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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 11, pp 1487–1494 | Cite as

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

  • Boris Sowa
  • Martin Bochenek
  • Steffen Braun
  • Jan Philippe Kretzer
  • Felix Zeifang
  • Thomas Bruckner
  • Gilles Walch
  • Patric Raiss
Orthopaedic Surgery
  • 103 Downloads

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.

Keywords

TSA Subchondral Glenoid Reaming A1 Anatomic 

Notes

Acknowledgements

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

Compliance with ethical standards

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.

References

  1. 1.
    Antuna S, Sperling JW, Cofield RH (2002) Reimplantation of a glenoid component after component removal and allograft bone grafting: a report of 3 cases. J Shoulder Elbow Surg 11(6):637–641.  https://doi.org/10.1067/mse.2002.126100 CrossRefPubMedGoogle Scholar
  2. 2.
    Denard PJ, Raiss P, Sowa B, Walch G (2013) Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis. J Shoulder Elbow Surg 22(7):894–900.  https://doi.org/10.1016/j.jse.2012.09.016 CrossRefPubMedGoogle Scholar
  3. 3.
    Deshmukh AV, Koris M, Zurakowski D, Thornhill TS (2005) Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life. J Shoulder Elbow Surg 14(5):471–479.  https://doi.org/10.1016/j.jse.2005.02.009 CrossRefPubMedGoogle Scholar
  4. 4.
    Kasten P, Pape G, Raiss P, Bruckner T, Rickert M, Zeifang F, Loew M (2010) Mid-term survivorship analysis of a shoulder replacement with a keeled glenoid and a modern cementing technique. J Bone Joint Surg Br 92(3):387–392.  https://doi.org/10.1302/0301-620x.92b3.23073 CrossRefPubMedGoogle Scholar
  5. 5.
    Raiss P, Aldinger PR, Kasten P, Rickert M, Loew M (2008) Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis. J Bone Joint Surg Br 90(6):764–769.  https://doi.org/10.1302/0301-620x.90b6.20387 CrossRefPubMedGoogle Scholar
  6. 6.
    Walch G, Young AA, Melis B, Gazielly D, Loew M, Boileau P (2011) Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years. J Shoulder Elbow Surg 20(3):385–394.  https://doi.org/10.1016/j.jse.2010.07.011 CrossRefPubMedGoogle Scholar
  7. 7.
    Bohsali KI, Wirth MA, Rockwood CA Jr (2006) Complications of total shoulder arthroplasty. J Bone Joint Surg Am 88(10):2279–2292.  https://doi.org/10.2106/jbjs.f.00125 CrossRefPubMedGoogle Scholar
  8. 8.
    Wirth MA, Tapscott RS, Southworth C, Rockwood CA Jr (2006) Treatment of glenohumeral arthritis with a hemiarthroplasty: a minimum five-year follow-up outcome study. J Bone Joint Surg Am 88(5):964–973.  https://doi.org/10.2106/JBJS.D.03030 CrossRefPubMedGoogle Scholar
  9. 9.
    Chin PY, Sperling JW, Cofield RH, Schleck C (2006) Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg 15(1):19–22.  https://doi.org/10.1016/j.jse.2005.05.005 CrossRefPubMedGoogle Scholar
  10. 10.
    Sperling JW, Cofield RH, Rowland CM (2004) Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger. J Shoulder Elbow Surg 13(6):604–613.  https://doi.org/10.1016/S1058274604001296 CrossRefPubMedGoogle Scholar
  11. 11.
    Bercik MJ, Kruse K 2nd, Yalizis M, Gauci MO, Chaoui J, Walch G (2016) A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 25(10):1601–1606.  https://doi.org/10.1016/j.jse.2016.03.010 CrossRefPubMedGoogle Scholar
  12. 12.
    Bergmann G, Graichen F, Bender A, Rohlmann A, Halder A, Beier A, Westerhoff P (2011) In vivo gleno-humeral joint loads during forward flexion and abduction. J Biomech 44(8):1543–1552.  https://doi.org/10.1016/j.jbiomech.2011.02.142 CrossRefPubMedGoogle Scholar
