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[PMID]: 29516162
[Au] Autor:Sowa B; Bochenek M; Braun S; Zeifang F; Kretzer JP; Bruckner T; Walch G; Raiss P
[Ad] Address:Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
[Ti] Title:Replacement options for the B2 glenoid in osteoarthritis of the shoulder: a biomechanical study.
[So] Source:Arch Orthop Trauma Surg;, 2018 Mar 07.
[Is] ISSN:1434-3916
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Glenoid replacement in cases of severe glenoid retroversion (RV) or eccentric wear is challenging. The aim of this study was to evaluate different treatment methods under standardized conditions to assist surgeons in the decision-making process. METHODS: Three treatment options for severe glenoid RV (15°) were compared: (1) no RV correction; (2) complete RV correction; (3) no RV correction and implantation of a posterior augmented glenoid (PAG). A highly standardized implantation protocol using artificial glenoid bones (five per group) was chosen, and a physiologic shoulder movement was applied in a biomechanical setting. Micromotions (MM) between glenoid components and bone were quantified using an optical 3D measuring system. RESULTS: In the uncorrected retroversion group, three instances of subluxation of the prosthetic head occurred between 2000 and 4000 cycles. At 2000 cycles, significantly more MM were observed in the uncorrected RV group than in the corrected RV group (p < 0.0001) or to the augmented group (p < 0.0001). At 10|000 cycles, more MM were observed in the posterior augmented group than in the corrected RV group (p < 0.0001). CONCLUSION: If sufficient bone stock is available, retroversion correction should be favored. Posterior augmented glenoids seem to be a suitable treatment option if complete correction of the retroversion is not possible without compromising the glenoid vault. Without correction of the retroversion, high failure rates were observed.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1007/s00402-018-2915-z

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[PMID]: 29509615
[Au] Autor:Donohue KW; Ricchetti ET; Ho JC; Iannotti JP
[Ad] Address:Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
[Ti] Title:The Association Between Rotator Cuff Muscle Fatty Infiltration and Glenoid Morphology in Glenohumeral Osteoarthritis.
[So] Source:J Bone Joint Surg Am;100(5):381-387, 2018 Mar 07.
[Is] ISSN:1535-1386
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Glenoid morphology and rotator cuff muscle quality are important anatomic factors that can impact longevity of the glenoid component following total shoulder arthroplasty (TSA). We hypothesized that rotator cuff muscle fatty infiltration is associated with increased pathologic glenoid bone loss in glenohumeral osteoarthritis (OA). METHODS: We retrospectively reviewed 190 preoperative computed tomography (CT) scans of 175 patients (mean age, 66 years; range, 44 to 90 years) who underwent TSA for the treatment of primary glenohumeral OA. Two-dimensional orthogonal CT images were reformatted in the plane of the scapula from 3-dimensional images. Pathologic joint-line medialization was defined with use of the glenoid vault model. Pathologic glenoid version was measured directly. Glenoid morphology was graded according to a modified Walch classification (subtypes A1, A2, B1, B2, B3, C1, and C2). Rotator cuff muscle fatty infiltration was assessed and assigned a Goutallier score on the sagittal CT slice just medial to the spinoglenoid notch for each muscle. RESULTS: There was a significant difference in the Goutallier score for the supraspinatus, infraspinatus, and teres minor muscles between Walch subtypes (p ≤ 0.05). High-grade posterior rotator cuff muscle fatty infiltration was present in 55% (21) of 38 B3 glenoids compared with 8% (3) of 39 A1 glenoids. Increasing joint-line medialization was associated with increasing fatty infiltration of all rotator cuff muscles (p ≤ 0.05). Higher fatty infiltration of the infraspinatus, teres minor, and combined posterior rotator cuff muscles was associated with increasing glenoid retroversion (p ≤ 0.05). After controlling for joint-line medialization and retroversion, B3 glenoids were more likely to have fatty infiltration of the supraspinatus and infraspinatus muscles than B2 glenoids were. CONCLUSIONS: High-grade rotator cuff muscle fatty infiltration is associated with B3 glenoids, increased pathologic glenoid retroversion, and increased joint-line medialization. Additional studies are needed to determine the causal relationship between these muscle changes and glenoid wear, whether these muscle changes independently affect clinical and radiographic outcomes in anatomic TSA, and whether fatty infiltration can improve postoperatively with correction of pathologic version and/or joint-line restoration. CLINICAL RELEVANCE: This study investigates the association between different patterns of glenoid bone loss and rotator cuff muscle fatty infiltration. Both factors have been shown to affect clinical outcome following TSA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Data-Review
[do] DOI:10.2106/JBJS.17.00232

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[PMID]: 29470236
[Au] Autor:Marchand LS; Todd DC; Kellam P; Adeyemi TF; Rothberg DL; Maak TG
[Ad] Address:Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
[Ti] Title:Is the Lesser Trochanter Profile a Reliable Means of Restoring Anatomic Rotation After Femur Fracture Fixation?
