Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear

Simon, Péter; Gupta, Anil K.; Pappou, Ioannis P.; Hussey, Michael M.; Santoni, Brandon G.; Inoue, Nozomu; Frankle, Mark A.

doi:10.1016/j.jse.2014.06.054

Cited by 42 publications

(34 citation statements)

References 14 publications

(16 reference statements)

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“…Both of these findings support the assertion that component design was the primary determinant of the findings seen. A final limitation for this study is that in vivo remodeling of subchondral glenoid bone density in osteoarthritis was not modeled and also might affect implant fixation [4,26,38]. This limitation is inherent in cadaveric and synthetic test models.…”

Section: Discussionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Uncorrected glenoid retroversion during total shoulder arthroplasty may lead to an increased likelihood of glenoid prosthetic loosening. Augmented glenoid components seek to correct retroversion to address posterior glenoid bone loss, but few biomechanical studies have evaluated their performance. Questions/purposes We compared the use of augmented glenoid components with eccentric reaming with standard glenoid components in a posterior glenoid wear model. The primary outcome for biomechanical stability in this model was assessed by (1) implant edge displacement in superior and inferior edge loading at intervals up to 100,000 cycles, with secondary outcomes including (2) implant edge load during superior and inferior translation at intervals up to 100,000 cycles, and (3) incidence of glenoid fracture during implant preparation and after cyclic loading. Methods A 12°-posterior glenoid defect was created in 12 composite scapulae, and the specimens were divided in two equal groups. In the posterior augment group, glenoid version was corrected to 8°and an 8°-augmented polyethylene glenoid component was placed. In the eccentric reaming group, anterior glenoid reaming was performed to neutral version and a standard polyethylene glenoid component was placed. Specimens were cyclically loaded in the superoinferior direction to 100,000 cycles. Superior and inferior glenoid edge displacements were recorded. Results Surviving specimens in the posterior augment group showed greater displacement than the eccentric reaming group of superior (1.01 ± 0.02 [95% CI, 0.89-1.13] versus 0. 83 ± 0.10 [95% CI,

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Section: Discussionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Multiple small press-fitted pegs have the ability to resist shear forces 21 and reduce the effects of rocking horse movement because they may be placed near the periphery of the glenoid 22 so that they anchor in stiffer and denser subchondral bone instead of the deeper trabecular bone near the center. [23][24][25][26][27] Pull-out tests have been used to assess fixation stability of bone screws 28 or cemented pegs 16 but data on the performance of small press-fitted UHMWPE pegs is currently unavailable.…”

mentioning

confidence: 99%

Stability of small pegs for cementless implant fixation

Geraldes

Hansen

Jeffers

et al. 2017

Journal Orthopaedic Research

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Most glenoid implants rely on large centrally located fixation features to avoid perforation of the glenoid vault in its peripheral regions. Upon revision of such components there may not be enough bone left for the reinsertion of an anatomical prosthesis. Multiple press‐fit small pegs would allow for less bone resection and strong anchoring in the stiffer and denser peripheral subchondral bone. This study assessed the fixation characteristics, measured as the push‐in (P in) and pull‐out (P out) forces, and spring‐back, measured as the elastic displacement immediately after insertion, for five different small press‐fitted peg configurations manufactured out of UHMWPE cylinders (5 mm diameter and length). A total of 16 specimens for each configuration were tested in two types of solid bone substitute: Hard (40 PCF, 0.64 g/cm3, worst‐case scenario of P in) and soft (15 PCF, 0.24 g/cm3, worst‐case scenario of spring‐back and P out). Two different diametric interference‐fits were studied. Geometries with lower stiffness fins (large length to width aspect ratio) were the best performing designs in terms of primary fixation stability. They required the lowest force to fully seat, meaning they are less damaging to the bone during implantation, while providing the highest P out/P in ratio, indicating that when implanted they provide the strongest anchoring for the glenoid component. It is highlighted that drilling of chamfered holes could minimize spring‐back displacements. These findings are relevant for the design of implants press‐fitted pegs because primary fixation has been shown to be an important factor in achieving osseointegration and longevity of secondary fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2765–2772, 2017.

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“…In addition, the distribution of subarticular bone density in B2 glenoids is characteristically different compared with symmetrically eroded glenoids. 10,18 Bone density is greatest in the subarticular bone of the posterior eroded glenoid facet, or neoglenoid as termed by Walch et al 5,21 As such, the neoglenoid contains thicker, denser, and less porous bone. Unfortunately, this good-quality bone in the neoglenoid is found in the subarticular zone only and diminishes with greater depth.…”

mentioning

confidence: 99%

“…Unfortunately, this good-quality bone in the neoglenoid is found in the subarticular zone only and diminishes with greater depth. 10,18 Augmented implant preparation techniques that involve removal of substantial amounts of the neoglenoid bone may leave behind less dense bone with greater porosity to support the implant for its life span.…”

mentioning

confidence: 99%

Augmented glenoid component designs for type B2 erosions: a computational comparison by volume of bone removal and quality of remaining bone

Knowles

Ferreira

Athwal

2015

Journal of Shoulder and Elbow Surgery

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Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear

Cited by 42 publications

References 14 publications

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Stability of small pegs for cementless implant fixation

Augmented glenoid component designs for type B2 erosions: a computational comparison by volume of bone removal and quality of remaining bone

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