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The subchondral bone layer and glenoid implant design are relevant for primary stability in glenoid arthroplasty

  • Orthopaedic Surgery
  • Published:
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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.

Methods

Different techniques for preparation of an A1 glenoid were compared: (1) preserving the subchondral bone layer; (2) removal of the subchondral bone layer; (3) implantation of a glenoid component that does not adapt to the native anatomy. Artificial glenoid bones (n = 5 each) were used with a highly standardized preparation and implantation protocol. Biomechanical testing was performed during simulated physiological shoulder motion. Using a high-resolution optical system, the micromotions between implant and bone were measured up to 10,000 motion cycles.

Results

At the 10,000 cycle measuring point, significantly more micromotions were found in the subchondral layer removed group than in the subchondral layer preserved group (p = 0.0427). The number of micromotions in the nonadapted group was significantly higher than in the subchondral layer preserved group (p = 0.0003) or the subchondral layer removed group (p = 0.0207).

Conclusion

Conservative reaming proved important to diminish the micromotions of the glenoid component. Implantation of a glenoid component that matches with the bony underlying glenoid can help to preserve the subchondral bone layer without sacrificing proper implant seating.

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Acknowledgements

We would like to thank the non-profit research fund of Stiftung Endoprothetik (Hamburg, Germany) for supporting this study.

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Authors and Affiliations

  1. Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Boris Sowa, Martin Bochenek, Steffen Braun, Jan Philippe Kretzer & Patric Raiss

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Thomas Bruckner

  3. Hôpital Privé Jean-Mermoz –GDS Ramsay, 24, Avenue Paul Santy, 69008, Lyon, France

    Gilles Walch

  4. OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany

    Patric Raiss

  5. Ethianum Clinic Heidelberg, Voßstraße 6, 69115, Heidelberg, Germany

    Felix Zeifang

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  1. Boris Sowa
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  2. Martin Bochenek
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  3. Steffen Braun
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  4. Jan Philippe Kretzer
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  7. Gilles Walch
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Corresponding author

Correspondence to Boris Sowa.

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Conflict of interest

Gilles Walch receives royalties from Wright Medical. Gilles Walch, Felix Zeifang and Patric Raiss have consultancy contracts with Wright Medical. The other authors, their immediate families, and any research foundations with which they are affiliated have received no financial payments or other benefits from any commercial entity related to the subject of this article. The prostheses used for this investigation were supplied free of charge by the manufacturer (Wright Medical®, Memphis, Tennessee, USA). The manufacturer had no influence on the design or results of this study.

Ethical statement

The study is original and not under review by another journal. Ethical approval is not required, as for this biomechanical investigation only artificial bones were used.

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Sowa, B., Bochenek, M., Braun, S. et al. The subchondral bone layer and glenoid implant design are relevant for primary stability in glenoid arthroplasty. Arch Orthop Trauma Surg 138, 1487–1494 (2018). https://doi.org/10.1007/s00402-018-2990-1

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  • DOI: https://doi.org/10.1007/s00402-018-2990-1

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