[So] Source:Clin Orthop Relat Res;, 2018 Feb 21.
[Is] ISSN:1528-1132
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Restoring normal femoral rotation is an important consideration when managing femur fractures. Femoral malrotation after fixation is common and several preventive techniques have been described. Use of the lesser trochanter profile is a simple method to prevent malrotation, because the profile changes with femoral rotation, but the accuracy of this method is unclear. QUESTIONS/PURPOSES: The purposes of this study were (1) to report the rotational profiles of uninjured femora in an adult population; and (2) to determine if the lesser trochanter profile was associated with variability in femoral rotation. METHODS: One hundred fifty-five consecutive patients (72% female and 28% male) with a mean age of 32 years (range, 12-56 years) with a CT scanogram were retrospectively evaluated. Patients were included if CT scanograms had adequate cuts of the proximal and distal femur. Patients were excluded if they had prior hip/femur surgery or anatomic abnormalities of the proximal femur. CT scanogram measurements of femoral rotation were compared with the lesser trochanter profile (distance from the tip of the lesser trochanter to the medial cortex of the femur) measured on weightbearing AP radiographs. These measurements were made by a single fellowship-trained orthopaedic surgeon and repeated for intraobserver reliability testing. Presence of rotational differences based on sex and laterality was assessed and correlation of the difference in lesser trochanter profile to the difference in femoral rotation was determined using a coefficient of determination (r). RESULTS: The mean femoral rotation was 10.9° (SD ± 8.8°) of anteversion. Mean right femoral rotation was 11.0° (SD ± 8.9°) and mean left femoral rotation was 10.7° (SD ± 8.7°) with a mean difference of 0.3° (95% confidence interval [CI], -1.7° to 2.3°; p = 0.76). Males had a mean rotation of 9.4°(SD ± 7.7°) and females had a mean rotation of 11.5° (SD ± 9.1°) with a mean difference of 2.1° (95% CI, -0.1° to 4.3°; p = 0.06). Mean lesser trochanter profile was 6.6 mm (SD ± 4.0 mm). Mean right lesser trochanter profile was 6.6 mm (SD ± 3.9 mm) and mean left lesser trochanter profile was 6.5 mm (SD ± 4.0 mm) with a mean difference of 0.1 mm (-0.8 mm to 1.0 mm, p = 0.86). The lesser trochanter profile varied between the sexes; males had a mean of 8.3 mm (SD ± 3.4), and females had a mean of 5.9 mm (SD ± 4.0). The mean difference between sexes was 2.5 mm (1.5-3.4 mm; p < 0.001). The magnitude of the lesser trochanter profile measurement and degree of femoral rotation were positively correlated such that increasing measures of the lesser trochanter profile were associated with increasing amounts of femoral anteversion. The lesser trochanter profile was associated with femoral version in a linear regression model (r = 0.64; p < 0.001). Thus, 64% of the difference in femoral rotation can be explained by the difference in the lesser trochanter profile. Intraobserver reliability for both the femoral version and lesser trochanter profile was noted to be excellent with intraclass correlation coefficients of 0.94 and 0.95, respectively. CONCLUSIONS: This study helps define the normal femoral rotation profile among adults without femoral injury or bone deformity and demonstrated no rotational differences between sexes. The lesser trochanter profile was found to be positively associated with femoral rotation. Increasing and decreasing lesser trochanter profile measurements are associated with increasing and decreasing amounts of femoral rotation, respectively. CLINICAL RELEVANCE: The lesser trochanter profile can determine the position of the femur in both anteversion and retroversion, supporting its use as a method to restore preinjury femoral rotation after fracture fixation. Although some variability in the rotation between sides may exist, matching the lesser trochanter profile between injured and uninjured femora can help reestablish native rotation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:Publisher