  13. 13.
    Papadonikolakis A, Matsen FA 3rd (2014) Metal-backed glenoid components have a higher rate of failure and fail by different modes in comparison with all-polyethylene components: a systematic review. J Bone Joint Surg Am 96(12):1041–1047.  https://doi.org/10.2106/JBJS.M.00674 CrossRefPubMedGoogle Scholar
  14. 14.
    Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D (2002) Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg 11(4):351–359.  https://doi.org/10.1067/mse.2002.125807 CrossRefPubMedGoogle Scholar
  15. 15.
    Martin SD, Zurakowski D, Thornhill TS (2005) Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes. J Bone Joint Surg Am 87(6):1284–1292.  https://doi.org/10.2106/jbjs.c.00947 CrossRefPubMedGoogle Scholar
  16. 16.
    Taunton MJ, McIntosh AL, Sperling JW, Cofield RH (2008) Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component. Medium to long-term results. J Bone Joint Surg Am 90(10):2180–2188.  https://doi.org/10.2106/JBJS.G.00966 CrossRefPubMedGoogle Scholar
  17. 17.
    Fucentese SF, Costouros JG, Kuhnel SP, Gerber C (2010) Total shoulder arthroplasty with an uncemented soft-metal-backed glenoid component. J Shoulder Elbow Surg 19(4):624–631.  https://doi.org/10.1016/j.jse.2009.12.021 CrossRefPubMedGoogle Scholar
  18. 18.
    Castagna A, Randelli M, Garofalo R, Maradei L, Giardella A, Borroni M (2010) Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br 92(10):1410–1415.  https://doi.org/10.1302/0301-620X.92B10.23578 CrossRefPubMedGoogle Scholar
  19. 19.
    Katz D, Kany J, Valenti P, Sauzieres P, Gleyze P, El Kholti K (2013) New design of a cementless glenoid component in unconstrained shoulder arthroplasty: a prospective medium-term analysis of 143 cases. Eur J Orthop Surg Traumatol 23(1):27–34.  https://doi.org/10.1007/s00590-012-1109-6 CrossRefPubMedGoogle Scholar
  20. 20.
    Young A, Walch G, Boileau P, Favard L, Gohlke F, Loew M, Mole D (2011) A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis. J Bone Joint Surg Br 93(2):210–216.  https://doi.org/10.1302/0301-620x.93b2.25086 CrossRefPubMedGoogle Scholar
  21. 21.
    Collins D, Tencer A, Sidles J, Matsen F 3rd (1992) Edge displacement and deformation of glenoid components in response to eccentric loading. The effect of preparation of the glenoid bone. J Bone Joint Surg Am 74(4):501–507CrossRefGoogle Scholar
  22. 22.
    Walch G, Young AA, Boileau P, Loew M, Gazielly D, Mole D (2012) Patterns of loosening of polyethylene keeled glenoid components after shoulder arthroplasty for primary osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am 94(2):145–150.  https://doi.org/10.2106/JBJS.J.00699 CrossRefPubMedGoogle Scholar
  23. 23.
    Terrier A, Obrist R, Becce F, Farron A (2017) Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality. J Shoulder Elbow Surg 26(9):1644–1652.  https://doi.org/10.1016/j.jse.2017.02.023 CrossRefPubMedGoogle Scholar
  24. 24.
    Clinton J, Franta AK, Lenters TR, Mounce D, Matsen FA 3rd (2007) Nonprosthetic glenoid arthroplasty with humeral hemiarthroplasty and total shoulder arthroplasty yield similar self-assessed outcomes in the management of comparable patients with glenohumeral arthritis. J Shoulder Elbow Surg 16(5):534–538.  https://doi.org/10.1016/j.jse.2006.11.003 CrossRefPubMedGoogle Scholar
  25. 25.
