conducted a systematic review and identified twenty-seven articles presenting data on Glenoid Component failure rates that met the inclusion criteria. These articles represented data from 3853 total shoulder arthroplasties performed from 1976 to 2007. Results: Asymptomatic radiolucent lines occurred at a rate of 7.3% per year after the primary shoulder replacement. Symptomatic Glenoid loosening occurred at 1.2% per year, and surgical revision occurred at 0.8% per year. There was no significant evidence that the rate of symptomatic loosening has diminished over time. Keeled Components had greater rates of asymptomatic radiolucent lines compared with pegged Components in side-by-side comparison studies. However, as a result of wide variability in outcomes reporting, only sex, Walch class, and diagnosis were significantly associated with the risk of Glenoid Component failure in the overall analysis. Conclusions: This is the first systematic review of the published evidence on Glenoid Component failure. Although the authors of individual articles proposed various risk factors for Glenoid Component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve the quality of the evidence on which patients, techniques, and prostheses are selected for total shoulder arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • failure of the Glenoid Component in anatomic total shoulder arthroplasty a systematic review of the english language literature between 2006 and 2012
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Anastasios Papadonikolakis, Moni B Neradilek, Frederick A Matsen
    Abstract:

    Background: Although Glenoid Component failure is one of the most common complications of anatomic total shoulder arthroplasty, substantial evidence from the recent published literature is lacking regarding the temporal trend in the rate of this complication and the risk factors for its occurrence. Methods: We conducted a systematic review and identified twenty-seven articles presenting data on Glenoid Component failure rates that met the inclusion criteria. These articles represented data from 3853 total shoulder arthroplasties performed from 1976 to 2007. Results: Asymptomatic radiolucent lines occurred at a rate of 7.3% per year after the primary shoulder replacement. Symptomatic Glenoid loosening occurred at 1.2% per year, and surgical revision occurred at 0.8% per year. There was no significant evidence that the rate of symptomatic loosening has diminished over time. Keeled Components had greater rates of asymptomatic radiolucent lines compared with pegged Components in side-by-side comparison studies. However, as a result of wide variability in outcomes reporting, only sex, Walch class, and diagnosis were significantly associated with the risk of Glenoid Component failure in the overall analysis. Conclusions: This is the first systematic review of the published evidence on Glenoid Component failure. Although the authors of individual articles proposed various risk factors for Glenoid Component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve the quality of the evidence on which patients, techniques, and prostheses are selected for total shoulder arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Glenoid Component failure in total shoulder arthroplasty
    Journal of Bone and Joint Surgery American Volume, 2008
    Co-Authors: Frederick A Matsen, Jeremiah Clinton, Alexander Bertelsen, Joseph R. Lynch, Michael L. Richardson
    Abstract:

    Glenoid Component failure is the most common complication of total shoulder arthroplasty. Glenoid Components fail as a result of their inability to replicate essential properties of the normal Glenoid articular surface to achieve durable fixation to the underlying bone, to withstand repeated eccentric loads and glenohumeral translation, and to resist wear and deformation. The possibility of Glenoid Component failure should be considered whenever a total shoulder arthroplasty has an unsatisfactory result. High-quality radiographs made in the plane of the scapula and in the axillary projection are usually sufficient to evaluate the status of the Glenoid Component. Failures of prosthetic Glenoid arthroplasty can be understood in terms of failure of the Component itself, failure of seating, failure of fixation, failure of the Glenoid bone, and failure to effectively manage eccentric loading. An understanding of these modes of failure leads to strategies to minimize complications related to prosthetic Glenoid arthroplasty.

  • self assessed outcome at two to four years after shoulder hemiarthroplasty with concentric Glenoid reaming
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Joseph R. Lynch, Amy K Franta, William H Montgomery, Tim R Lenters, Doug Mounce, Frederick A Matsen
    Abstract:

    Background: Active and young individuals with glenohumeral arthritis who are treated with total glenohumeral arthroplasty are at risk for loosening or wear of the prosthetic Glenoid Component. This study tests the hypothesis that patients with severe glenohumeral arthritis have improvement in self-a

Robert H Cofield - One of the best experts on this subject based on the ideXlab platform.

