Skip to main content
SpringerLink
Log in

Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The technique and results of shoulder arthroplasty are influenced by glenohumeral pathoanatomy. Although some authors advocate a routine preoperative CT scan to define this anatomy, ordering a CT scan substantially increases the cost and the radiation exposure for the patient.

Questions/purposes

We asked whether measurements of arthritic shoulders on a standardized axillary view are reliable; if postoperative radiographs can reliably show the changes in glenoid anatomy and glenohumeral relationships after shoulder arthroplasty, and if the axillary view can show differences in glenohumeral pathoanatomy in the different sexes and disease types.

Methods

These questions were addressed using cross-sectional studies of 344 shoulders with different types of arthritis and of 128 osteoarthritic shoulders having a ream and run arthroplasty (a glenohumeral arthroplasty that combines a noncemented humeral hemiarthroplasty with concentric reaming of the glenoid bone without implantation of a prosthetic glenoid component). Measurements of glenoid type, glenoid version, and glenohumeral contact were made on standardized axillary radiographs. Interobserver reliability was calculated, preoperative and postoperative measurements were compared, and morphologic differences were compared as stratified by sex and disease type.

Results

The measurements on axillary views showed a high degree of interobserver reliability and sensitivity to the changes effected by arthroplasty. The ream and run substantially corrected the glenoid type and point of glenohumeral contact. Male shoulders and shoulders with osteoarthritis had more type B glenoids (ie, those with posterior erosion and biconcavity of the glenoid), more retroversion, and a greater degree of posterior displacement of the point of glenohumeral contact.

Conclusions

The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan.

Level of Evidence

Level IV, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B
Fig. 3A–B
Fig. 4A–B
Fig. 5A–D

Similar content being viewed by others

References

  1. Badet R, Boileau P, Noel E, Walch G. Arthrography and computed arthrotomography study of seventy patients with primary glenohumeral osteoarthritis. Rev Rhum Engl Ed. 1995;62:555–562.

    CAS  PubMed  Google Scholar 

  2. Badet R, Walch G, Boulahia A. Computed tomography in primary glenohumeral osteoarthritis without humeral head elevation. Rev Rhum Engl Ed. 1998;65:187–194.

    CAS  PubMed  Google Scholar 

  3. Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91:1882–1889.

    Article  PubMed  Google Scholar 

  4. Bohsali KI, Wirth MA, Rockwood CA Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88:2279–2292.

    Article  PubMed  Google Scholar 

  5. Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D. Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg. 2002;11:351–359.

    Article  PubMed  Google Scholar 

  6. Bokor DJ, O’Sullivan MD, Hazan GJ. Variability of measurement of glenoid version on computed tomography scan. J Shoulder Elbow Surg. 1999;8:595–598.

    Article  CAS  PubMed  Google Scholar 

  7. Budge MD, Lewis GS, Schaefer E, Coquia S, Flemming DJ, Armstrong AD. Comparison of standard two-dimensional and three-dimensional corrected glenoid version measurements. J Shoulder Elbow Surg. 2011;20:577–583.

    Article  PubMed  Google Scholar 

  8. Collin P, Tay AK, Melis B, Boileau P, Walch G. A ten-year radiologic comparison of two-all polyethylene glenoid component designs: a prospective trial. J Shoulder Elbow Surg. 2011;20:1217–1223.

    Article  PubMed  Google Scholar 

  9. Collins D, Tencer A, Sidles J, Matsen F 3rd. 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. 1992;74:501–507.

    CAS  PubMed  Google Scholar 

  10. Couteau B, Mansat P, Darmana R, Mansat M, Egan J. Morphological and mechanical analysis of the glenoid by 3D geometric reconstruction using computed tomography. Clin Biomech (Bristol, Avon). 2000;15(s uppl 1):S8–12.

    Google Scholar 

  11. Denard PJ, Raiss P, Sowa B, Walch G. 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. 2013;22:894–900.

    Article  PubMed  Google Scholar 

  12. Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G. Shoulder arthroplasty in patients with osteoarthritis and dysplastic glenoid morphology. J Shoulder Elbow Surg. 2004;13:1–4.

    Article  PubMed  Google Scholar 

  13. Farron A, Terrier A, Buchler P. Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg. 2006;15:521–526.

    Article  PubMed  Google Scholar 

  14. Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:859–863.

    Article  PubMed  Google Scholar 

  15. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder arthroplasty: association with rotator cuff deficiency. J Arthroplasty. 1988;3:39–46.

    Article  CAS  PubMed  Google Scholar 

  16. Friedman RJ, Hawthorne KB, Genez BM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am. 1992;74:1032–1037.

    CAS  PubMed  Google Scholar 

  17. Gerber C, Costouros JG, Sukthankar A, Fucentese SF. Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:505–510.

    Article  PubMed  Google Scholar 

  18. Godeneche A, Boileau P, Favard L, Le Huec JC, Levigne C, Nove-Josserand L, Walch G, Edwards TB. Prosthetic replacement in the treatment of osteoarthritis of the shoulder: early results of 268 cases. J Shoulder Elbow Surg. 2002;11:11–18.