    Simon P, Gupta A, Pappou I, Hussey MM, Santoni BG, Inoue N, Frankle MA (2015) Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear. J Shoulder Elbow Surg 24(3):416–424.  https://doi.org/10.1016/j.jse.2014.06.054 CrossRefPubMedGoogle Scholar
  26. 26.
    Denard PJ, Walch G (2013) Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elbow Surg 22(11):1589–1598.  https://doi.org/10.1016/j.jse.2013.06.017 CrossRefPubMedGoogle Scholar
  27. 27.
    Nowak DD, Bahu MJ, Gardner TR, Dyrszka MD, Levine WN, Bigliani LU, Ahmad CS (2009) Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: the amount of glenoid retroversion that can be corrected. J Shoulder Elbow Surg 18(5):680–688.  https://doi.org/10.1016/j.jse.2009.03.019 CrossRefPubMedGoogle Scholar
  28. 28.
    Favorito PJ, Freed RJ, Passanise AM, Brown MJ (2016) Total shoulder arthroplasty for glenohumeral arthritis associated with posterior glenoid bone loss: results of an all-polyethylene, posteriorly augmented glenoid component. J Shoulder Elbow Surg 25(10):1681–1689.  https://doi.org/10.1016/j.jse.2016.02.020 CrossRefPubMedGoogle Scholar
  29. 29.
    Stephens SP, Spencer EE, Wirth MA (2016) Radiographic results of augmented all-polyethylene glenoids in the presence of posterior glenoid bone loss during total shoulder arthroplasty. J Shoulder Elbow Surg.  https://doi.org/10.1016/j.jse.2016.09.053 CrossRefPubMedGoogle Scholar
  30. 30.
    Neer CS 2nd, Morrison DS (1988) Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am 70(8):1154–1162CrossRefGoogle Scholar
  31. 31.
    Hill JM, Norris TR (2001) Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid. J Bone Joint Surg Am 83-A(6):877–883CrossRefGoogle Scholar
  32. 32.
    Sabesan V, Callanan M, Ho J, Iannotti JP (2013) Clinical and radiographic outcomes of total shoulder arthroplasty with bone graft for osteoarthritis with severe glenoid bone loss. J Bone Joint Surg Am 95(14):1290–1296.  https://doi.org/10.2106/JBJS.L.00097 CrossRefPubMedGoogle Scholar
  33. 33.
    Mizuno N, Denard PJ, Raiss P, Walch G (2013) Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 95(14):1297–1304.  https://doi.org/10.2106/JBJS.L.00820 CrossRefPubMedGoogle Scholar
  34. 34.
    McFarland EG, Huri G, Hyun YS, Petersen SA, Srikumaran U (2016) Reverse total shoulder arthroplasty without bone-grafting for severe glenoid bone loss in patients with osteoarthritis and intact rotator cuff. J Bone Joint Surg Am 98(21):1801–1807.  https://doi.org/10.2106/JBJS.15.01181 CrossRefPubMedGoogle Scholar
  35. 35.
    Gallusser N, Farron A (2014) Complications of shoulder arthroplasty for osteoarthritis with posterior glenoid wear. Orthop Traumatol Surg Res 100(5):503–508.  https://doi.org/10.1016/j.otsr.2014.06.002 CrossRefPubMedGoogle Scholar
  36. 36.
    Walch G, Boileau P (1999) Prosthetic adaptability: a new concept for shoulder arthroplasty. J Shoulder Elbow Surg 8(5):443–451CrossRefGoogle Scholar
  37. 37.
    Moineau G, Levigne C, Boileau P, Young A, Walch G, French Society for S, Elbow (2012) Three-dimensional measurement method of arthritic glenoid cavity morphology: feasibility and reproducibility. Orthop Traumatol Surg Res 98(6 Suppl):S139–S145.  https://doi.org/10.1016/j.otsr.2012.06.007 CrossRefPubMedGoogle Scholar
  38. 38.
    Walch G, Mesiha M, Boileau P, Edwards TB, Levigne C, Moineau G, Young A (2013) Three-dimensional assessment of the dimensions of the osteoarthritic glenoid. Bone Joint J 95-B (10):1377–1382.  https://doi.org/10.1302/0301-620X.95B10.32012 CrossRefPubMedGoogle Scholar