  • revisions for aseptic Glenoid Component loosening after anatomic shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2017
    Co-Authors: William R Aibinder, Bradley S Schoch, John W Sperling, Cathy D Schleck, Robert H Cofield
    Abstract:

    Background Glenoid Component loosening is a common indication for revision shoulder arthroplasty. The objective of this study is to assess the longer-term outcomes of patients undergoing revision specifically for aseptic loosening. Materials and methods Between 1985 and 2005, 34 revision shoulder arthroplasties were performed for aseptic Glenoid loosening. Three patients were lost to follow-up. Treatment included Component reimplantation in 20 shoulders (group I) or Component removal with bone grafting in 11 shoulders (group II). We identified 9 cases of instability with or without rotator cuff tearing prior to revision. The mean follow-up period was 8.3 years. Results The rate of survival free of reoperation at 10 years was 78.9% in group I and 83.9% in group II ( P  = .5). Pain relief occurred in 26 of 31 shoulders, with no difference between groups ( P  > .99). Active elevation and external rotation improved in both groups ( P  = .8). Five shoulders in group I had radiographically loose Glenoids, with two requiring reoperation. Nine shoulders in group II had medial Glenoid erosion, with two requiring reoperation for pain. There was a trend toward reoperation in those with preoperative instability (5 of 8 re-revisions). Discussion and conclusion Glenoid revision surgery in the absence of infection provides satisfactory results, especially when instability is not coexisting. When Glenoid bone stock permits, reimplantation of a new Glenoid Component in an active patient with an intact rotator cuff and no instability is reasonable. When the remaining Glenoid bone will not support a new Component, conversion to a hemiarthroplasty is also reasonable.

  • survival of the pegged Glenoid Component in shoulder arthroplasty part ii
    Journal of Shoulder and Elbow Surgery, 2017
    Co-Authors: Paul B Mclendon, Bradley S Schoch, John W Sperling, Joaquin Sanchezsotelo, Cathy D Schleck, Robert H Cofield
    Abstract:

    Background Loosening of the Glenoid Component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged Glenoids were designed in an effort to outperform keeled Components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged Glenoid Component and identified risk factors for radiographic loosening and clinical failure. Materials and methods There were 330 total shoulder arthroplasties that had been implanted with a cemented, all-polyethylene, in-line pegged Glenoid Component evaluated with an average clinical follow-up of 7.2 years. Of these shoulders, 287 had presurgical, initial postsurgical, and late postsurgical radiographs (mean radiographic follow-up, 7.0 years). Results At most recent follow-up, 30 Glenoid Components had been revised for aseptic loosening. This translated to a rate of Glenoid Component survival free from revision for all 330 shoulders of 99% at 5 years and 83% at 10 years. Of 287 Glenoid Components, 120 were considered loose on the basis of radiographic evaluation. Four humeral Components were considered loose. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years was 92% and 43%. Severe presurgical Glenoid erosion (Walch A2, B2, C) and patient age Conclusion Despite the predominant thinking that pegged Glenoid Components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged Component design, particularly after 5 years. Advanced presurgical Glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic Glenoid loosening.

  • structural bone grafting for Glenoid deficiency in primary total shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2014
    Co-Authors: Brian J Klika, Scott P Steinmann, John W Sperling, Cathy D Schleck, Clint Wooten, William S Harmsen, Robert H Cofield
    Abstract:

    Background Glenoid bone grafting can be useful to restore an asymmetrically eroded Glenoid to better support the Glenoid Component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for Glenoid deficiency with placement of a cemented Glenoid Component during primary total shoulder arthroplasty. Methods Between January 1, 1976, and December 31, 2008, 24 patients (25 shoulders) of 2607 shoulders undergoing primary total shoulder arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years. Results Twenty-three shoulders experienced pain relief, and patients expressed satisfaction with the operation in these shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 shoulders had Glenoids at risk for Component loosening. Two of these shoulders were symptomatic and underwent revision surgery to address Glenoid Component loosening. The Neer result rating was excellent in 18 shoulders, satisfactory in 5, and unsatisfactory in the 2 shoulders undergoing revision. Conclusion Structural bone grafting in primary total shoulder arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of Glenoid Component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing Glenoid wear.