[do] DOI:10.1007/s11999.0000000000000226

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[PMID]: 29244705
[Au] Autor:Grieshaber-Bouyer R; Gerber C
[Ad] Address:1Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
[Ti] Title:Arthroscopic Repair of Recurrent Posterior Shoulder Subluxation After Total Shoulder Arthroplasty: A Case Report.
[So] Source:JBJS Case Connect;7(3):e71, 2017 Jul-Sep.
[Is] ISSN:2160-3251
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CASE: A 53-year-old man presented with osteoarthritis (Walch biconcave [B2] glenoid retroversion, 22°; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. Following anatomic total joint replacement, he developed disabling recurrent posterior subluxation despite a stable prosthesis and a correctly centered glenoid head, as observed with postoperative radiography and computed tomography. In order to avoid bone loss and the complications associated with revision arthroplasty, we performed arthroscopic reefing of the posterior capsule as an experimental minimally invasive treatment. The reduction in capsular volume successfully stabilized the shoulder for approximately 9 years; thereafter, the recurrence of instability ultimately required the conversion to a reverse prosthesis. CONCLUSION: Arthroscopic capsular reefing proved to be an effective treatment for posterior shoulder subluxations after total shoulder arthroplasty, and can be considered to avoid revision arthroplasty in young patients with a stable and correctly centered prosthesis.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171215
[Lr] Last revision date:171215
[St] Status:In-Process
[do] DOI:10.2106/JBJS.CC.17.00048

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[PMID]: 29212680
[Au] Autor:Wassilew GI; Heller MO; Janz V; Perka C; Müller M; Renner L
[Ad] Address:Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
[Ti] Title:High prevalence of acetabular retroversion in asymptomatic adults: a 3D CT-based study.
[So] Source:Bone Joint J;99-B(12):1584-1589, 2017 Dec.
[Is] ISSN:2049-4408
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:AIMS: This study sought to establish the prevalence of the cross over sign (COS) and posterior wall sign (PWS) in relation to the anterior pelvic plane (APP) in an asymptomatic population through reliable and accurate 3D-CT based assessment. MATERIALS AND METHODS: Data from pelvic CT scans of 100 asymptomatic subjects (200 hips) undertaken for conditions unrelated to disorders of the hip were available for analysis in this study. A previously established 3D analysis method was applied to assess the prevalence of the COS and PWS in relation to the APP. RESULTS: Of the 200 included hips, 24% (48) presented a positive COS and 5.5% (11) presented a positive PWS. A combination of COS and PWS was observed in 1% (two) of all hips (1%). CONCLUSION: The high incidence of acetabular retroversion, determined by the COS, shows that this anatomic configuration may not differ in frequency between asymptomatic individuals and patients with symptomatic femoroacetabular impingement (FAI). Patients presenting with hip pain and evidence of FAI should be subjected to strict diagnostic scrutiny and evaluated in the sum of their clinical and radiological presentation. In our cohort of asymptomatic adults, the COS showed a higher incidence than the PWS or a combined COS/PWS. Cite this article: 2017;99-B:1584-9.