  39. 39.
    Wang T, Abrams GD, Behn AW, Lindsey D, Giori N, Cheung EV (2015) Posterior glenoid wear in total shoulder arthroplasty: eccentric anterior reaming is superior to posterior augment. Clin Orthop Relat Res 473(12):3928–3936.  https://doi.org/10.1007/s11999-015-4482-8 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Farron A, Terrier A, Buchler P (2006) Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg 15(4):521–526.  https://doi.org/10.1016/j.jse.2005.10.003 CrossRefPubMedGoogle Scholar
  41. 41.
    Hopkins AR, Hansen UN, Amis AA, Emery R (2004) The effects of glenoid component alignment variations on cement mantle stresses in total shoulder arthroplasty. J Shoulder Elbow Surg 13(6):668–675.  https://doi.org/10.1016/S1058274604001399 CrossRefPubMedGoogle Scholar
  42. 42.
    Hermida JC, Flores-Hernandez C, Hoenecke HR, D’Lima DD (2014) Augmented wedge-shaped glenoid component for the correction of glenoid retroversion: a finite element analysis. J Shoulder Elbow Surg 23(3):347–354.  https://doi.org/10.1016/j.jse.2013.06.008 CrossRefPubMedGoogle Scholar
  43. 43.
    Kersten AD, Flores-Hernandez C, Hoenecke HR, D’Lima DD (2015) Posterior augmented glenoid designs preserve more bone in biconcave glenoids. J Shoulder Elbow Surg 24(7):1135–1141.  https://doi.org/10.1016/j.jse.2014.12.007 CrossRefPubMedGoogle Scholar
  44. 44.
    Allred JJ, Flores-Hernandez C, Hoenecke HR Jr, D’Lima DD (2016) Posterior augmented glenoid implants require less bone removal and generate lower stresses: a finite element analysis. J Shoulder Elbow Surg 25(5):823–830.  https://doi.org/10.1016/j.jse.2015.10.003 CrossRefPubMedGoogle Scholar
  45. 45.
    Knowles NK, Ferreira LM, Athwal GS (2015) Augmented glenoid component designs for type B2 erosions: a computational comparison by volume of bone removal and quality of remaining bone. J Shoulder Elbow Surg 24(8):1218–1226.  https://doi.org/10.1016/j.jse.2014.12.018 CrossRefPubMedGoogle Scholar
  46. 46.
    Gauci MO, Boileau P, Baba M, Chaoui J, Walch G (2016) Patient-specific glenoid guides provide accuracy and reproducibility in total shoulder arthroplasty. Bone Joint J 98-B(8):1080–1085.  https://doi.org/10.1302/0301-620X.98B8.37257 CrossRefPubMedGoogle Scholar
  47. 47.
    Iannotti JP, Weiner S, Rodriguez E, Subhas N, Patterson TE, Jun BJ, Ricchetti ET (2015) Three-dimensional imaging and templating improve glenoid implant positioning. J Bone Joint Surg Am 97(8):651–658.  https://doi.org/10.2106/JBJS.N.00493 CrossRefPubMedGoogle Scholar
  48. 48.
    Hendel MD, Bryan JA, Barsoum WK, Rodriguez EJ, Brems JJ, Evans PJ, Iannotti JP (2012) Comparison of patient-specific instruments with standard surgical instruments in determining glenoid component position: a randomized prospective clinical trial. J Bone Joint Surg Am 94(23):2167–2175.  https://doi.org/10.2106/JBJS.K.01209 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Boris Sowa
    • 1
  • Martin Bochenek
    • 1
  • Steffen Braun
    • 1
  • Jan Philippe Kretzer
    • 1
  • Felix Zeifang
    • 5
  • Thomas Bruckner
    • 2
  • Gilles Walch
    • 3
  • Patric Raiss
    • 1
    • 4
  1. 1.Clinic of Orthopedic and Trauma SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  3. 3.Hôpital Privé Jean-Mermoz –GDS RamsayLyonFrance
  4. 4.OCM (Orthopädische Chirurgie München) ClinicMunichGermany
  5. 5.Ethianum Clinic HeidelbergHeidelbergGermany

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