  • survival of the Glenoid Component in shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2009
    Co-Authors: Tyler J Fox, John W Sperling, Joaquin Sanchezsotelo, Cathy D Schleck, Akin Cil, Robert H Cofield
    Abstract:

    Introduction This study was conducted to determine the survival of different Glenoid Component designs, assess the reasons for revision surgery, and identify patient and diagnostic factors that influence this need. Methods Between January 1, 1984, and December 31, 2004, 1337 patients underwent 1542 total shoulder arthroplasties with 6 types of Glenoid Components: Neer II all-polyethylene, Neer II metal-backed, Cofield 1 metal-backed bone-ingrowth, Cofield 1 all-poly keeled, Cofield 2 all-poly keeled, and Cofield 2 all-poly pegged. Results Revision was required in 125 shoulders for Glenoid Component failure. Survival rates free of revision by Glenoid implant type at 5, 10, and 15 years were, respectively, 96%, 96%, and 95% for 99 Neer II all-poly; 96%, 94%, and 89% for 316 Neer II metal-backed; 86%, 79%, and 67% for 316 Cofield 1 metal-backed; 94%, 94%, and 87% for 18 Cofield 1 all-poly; 99%, 94%, and 89% for 497 Cofield 2 all-poly keeled; and 99% at 5 years for 358 Cofield 2 all-poly pegged. Glenoid Component type was significantly associated with Component revision ( P P P = .02) and avascular necrosis ( P = .06) were associated with increased risk of revision. Conclusions Survival is improved with cemented all-polyethylene Glenoid Components. Revision of cemented all-polyethylene Components may be lessened with the use of pegged Components in early follow-up. Male gender and the operative diagnoses of posttraumatic arthritis or avascular necrosis are associated with an increased risk of failure. Level of Evidence Level IV, Case Series, Treatment Study.

  • total shoulder arthroplasty with a metal backed bone ingrowth Glenoid Component medium to long term results
    Journal of Bone and Joint Surgery American Volume, 2008
    Co-Authors: Michael J Taunton, John W Sperling, Amy L Mcintosh, Robert H Cofield
    Abstract:

    Background: Loosening of a cemented Glenoid Component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth Glenoid Component as an alternative to a cemented Component. Methods: The study group included eighty-three total shoulder arthroplasties with a metal-backed, bone-ingrowth Glenoid Component performed between 1989 and 1994. Seventy-four shoulders had a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with Glenoid Component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the Glenoid Component was noted in twenty-one shoulders, and humeral Component loosening was seen in fifteen shoulders. Revision procedures were performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth Glenoid Component raises concerns as to its use, and perhaps the use of other types of metal-backed Components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Gilles Walch - One of the best experts on this subject based on the ideXlab platform.

  • the subchondral bone layer and Glenoid implant design are relevant for primary stability in Glenoid arthroplasty
    Archives of Orthopaedic and Trauma Surgery, 2018
    Co-Authors: Boris Sowa, Martin Bochenek, Steffen Braun, J P Kretzer, Felix Zeifang, Thomas Bruckner, Gilles Walch, Patric Raiss
    Abstract:

    Background Clinical studies suggest that reaming of the subchondral bone layer to achieve good implant seating is a risk factor for Glenoid loosening. This study aims to evaluate (1) the importance of the subchondral bone layer and (2) the influence of the design of the Glenoid Component.

  • Anatomical total shoulder arthroplasty in young patients with osteoarthritis
    The Bone & Joint Journal (BJJ), 2018
    Co-Authors: Marc Olivier Gauci, Gilles Walch, Nicolas Bonnevialle, Grégory Moineau, Mohammed Baba, Pascal Boileau
    Abstract:

    AIMS: Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the Glenoid Component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed Glenoid Components. MATERIALS AND METHODS: A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene Component and 23 were undertaken using a cementless metal-backed Component. The age, gender, preoperative function, mobility, premorbid Glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan-Meier survivorship analysis was performed with revision as the endpoint. RESULTS: A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years' follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene Components and 24% (sd 0.10) for metal-backed Components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted Glenoid (Walch B2) had an adverse effect on the survival of a metal-backed Component. CONCLUSION: The survival of a cemented polyethylene Glenoid Component is three times higher than that of a cementless metal-backed Glenoid Component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) Glenoid have the highest risk of failure.