[Mh] MeSH terms primary: Acetabulum/diagnostic imaging
Bone Retroversion/diagnostic imaging
Femoracetabular Impingement/diagnostic imaging
[Mh] MeSH terms secundary: Adolescent
Adult
Female
Hip Joint/diagnostic imaging
Humans
Imaging, Three-Dimensional
Joint Diseases/diagnostic imaging
Male
Prevalence
Tomography, X-Ray Computed
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171213
[Lr] Last revision date:171213
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171208
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B12.37081

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[PMID]: 29085983
[Au] Autor:Harmsen S; Casagrande D; Norris T
[Ad] Address:The Orthopedic Clinic Association, 2222 E Highland Ave #300, 85016, Phoenix, AZ, USA. gwsharmsen@gmail.com.
[Ti] Title:Inverse Schulterendoprothese mit individuellem autologem Glenoidaufbau : Therapie für primäre Omarthrose mit deutlichem posteriorem Glenoiddefekt (Typ B2, B3 und C). "Shaped" humeral head autograft reverse shoulder arthroplasty : Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type).
[So] Source:Orthopade;, 2017 Oct 30.
[Is] ISSN:1433-0431
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Posterior glenoid bone loss in primary glenohumeral osteoarthritis (GHOA) presents a challenge when considering replacement surgery. Results with anatomic shoulder arthroplasty are unpredictable due to posterior humeral instability and limited bone stock for glenoid component fixation. OBJECTIVES: To describe and evaluate the results of a "shaped" humeral head autograft with reverse shoulder arthroplasty (RSA) for the treatment of primary GHOA with significant posterior glenoid bone loss and an intact, functional rotator cuff. MATERIALS AND METHODS: We retrospectively reviewed 29 "shaped" humeral head autografts with RSA for the treatment of GHOA with B2 (n = 16), B3 (n = 10), or C (n = 3) glenoid morphology based on the Walch classification system. Average glenoid retroversion was 32.3°. Humeral head autografts were "shaped" to match each patient's individual glenoid morphology. Functional outcome scores, range of motion, strength, and radiographic outcomes were evaluated. RESULTS: At average follow-up of 34.6 months (range 23.7-88.9 months), significant improvements were seen in all functional outcome scores, ranges of motion, and strength (p <0.01). No recurrent instability or glenoid fixation failure occurred. Two complications (1 superficial and 1 deep infection) in 2 patients were identified. All autografts incorporated without radiographic evidence of loosening. Scapular notching was observed in 8 shoulders. No negative correlations were identified with glenoid morphology. CONCLUSIONS: "Shaped" humeral head autograft with RSA for the treatment of primary GHOA with significant posterior glenoid bone loss is associated with excellent clinical and radiographic outcomes and a low complication profile at short- to mid-term follow-up.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171031
[Lr] Last revision date:171031
[St] Status:Publisher
[do] DOI:10.1007/s00132-017-3497-0

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[PMID]: 29040131
[Au] Autor:Bulat E; Maranho DA; Kalish LA; Millis MB; Kim YJ; Novais EN
[Ad] Address:1Department of Orthopedic Surgery (E.B., D.A.M., M.B.M., Y.-J.K., and E.N.N.) and Clinical Research Center (L.A.K.), Boston Children's Hospital, Boston, Massachusetts 2Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
[Ti] Title:Acetabular Global Insufficiency in Patients with Down Syndrome and Hip-Related Symptoms: A Matched-Cohort Study.
[So] Source:J Bone Joint Surg Am;99(20):1760-1768, 2017 Oct 18.