    Article  PubMed  Google Scholar 

  19. Gunther SB, Lynch TL, O’Farrell D, Calyore C, Rodenhouse A. Finite element analysis and physiologic testing of a novel, inset glenoid fixation technique. J Shoulder Elbow Surg. 2012;21:795–803.

    Article  PubMed  Google Scholar 

  20. Habermeyer P, Magosch P, Lichtenberg S. Recentering the humeral head for glenoid deficiency in total shoulder arthroplasty. Clin Orthop Relat Res. 2007;457:124–132.

    PubMed  Google Scholar 

  21. Habermeyer P, Magosch P, Luz V, Lichtenberg S. Three-dimensional glenoid deformity in patients with osteoarthritis: a radiographic analysis. J Bone Joint Surg Am. 2006;88:1301–1307.

    Article  CAS  PubMed  Google Scholar 

  22. Ho JC, Youderian A, Davidson IU, Bryan J, Iannotti JP. Accuracy and reliability of postoperative radiographic measurements of glenoid anatomy and relationships in patients with total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22:1068–1077.

    Article  PubMed  Google Scholar 

  23. Hoenecke HR Jr, Hermida JC, Flores-Hernandez C, D’Lima DD. Accuracy of CT-based measurements of glenoid version for total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19:166–171.

    Article  PubMed  Google Scholar 

  24. Hoenecke HR Jr, Tibor LM, D’Lima DD. Glenoid morphology rather than version predicts humeral subluxation: a different perspective on the glenoid in total shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21:1136–1141.

    Article  PubMed  Google Scholar 

  25. Iannotti JP, Greeson C, Downing D, Sabesan V, Bryan JA. Effect of glenoid deformity on glenoid component placement in primary shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21:48–55.

    Article  PubMed  Google Scholar 

  26. Kasten P, Pape G, Raiss P, Bruckner T, Rickert M, Zeifang F, Loew M. Mid-term survivorship analysis of a shoulder replacement with a keeled glenoid and a modern cementing technique. J Bone Joint Surg Br. 2010;92:387–392.

    Article  CAS  PubMed  Google Scholar 

  27. Kidder JF, Rouleau DM, Pons-Villanueva J, Dynamidis S, DeFranco MJ, Walch G. Humeral head posterior subluxation on CT scan: Validation and comparison of 2 methods of measurement. Tech Shoulder Elbow Surg. 2010;11:72–76.

    Article  Google Scholar 

  28. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg. Am. 2011;93:2249–2254.

    PubMed  Google Scholar 

  29. Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P. Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elbow Surg. 2009;18:515–520.

    Article  PubMed  Google Scholar 

  30. Lazarus MD, Jensen KL, Southworth C, Matsen FA 3rd. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84:1174–1182.

    PubMed  Google Scholar 

  31. Matsen FA 3rd, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90:885–896.

    Article  PubMed  Google Scholar 

  32. Moineau G, Levigne C, Boileau P, Young A, Walch G; French Society for Shoulder & Elbow (SOFEC). Three-dimensional measurement method of arthritic glenoid cavity morphology: feasibility and reproducibility. Orthop Traumatol Surg Res. 2012;98(6 suppl):S139–145.

    Article  CAS  PubMed  Google Scholar 

  33. Namdari S, Hsu JE, Barron M, Huffman GR, Glaser D. Immediate postoperative radiographs after shoulder arthroplasty are often poor quality and do not alter care. Clin Orthop Relat Res. 2013;471:1257–1262.

    Article  PubMed  Google Scholar 

  34. New Choice Health Inc. Shoulder CT scan cost and procedure information. Available at: http://www.newchoicehealth.com/Directory/Procedure/12/ShoulderCTScan. Accessed January 17, 2013.

  35. Nowak DD, Bahu MJ, Gardner TR, Dyrszka MD, Levine WN, Bigliani LU, Ahmad CS. 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. 2009;18:680–688.

    Article  PubMed  Google Scholar 

  36. Nyffeler RW, Jost B, Pfirrmann CW, Gerber C. Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg. 2003;12:493–496.

    Article  PubMed  Google Scholar 

  37. Nyffeler RW, Sheikh R, Atkinson TS, Jacob HA, Favre P, Gerber C. Effects of glenoid component version on humeral head displacement and joint reaction forces: an experimental study. J Shoulder Elbow Surg. 2006;15:625–629.

    Article  PubMed  Google Scholar 

  38. Poon PC, Ting FS. A 2-dimensional glenoid vault method for measuring glenoid version on computed tomography. J Shoulder Elbow Surg. 2012;21:329–335.

    Article  PubMed  Google Scholar 

  39. Raiss P, Schmitt M, Bruckner T, Kasten P, Pape G, Loew M, Zeifang F. Results of cemented total shoulder replacement with a minimum follow-up of ten years. J Bone Joint Surg Am. 2012;94:e171 1–10.