  • total shoulder replacement using a bone ingrowth central peg polyethylene Glenoid Component a prospective clinical and computed tomography study with short to mid term follow up
    International Orthopaedics, 2016
    Co-Authors: Giovanni Merolla, Gilles Walch, Giovanni Ciaramella, Elisabetta Fabbri, Paolo Paladini, Giuseppe Porcellini
    Abstract:

    Aim of the study To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene Glenoid Component (APGC). Methods Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45-75), were implanted with the novel Component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24-39). Early and late follow-up CT scans were available for 21/30 shoulders. Results Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p 0.05). Discussion The partially cemented Glenoid Component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The Glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth. Conclusions The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene Glenoids.

  • three dimensional planning and use of patient specific guides improve Glenoid Component position an in vitro study
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Gilles Walch, Peter S Vezeridis, Pascal Boileau, Pierric Deransart, Jean Chaoui
    Abstract:

    Background Glenoid Component positioning is a key factor for success in total shoulder arthroplasty. Three-dimensional (3D) measurements of Glenoid retroversion, inclination, and humeral head subluxation are helpful tools for preoperative planning. The purpose of this study was to assess the reliability and precision of a novel surgical method for placing the Glenoid Component with use of patient-specific templates created by preoperative surgical planning and 3D modeling. Methods A preoperative computed tomography examination of cadaveric scapulae (N = 18) was performed. The Glenoid implants were virtually placed, and patient-specific guides were created to direct the guide pin into the desired orientation and position in the Glenoid. The 3D orientation and position of the guide pin were evaluated by performing a postoperative computed tomography scan for each scapula. The differences between the preoperative planning and the achieved result were analyzed. Results The mean error in 3D orientation of the guide pin was 2.39°, the mean entry point position error was 1.05 mm, and the mean inclination angle error was 1.42°. The average error in the version angle was 1.64°. There were no technical difficulties or complications related to use of patient-specific guides for guide pin placement. Quantitative analysis of guide pin positioning demonstrated a good correlation between preoperative planning and the achieved position of the guide pin. Conclusion This study demonstrates the reliability and precision of preoperative planning software and patient-specific guides for Glenoid Component placement in total shoulder arthroplasty.

  • radiographic changes around humeral Components in shoulder arthroplasty
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Patric Raiss, Thomas Bruckner, Pascal Boileau, Markus Loew, Bradley T Edwards, Allen Deutsch, Anup A Shah, Gilles Walch
    Abstract:

    Background: Our purposes were to analyze radiographic changes around humeral Components and to determine the influence of these changes on the clinical outcome of shoulder arthroplasty. Methods: Three hundred and ninety-five shoulders with primary osteoarthritis were treated with a shoulder replacement and were analyzed clinically and radiographically with a standardized protocol. Radiographs were evaluated for osteolysis and stress-shielding of the proximal part of the humerus and loosening of the humeral and Glenoid Components. The arthroplasty configurations included (1) hemiarthroplasty with cement (thirty shoulders), (2) hemiarthroplasty without cement (thirty-six), (3) total shoulder replacement with a cemented stem and a cemented flat-backed Glenoid Component (eighty-nine), (4) total shoulder replacement with a cemented stem and a cemented convex-backed Glenoid Component (ninety-four), (5) total shoulder replacement with a cemented stem and an uncemented metal-backed Glenoid Component (seventy-nine), and (6) total shoulder replacement with an uncemented stem and a cemented convex-backed Glenoid Component (sixty-seven). The mean duration of follow-up was 8.2 years (range, four to eighteen years). Results: The Constant score and shoulder motion were significantly greater at the latest follow-up examination than preoperatively (p < 0.001). One cemented stem loosened after a periprosthetic fracture, and another was judged to be at risk for loosening. Stress-shielding was noted only around uncemented stems in 63% of the shoulders with such stems. Osteolysis of the proximal part of the humerus occurred only with total shoulder arthroplasty in 43% of the shoulders. Patients with osteolysis had a poorer clinical outcome (p < 0.001). Shoulders with osteolysis around the proximal part of the humerus had more Glenoid loosening and polyethylene wear (p < 0.001). Conclusions: Glenoid issues have a substantial effect on humeral bone in shoulder arthroplasty. Polyethylene wear appears to be associated with the development of osteolysis of the proximal part of the humerus after total shoulder arthroplasty. With our implants, stress-shielding was only observed with uncemented humeral stems. The uncemented and cemented stem designs analyzed in this study appeared comparable and can be recommended for clinical use. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

