Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty?

Verhaegen, Filip; Plessers, Katrien; Verborgt, Olivier; Scheys, Lennart; Debeer, Philippe

doi:10.1016/j.jse.2017.12.024

Cited by 19 publications

(18 citation statements)

References 35 publications

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“… 47 The contralateral shoulder may be a reliable model; like side to side differences are limited to 5 degrees in 95% of cases. 48 It is also important to assess the version in three dimensions, as in cases with > 10 degrees version, it is not solely direct posteriorly but also in superior, inferior, and anterior directions. 49 A further important indicator when performing ATSA is that the version of the inferior part of the glenoid shows substantially less variability compared to the upper part and should therefore be used as the preferred intraoperative landmark in order to achieve adequate implant positioning.…”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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“…Using the registered contralateral bone, the glenoid bone defects in the dataset showed a mean (and p95 CI) of 7.2 mm (5.2-9.2) for the defect depth, 49.3% (37.3-61.6) for the defect area percentage, 25.8% (17.0-35.7) for the total vault loss percentage and 22.5% (13.4-32.9), 29.5% (19.6-40.5), 26.0% (17.1-36.1) and 29.1% (19.7-39.4) for the local vault loss percentages in respectively the superior, anterior, inferior and posterior region (Figure 6). The subluxation distance had a mean value of 7.5mm (5.6-9.6) with 5 humeri in the superior region, 5 in the anterior region, 4 in the inferior region and 13 in the posterior region.…”

Section: Resultsmentioning

confidence: 99%

“…To measure the accuracy of the reconstruction result, the healthy contralateral scapula was considered as a reference. 10,21,25 All healthy scapulae were mirrored and registered to the defect scapulae using icp registration. To avoid registering on defect parts, the affected regions of the defect scapulae were manually cut out before registering.…”

Section: Discussionmentioning

confidence: 99%

“…In order to account for the native glenoid shape when analyzing glenoid bone defects, the healthy contralateral bone can be considered as a template. 10,21,25 Registration of a healthy contralateral bone allows identifying the amount of bone erosion and performing quantitative measures on the glenoid bone defect. However, many patients suffer from bilateral shoulder degeneration and therefore no healthy contralateral side is available.…”

Section: Introductionmentioning

confidence: 99%

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Automated quantification of glenoid bone defects using 3-dimensional measurements

Plessers

Verhaegen

Dijck

et al. 2020

Journal of Shoulder and Elbow Surgery

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Background: Assessment of glenoid bone defects is important to select the optimal glenoid component design during shoulder arthroplasty planning and implantation. This study presents a fully automated method to describe glenoid bone loss using three-dimensional measurements and without the need for a healthy contralateral reference scapula. Methods:The native shape of the glenoid is reconstructed by fitting a statistical shape model (SSM) of the scapula. The total vault loss percentage, local vault loss percentages, defect depth, defect area percentage and subluxation distance and region are computed based on a comparison of the reconstructed and eroded glenoid. The method is evaluated by comparing its results with a contralateral-based reconstruction approach, on a dataset of 34 scapulae and humeri pairs with unilateral glenoid bone defects. Results:The SSM-based defect measurements deviated from the contralateral-based measurements with a mean absolute difference of 5.5% on the total vault loss percentage, 4.5 to 8.0% on the local vault loss percentages, 1.9mm on the defect depth, 14.8% on the defect area percentage and 1.6mm on the subluxation distance. The SSM-based method was found to be statistically equivalent to the contralateral-based method for all parameters except for the defect area percentage. Conclusion:The presented method is able to automatically analyze glenoid bone defects using three-dimensional measurements, without the need for a healthy contralateral bone.

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“…A finite element (FE) model was developed based on the mean shape of 66 scapulae without any signs of bony pathology from a computed tomography scan data set. 35 Scapular landmarks, planes, reference axes, and orientation were determined as described by Amadi et al 1 and Verhaegen et al 43 The scapular bone was modeled as a homogeneous material with a mean Young modulus of 1.8 GPa and Poisson ratio of 0.3, corresponding to a weighted average of 10% cortical and 90% cancellous bone. 6 Bone erosion was then simulated, using the most frequent type of erosion in osteoarthritis (type B2) according to the 3dimensional (3D) orientation of this type of erosion.…”

Section: Scanning Bone Erosion Creation and Virtual Implantationmentioning

confidence: 99%

How much bone support does an anatomic glenoid component need?

Verhaegen

Campopiano

Debeer

et al. 2020

Journal of Shoulder and Elbow Surgery

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Background: An important reason for failure of anatomic total shoulder arthroplasty is glenoid component loosening. We investigated the effect of backside bone support on the risk of failure of a glenoid component. Methods: A finite element model was developed. Virtual surgery was performed for 2 types of glenoid components (cemented all polyethylene [PE] vs. metal backed [MB]), both with gradually decreasing backside bone support. Both bone failure and fixation failure were analyzed. The percentages of bone failure and fixation failure in terms of the critical cement volume (CCV) and micromotion-threshold percentage ratio (MTPR) for the PE and MB components, respectively, were defined and compared. Results: For the reference PE model, the percentages of bone failure and fixation failure (CCV) were 17% and 34%, respectively. With eccentric loading for the MB component, the percentages of bone failure and fixation failure (MTPR) were 6% and 3%, respectively. A global increase in failure was observed with decreasing bone support. The increase in fixation failure, starting from the reference values (MTPR vs. CCV), was relatively more pronounced for the MB component (136% vs. 128%). Discussion: Decreasing backside bone support for an anatomic glenoid component leads to an increased risk of fixation and bone failure. For PE components, decreasing backside support to 95% bone support had only a limited effect. In the case of an MB component, we noticed an increase in micromotion and bone failure already starting from 97% bone support. We conclude that an anatomic glenoid component should always be implanted while maximizing backside bone support.

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Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty?

Cited by 19 publications

References 35 publications

Biomechanics of anatomic and reverse shoulder arthroplasty

Biomechanics of anatomic and reverse shoulder arthroplasty

Automated quantification of glenoid bone defects using 3-dimensional measurements

How much bone support does an anatomic glenoid component need?

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