[Is] ISSN:1535-1386
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The etiology of hip instability in Down syndrome is not completely understood. We investigated the morphology of the acetabulum and femur in patients with Down syndrome and compared measurements of the hips with those of matched controls. METHODS: Computed tomography (CT) images of the pelvis of 42 patients with Down syndrome and hip symptoms were compared with those of 42 age and sex-matched subjects without Down syndrome or history of hip disease who had undergone CT for abdominal pain. Each of the cohorts had 23 male and 19 female subjects. The mean age (and standard deviation) in each cohort was 11.3 ± 5.3 years. The lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version, and anterior and posterior acetabular sector angles (AASA and PASA) were compared. The neck-shaft angle and femoral version were measured in the patients with Down syndrome only. The hips of the patients with Down syndrome were further categorized as stable (n = 21) or unstable (n = 63) for secondary analysis. RESULTS: The hips in the Down syndrome group had a smaller LCEA (mean, 10.8° ± 12.6° compared with 25.6° ± 4.6°; p < 0.0001), a larger IA (mean, 17.4° ± 10.3° compared with 10.9° ± 4.8°; p < 0.0001), a lower ADR (mean, 231.9 ± 56.2 compared with 306.8 ± 31.0; p < 0.0001), a more retroverted acetabulum (mean acetabular version as measured at the level of the centers of the femoral heads [AVC], 7.8° ± 5.1° compared with 14.0° ± 4.5°; p < 0.0001), a smaller AASA (mean, 55.0° ± 9.9° compared with 59.7° ± 7.8°; p = 0.005), and a smaller PASA (mean, 67.1° ± 10.4° compared with 85.2° ± 6.8°; p < 0.0001). Within the Down syndrome cohort, the unstable hips showed greater femoral anteversion (mean, 32.7° ± 14.6° compared with 23.6° ± 10.6°; p = 0.002) and worse global acetabular insufficiency compared with the stable hips. No differences between the unstable and stable hips were found with respect to acetabular version (mean AVC, 7.8° ± 5.5° compared with 7.6° ± 3.8°; p = 0.93) and the neck-shaft angle (mean, 133.7° ± 6.7° compared with 133.2° ± 6.4°; p = 0.81). CONCLUSIONS: Patients with Down syndrome and hip-related symptoms had more retroverted and shallower acetabula with globally reduced coverage of the femoral head compared with age and sex-matched subjects. Hip instability among those with Down syndrome was associated with worse global acetabular insufficiency and increased femoral anteversion, but not with more severe acetabular retroversion. No difference in the mean femoral neck-shaft angle was observed between the stable and unstable hips in the Down syndrome cohort. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] MeSH terms primary: Acetabulum/pathology
Down Syndrome/complications
Femur Head/pathology
Hip Joint/pathology
Joint Instability/etiology
Tomography, X-Ray Computed
[Mh] MeSH terms secundary: Acetabulum/diagnostic imaging
Acetabulum/physiopathology
Adolescent
Adult
Bone Anteversion/diagnostic imaging
Bone Anteversion/etiology
Bone Anteversion/pathology
Bone Anteversion/physiopathology
Bone Retroversion/diagnostic imaging
Bone Retroversion/etiology
Bone Retroversion/pathology
Bone Retroversion/physiopathology
Case-Control Studies
Child
Child, Preschool
Down Syndrome/pathology
Down Syndrome/physiopathology
Female
Femur Head/diagnostic imaging
Femur Head/physiopathology
Hip Joint/diagnostic imaging
Hip Joint/physiopathology
Humans
Joint Instability/diagnostic imaging
Joint Instability/pathology
Male
Retrospective Studies
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171018
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.17.00341

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[PMID]: 28965687
[Au] Autor:Domos P; Checchia CS; Walch G
[Ad] Address:Sheffield Teaching Hospitals NHS Foundation Trust, The Northern General Hospital, Sheffield, UK. Electronic address: peter.domos@googlemail.com.
[Ti] Title:Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head.
[So] Source:J Shoulder Elbow Surg;, 2017 Sep 28.