John W Sperling - One of the best experts on this subject based on the ideXlab platform.

  • revisions for aseptic Glenoid Component loosening after anatomic shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2017
    Co-Authors: William R Aibinder, Bradley S Schoch, John W Sperling, Cathy D Schleck, Robert H Cofield
    Abstract:

    Background Glenoid Component loosening is a common indication for revision shoulder arthroplasty. The objective of this study is to assess the longer-term outcomes of patients undergoing revision specifically for aseptic loosening. Materials and methods Between 1985 and 2005, 34 revision shoulder arthroplasties were performed for aseptic Glenoid loosening. Three patients were lost to follow-up. Treatment included Component reimplantation in 20 shoulders (group I) or Component removal with bone grafting in 11 shoulders (group II). We identified 9 cases of instability with or without rotator cuff tearing prior to revision. The mean follow-up period was 8.3 years. Results The rate of survival free of reoperation at 10 years was 78.9% in group I and 83.9% in group II ( P  = .5). Pain relief occurred in 26 of 31 shoulders, with no difference between groups ( P  > .99). Active elevation and external rotation improved in both groups ( P  = .8). Five shoulders in group I had radiographically loose Glenoids, with two requiring reoperation. Nine shoulders in group II had medial Glenoid erosion, with two requiring reoperation for pain. There was a trend toward reoperation in those with preoperative instability (5 of 8 re-revisions). Discussion and conclusion Glenoid revision surgery in the absence of infection provides satisfactory results, especially when instability is not coexisting. When Glenoid bone stock permits, reimplantation of a new Glenoid Component in an active patient with an intact rotator cuff and no instability is reasonable. When the remaining Glenoid bone will not support a new Component, conversion to a hemiarthroplasty is also reasonable.

  • survival of the pegged Glenoid Component in shoulder arthroplasty part ii
    Journal of Shoulder and Elbow Surgery, 2017
    Co-Authors: Paul B Mclendon, Bradley S Schoch, John W Sperling, Joaquin Sanchezsotelo, Cathy D Schleck, Robert H Cofield
    Abstract:

    Background Loosening of the Glenoid Component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged Glenoids were designed in an effort to outperform keeled Components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged Glenoid Component and identified risk factors for radiographic loosening and clinical failure. Materials and methods There were 330 total shoulder arthroplasties that had been implanted with a cemented, all-polyethylene, in-line pegged Glenoid Component evaluated with an average clinical follow-up of 7.2 years. Of these shoulders, 287 had presurgical, initial postsurgical, and late postsurgical radiographs (mean radiographic follow-up, 7.0 years). Results At most recent follow-up, 30 Glenoid Components had been revised for aseptic loosening. This translated to a rate of Glenoid Component survival free from revision for all 330 shoulders of 99% at 5 years and 83% at 10 years. Of 287 Glenoid Components, 120 were considered loose on the basis of radiographic evaluation. Four humeral Components were considered loose. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years was 92% and 43%. Severe presurgical Glenoid erosion (Walch A2, B2, C) and patient age Conclusion Despite the predominant thinking that pegged Glenoid Components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged Component design, particularly after 5 years. Advanced presurgical Glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic Glenoid loosening.

