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.
- 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
- 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
- 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.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
- 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.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
- 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
- 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.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
- 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.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
- 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
- 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
- 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
- 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