[Is] ISSN:1532-6500
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The management of primary osteoarthritis of the shoulder has been well investigated. However, the etiology and management of posterior humeral head subluxation in the context of primary glenohumeral osteoarthritis remain controversial. The finding of static posterior subluxation of the humeral head before the development of posterior bone erosion of the glenoid in young men with radiographic findings of primary osteoarthritis has been described as arthrogenic posterior subluxation of the humeral head. It demonstrates the earliest form of the osteoarthritic evolution, and an excessive glenoid retroversion is the only probable cause of this static subluxation, although this is controversial. The clinical relevance of these findings is important in allowing the identification of patients at risk for development of glenohumeral osteoarthritis and in developing an early treatment for the subluxation to try to alter the natural course of this disease. The aim of our summary paper was to review the current literature on this matter in an attempt to better understand the pathophysiologic mechanism of this condition, which we named pre-osteoarthritic posterior subluxation of the humeral head, or Walch B-zero (B0) glenoid. It appears that Walch B0 glenoid is a pathologic condition (initially dynamic, eventually evolving into a static condition) that may lead to posterior erosion of the glenoid, taking place once there is asymmetric increased posterior glenohumeral contact forces and possibly associated with increased glenoid retroversion.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1710
[Cu] Class update date: 171002
[Lr] Last revision date:171002
[St] Status:Publisher

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[PMID]: 28948516
[Au] Autor:Chen X; Reddy AS; Kontaxis A; Choi DS; Wright T; Dines DM; Warren RF; Berhouet J; Gulotta LV
[Ad] Address:Hospital for Special Surgery, 535 East 70 Street, New York, NY, 10021, USA. chenx@hss.edu.
[Ti] Title:Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.
[So] Source:Clin Orthop Relat Res;475(12):3090-3099, 2017 Dec.
[Is] ISSN:1528-1132
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Version correction via eccentric reaming reduces clinically important retroversion in Walch type B2 glenoids (those with substantial glenoid retroversion and a second, sclerotic neoglenoid cavity) before total shoulder arthroplasty (TSA). Clinically, an increased risk of glenoid component loosening in B2 glenoids was hypothesized to be the result of compromised glenoid bone quality attributable to eccentric reaming. However, no established guidelines exist regarding how much version correction can be applied without compromising the quality of glenoid bone. QUESTIONS/PURPOSES: (1) How does version correction correlate to the reaming depth and the volume of resected bone during eccentric reaming of B2 glenoids? (2) How does version correction affect the density of the remaining glenoid bone? (3) How does version correction affect the spatial distribution of high-quality bone in the remaining glenoid? METHODS: CT scans of 25 patients identified with Walch type B2 glenoids (age, 68 ± 9 years; 14 males, 11 females) were selected from a cohort of 111 patients (age, 69 ± 10 years; 50 males, 61 females) with primary shoulder osteoarthritis who underwent TSA. Virtual TSA with version corrections of 0°, 5°, 10°, and 15° was performed on 25 CT-reconstructed three-dimensional models of B2 scapulae. After simulated eccentric reaming at each version correction angle, bone density (Hounsfield units [HUs]) was analyzed in five adjacent 1-mm layers under the reamed glenoid surface. Remaining high-quality bone (> 650 HUs) distribution in each 1-mm layer at different version corrections was observed on spatial distribution maps. RESULTS: Larger version corrections required more bone resection, especially from the anterior glenoid. Mean bone densities in the first 1-mm bone bed under the reamed surface were lower with 10° (523.3 ± 79.9 HUs) and 15° (479.5 ± 81.0 HUs) version corrections relative to 0° (0°, 609.0 ± 103.9 HUs; mean difference between 0° and 15°, 129.5 HUs [95% CI, 46.3-212.8 HUs], p < 0.001; mean difference between 0° and 10°, 85.7 HUs [95% CI, 8.6-162.9 HUs], p = 0.021) version correction. Similar results were observed for the second 1-mm bone bed. Spatial distribution maps qualitatively showed a decreased frequency of high-quality bone in the anterior glenoid as version correction increased. CONCLUSIONS: A version correction as low as 10° was shown to reduce the density of the glenoid bone bed for TSA glenoid fixation in our computational study that simulated reaming on CT-reconstructed B2 glenoid models. Increased version correction resulted in gradual depletion of high-quality bone from the anterior region of B2 glenoids. CLINICAL RELEVANCE: This computational study of eccentric reaming of the glenoid before TSA quantitatively showed glenoid bone quality is sensitive to version correction via simulated eccentric reaming. The bone density results of our study may benefit surgeons to better plan TSA on B2 glenoids needing durable bone support, and help to clarify goals for development of precision surgical tools.