  • patient specific targeting guides compared with traditional instrumentation for Glenoid Component placement in shoulder arthroplasty a multi surgeon study in 70 arthritic cadaver specimens
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Thomas W Throckmorton, Lawrence V Gulotta, Frank O Bonnarens, Stephen A Wright, Jeffrey L Hartzell, William B Rozzi, Jason M Hurst, Simon P Frostick, John W Sperling
    Abstract:

    Hypothesis and background The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place Components more accurately than standard instrumentation. Materials and methods Seventy cadaver shoulders with radiographically confirmed arthritis were randomized in equal groups to 5 surgeons of varying experience levels who were not involved in development of the patient-specific guidance system. Specimens were then randomized to patient-specific guides based off of computed tomography scanning, standard instrumentation, and anatomic TSA or reverse TSA. Variances in version or inclination of more than 10° and more than 4 mm in starting point were considered indications of significant Component malposition. Results TSA Glenoid Components placed with patient-specific guides averaged 5° of deviation from the intended position in version and 3° in inclination; those with standard instrumentation averaged 8° of deviation in version and 7° in inclination. These differences were significant for version (P = .04) and inclination (P = .01). Multivariate analysis of variance to compare the overall accuracy for the entire cohort (TSA and reverse TSA) revealed patient-specific guides to be significantly more accurate (P = .01) for the combined vectors of version and inclination. Patient-specific guides also had fewer instances of significant Component malposition than standard instrumentation did. Conclusion Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of Component malposition for Glenoid Component placement in this multi-surgeon cadaver study of arthritic shoulders. Long-term clinical studies are needed to determine if these improvements produce improved functional outcomes.

  • structural bone grafting for Glenoid deficiency in primary total shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2014
    Co-Authors: Brian J Klika, Scott P Steinmann, John W Sperling, Cathy D Schleck, Clint Wooten, William S Harmsen, Robert H Cofield
    Abstract:

    Background Glenoid bone grafting can be useful to restore an asymmetrically eroded Glenoid to better support the Glenoid Component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for Glenoid deficiency with placement of a cemented Glenoid Component during primary total shoulder arthroplasty. Methods Between January 1, 1976, and December 31, 2008, 24 patients (25 shoulders) of 2607 shoulders undergoing primary total shoulder arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years. Results Twenty-three shoulders experienced pain relief, and patients expressed satisfaction with the operation in these shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 shoulders had Glenoids at risk for Component loosening. Two of these shoulders were symptomatic and underwent revision surgery to address Glenoid Component loosening. The Neer result rating was excellent in 18 shoulders, satisfactory in 5, and unsatisfactory in the 2 shoulders undergoing revision. Conclusion Structural bone grafting in primary total shoulder arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of Glenoid Component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing Glenoid wear.

  • survival of the Glenoid Component in shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2009
    Co-Authors: Tyler J Fox, John W Sperling, Joaquin Sanchezsotelo, Cathy D Schleck, Akin Cil, Robert H Cofield
    Abstract:

    Introduction This study was conducted to determine the survival of different Glenoid Component designs, assess the reasons for revision surgery, and identify patient and diagnostic factors that influence this need. Methods Between January 1, 1984, and December 31, 2004, 1337 patients underwent 1542 total shoulder arthroplasties with 6 types of Glenoid Components: Neer II all-polyethylene, Neer II metal-backed, Cofield 1 metal-backed bone-ingrowth, Cofield 1 all-poly keeled, Cofield 2 all-poly keeled, and Cofield 2 all-poly pegged. Results Revision was required in 125 shoulders for Glenoid Component failure. Survival rates free of revision by Glenoid implant type at 5, 10, and 15 years were, respectively, 96%, 96%, and 95% for 99 Neer II all-poly; 96%, 94%, and 89% for 316 Neer II metal-backed; 86%, 79%, and 67% for 316 Cofield 1 metal-backed; 94%, 94%, and 87% for 18 Cofield 1 all-poly; 99%, 94%, and 89% for 497 Cofield 2 all-poly keeled; and 99% at 5 years for 358 Cofield 2 all-poly pegged. Glenoid Component type was significantly associated with Component revision ( P P P = .02) and avascular necrosis ( P = .06) were associated with increased risk of revision. Conclusions Survival is improved with cemented all-polyethylene Glenoid Components. Revision of cemented all-polyethylene Components may be lessened with the use of pegged Components in early follow-up. Male gender and the operative diagnoses of posttraumatic arthritis or avascular necrosis are associated with an increased risk of failure. Level of Evidence Level IV, Case Series, Treatment Study.