The subchondral bone layer and glenoid implant design are relevant for primary stability in glenoid arthroplasty
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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.
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.
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).
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.
KeywordsTSA Subchondral Glenoid Reaming A1 Anatomic
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.
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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