    Article  Google Scholar 

  40. Rouleau DM, Kidder JF, Pons-Villanueva J, Dynamidis S, Defranco M, Walch G. Glenoid version: how to measure it? Validity of different methods in two-dimensional computed tomography scans. J Shoulder Elbow Surg. 2010;19:1230–1237.

    Article  PubMed  Google Scholar 

  41. Scalise JJ, Bryan J, Polster J, Brems JJ, Iannotti JP. Quantitative analysis of glenoid bone loss in osteoarthritis using three-dimensional computed tomography scans. J Shoulder Elbow Surg. 2008;17:328–335.

    Article  PubMed  Google Scholar 

  42. Scalise JJ, Codsi MJ, Brems JJ, Iannotti JP. Inter-rater reliability of an arthritic glenoid morphology classification system. J Shoulder Elbow Surg. 2008;17:575–577.

    Article  PubMed  Google Scholar 

  43. Scalise JJ, Codsi MJ, Bryan J, Brems JJ, Iannotti JP. The influence of three-dimensional computed tomography images of the shoulder in preoperative planning for total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90:2438–2445.

    Article  PubMed  Google Scholar 

  44. Scalise JJ, Codsi MJ, Bryan J, Iannotti JP. The three-dimensional glenoid vault model can estimate normal glenoid version in osteoarthritis. J Shoulder Elbow Surg. 2008;17:487–491.

    Article  PubMed  Google Scholar 

  45. Sears BW, Johnston PS, Ramsey ML, Williams GR. Glenoid bone loss in primary total shoulder arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2012;20:604–613.

    Article  PubMed  Google Scholar 

  46. Shapiro TA, McGarry MH, Gupta R, Lee YS, Lee TQ. Biomechanical effects of glenoid retroversion in total shoulder arthroplasty. J Shoulder Elbow Surg. 2007;16(3 suppl):S90–95.

    Article  PubMed  Google Scholar 

  47. Suarez DR, Nerkens W, Valstar ER, Rozing PM, van Keulen F. Interface micromotions increase with less-conforming cementless glenoid components. J Shoulder Elbow Surg. 2012;21:474–482.

    Article  PubMed  Google Scholar 

  48. Szabo I, Buscayret F, Edwards TB, Nemoz C, Boileau P, Walch G. Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2005;14:636–642.

    Article  PubMed  Google Scholar 

  49. Tammachote N, Sperling JW, Vathana T, Cofield RH, Harmsen WS, Schleck CD. Long-term results of cemented metal-backed glenoid components for osteoarthritis of the shoulder. J Bone Joint Surg Am. 2009;91:160–166.

    Article  PubMed  Google Scholar 

  50. Taunton MJ, McIntosh AL, Sperling JW, Cofield RH. Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component: medium to long-term results. J Bone Joint Surg Am. 2008;90:2180–2188.

    Article  PubMed  Google Scholar 

  51. Walch G, Ascani C, Boulahia A, Nove-Josserand L, Edwards TB. Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult. J Shoulder Elbow Surg. 2002;11:309–314.

    Article  PubMed  Google Scholar 

  52. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14:756–760.

    Article  CAS  PubMed  Google Scholar 

  53. Walch G, Boulahia A, Boileau P, Kempf JF. Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group. Acta Orthop Belg. 1998;64(suppl 2):46–52.

    PubMed  Google Scholar 

  54. Walch G, Moraga C, Young A, Castellanos-Rosas J. Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elbow Surg. 2012;21:1526–1533.

    Article  PubMed  Google Scholar 

  55. Walch G, Young AA, Boileau P, Loew M, Gazielly D, Mole D. 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. 2012;94:145–150.

    Article  PubMed  Google Scholar 

  56. Walch G, Young AA, Melis B, Gazielly D, Loew M, Boileau P. 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. 2011;20:385–394.

    Article  PubMed  Google Scholar 

  57. Wirth MA, Loredo R, Garcia G, Rockwood CA Jr, Southworth C, Iannotti JP. Total shoulder arthroplasty with an all-polyethylene pegged bone-ingrowth glenoid component: a clinical and radiographic outcome study. J Bone Joint Surg Am. 2012;94:260–267.

    Article  PubMed  Google Scholar 

  58. Yian EH, Werner CM, Nyffeler RW, Pfirrmann CW, Ramappa A, Sukthankar A, Gerber C. Radiographic and computed tomography analysis of cemented pegged polyethylene glenoid components in total shoulder replacement. J Bone Joint Surg Am. 2005;87:1928–1936.

    Article  PubMed  Google Scholar 

  59. Young A, Walch G, Boileau P, Favard L, Gohlke F, Loew M, Mole D. 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. 2011;93:210–216.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Susan DeBartolo for her great assistance with preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Sports Medicine, University of Washington, Box 356500, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Frederick A. Matsen III MD & Akash Gupta MD

Authors
  1. Frederick A. Matsen III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akash Gupta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederick A. Matsen III MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Matsen, F.A., Gupta, A. Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run. Clin Orthop Relat Res 472, 894–902 (2014). https://doi.org/10.1007/s11999-013-3327-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3327-6

Keywords

Search

Navigation