[Mh] MeSH terms primary: Arthroplasty, Replacement/methods
Glenoid Cavity/surgery
Osteoarthritis/surgery
Osteotomy/methods
Patient-Specific Modeling
Shoulder Joint/surgery
Surgery, Computer-Assisted
[Mh] MeSH terms secundary: Aged
Arthroplasty, Replacement/adverse effects
Arthroplasty, Replacement/instrumentation
Bone Density
Female
Glenoid Cavity/diagnostic imaging
Glenoid Cavity/physiopathology
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Osteoarthritis/diagnostic imaging
Osteoarthritis/physiopathology
Osteotomy/adverse effects
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Shoulder Joint/diagnostic imaging
Shoulder Joint/physiopathology
Shoulder Prosthesis
Surgery, Computer-Assisted/adverse effects
Tomography, X-Ray Computed
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171117
[Lr] Last revision date:171117
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170927
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-017-5510-7

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[PMID]: 28941973
[Au] Autor:Takenaga T; Goto H; Sugimoto K; Tsuchiya A; Fukuyoshi M; Nakagawa H; Nozaki M; Takeuchi S; Otsuka T
[Ad] Address:Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: take10280425@yahoo.co.jp.
[Ti] Title:Left-handed skeletally mature baseball players have smaller humeral retroversion in the throwing arm than right-handed players.
[So] Source:J Shoulder Elbow Surg;26(12):2187-2192, 2017 Dec.
[Is] ISSN:1532-6500
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: It is known that the humeral retroversion of baseball players is greater in the throwing arm than in the nonthrowing arm. An investigation measuring dry bone specimens also showed that the right humerus had greater retroversion than the left. Considering these facts, it was hypothesized that humeral retroversion would differ between right- and left-handed players. This study aimed to compare the bilateral humeral retroversion between right- and left-handed skeletally mature baseball players. METHODS: We investigated 260 (196 right-handed and 64 left-handed) male baseball players who belonged to a college or amateur team. Bilateral humeral retroversion was assessed using an ultrasound-assisted technique (humeral torsion angle [HTA]) as described by previous studies. Analysis of covariance, adjusted for handedness and baseball position, assessed the effect of throwing arm dominance on HTA. RESULTS: In comparison of the throwing arm, HTA was significantly smaller in left-handed (left humerus) than in right-handed (right humerus) players (77° vs. 81°; P < .001). In comparison of the nonthrowing arm, HTA was significantly greater in left-handed (right humerus) than in right-handed (left humerus) players (73° vs. 69°; P < .001). The mean side-to-side difference of HTA was significantly smaller in left-handed than in right-handed players (3° vs. 12°; P < .001). CONCLUSIONS: Humeral retroversion of left-handed skeletally mature baseball players was significantly smaller in the throwing arm, greater in the nonthrowing arm, and smaller in side-to-side differences than that of right-handed players. These findings may be key to understanding some of the biomechanical differences between right- and left-handed baseball players.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 171117
[Lr] Last revision date:171117
[St] Status:In-Process


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