Comparison of Asymmetric Reaming versus a Posteriorly Augmented Component for Posterior Glenoid Wear and Retroversion: A Radiographic Study.

Augmented glenoid Glenoid reaming Shoulder arthritis Total shoulder arthoplasty

Journal

The archives of bone and joint surgery
ISSN: 2345-4644
Titre abrégé: Arch Bone Jt Surg
Pays: Iran
ID NLM: 101636743

Informations de publication

Date de publication:
Jul 2019
Historique:
entrez: 27 8 2019
pubmed: 27 8 2019
medline: 27 8 2019
Statut: ppublish

Résumé

Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty. Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either approach. Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were consecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version, humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views were reviewed to measure corrected inversion and humeral head subluxation. There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6.8 degrees in the AR group. In the PAG group, version improved 8.8 degrees with 3 mm augment, 13.4 degrees with 5 mm augment, and 12.8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group compared to other groups. The humeral head was re-centered within 6.1% of normal in all groups except 7 mm augments. This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilized in patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoid retroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study. Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.

Sections du résumé

BACKGROUND BACKGROUND
Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty. Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either approach.
METHODS METHODS
Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were consecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version, humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views were reviewed to measure corrected inversion and humeral head subluxation.
RESULTS RESULTS
There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6.8 degrees in the AR group. In the PAG group, version improved 8.8 degrees with 3 mm augment, 13.4 degrees with 5 mm augment, and 12.8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group compared to other groups. The humeral head was re-centered within 6.1% of normal in all groups except 7 mm augments.
CONCLUSION CONCLUSIONS
This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilized in patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoid retroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study. Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.

Identifiants

PMID: 31448306 PMC: PMC6686063
pubmed: 31448306
pmc: PMC6686063

Types de publication

Journal Article

Langues

eng

Pagination

307-313

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Auteurs

Jia-Wei Kevin Ko (JW)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Usman Ali Syed (UA)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Jonathan D Barlow (JD)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Scott Paxton (S)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Bryan J Loeffler (BJ)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Ocean Thakar (O)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Grant Jamgochian (G)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Joseph A Abboud (JA)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Charles L Getz (CL)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Gerald R Williams (GR)

Orthopedic Physician Associates at Swedish Orthopedic Institute Seattle, WA, USA.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Brown University, Providence, RI, USA.
OrthoCarolina, Charlotte, NC, USA.
Research performed at The Rothman Institute, Philadelphia, USA.

Classifications MeSH