Peter Simon1, Anil Gupta2, Ioannis Pappou2, Michael M Hussey2, Brandon G Santoni1, Nozomu Inoue3, Mark A Frankle4. 1. Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL, USA. 2. Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA. 3. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA. 4. Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
Abstract
BACKGROUND: Glenoid component loosening in total shoulder arthroplasty may be prevented by component placement on a congruent and adequate bony surface. Glenoid subchondral bone density (SBD) variability may be correlated with this concept. This study analyzed the 3-dimensional distribution of glenoid SBD in total shoulder arthroplasty patients with osteoarthritis. MATERIALS AND METHODS: Three-dimensional computed tomography osteoabsorptiometry (CT-OAM) was performed in 42 men (21 with eccentric and 21 with concentric wear patterns) with glenohumeral arthritis. Glenoid SBD was measured from the joint surface based on 5 clinically relevant topographic zones. The correlation of the wear pattern with the SBD distribution was investigated. RESULTS: The glenoid subarticular layers could be separated into distinct regions: calcified cartilage (≤ 1.5 mm), subchondral plate (2-4.5 mm) and cancellous bone (≥ 5 mm). There were significant differences in SBD among these layers within and between patients with concentric and eccentric wear patterns. In concentric glenoids, the SBD distribution was homogeneous, with greater mineralization in the central zone, 1,749.1 ± 162.3 Hounsfield units (HU) (at 2.5 mm), compared with the posterior, anterior, and superior zones (P < .001). In the eccentric group, the SBD distribution was inhomogeneous. Mineralization was greatest in the posterior zone, 1,739.0 ± 172.6 HU (at 2.5 mm), followed by the inferior zone, 1,722.1 ± 186.6 HU (at 3 mm). CONCLUSION: This study represents the first study using CT-OAM to evaluate the 3-dimensional SBD distribution of the glenoid vault for different arthritic wear patterns. The study findings indicate that the SBD distribution is dependent on (1) depth from the articular surface, (2) topographic zone, and (3) wear pattern. CT-OAM may be an effective tool to assist in preoperative planning for shoulder arthroplasty.
BACKGROUND: Glenoid component loosening in total shoulder arthroplasty may be prevented by component placement on a congruent and adequate bony surface. Glenoid subchondral bone density (SBD) variability may be correlated with this concept. This study analyzed the 3-dimensional distribution of glenoid SBD in total shoulder arthroplasty patients with osteoarthritis. MATERIALS AND METHODS: Three-dimensional computed tomography osteoabsorptiometry (CT-OAM) was performed in 42 men (21 with eccentric and 21 with concentric wear patterns) with glenohumeral arthritis. Glenoid SBD was measured from the joint surface based on 5 clinically relevant topographic zones. The correlation of the wear pattern with the SBD distribution was investigated. RESULTS: The glenoid subarticular layers could be separated into distinct regions: calcified cartilage (≤ 1.5 mm), subchondral plate (2-4.5 mm) and cancellous bone (≥ 5 mm). There were significant differences in SBD among these layers within and between patients with concentric and eccentric wear patterns. In concentric glenoids, the SBD distribution was homogeneous, with greater mineralization in the central zone, 1,749.1 ± 162.3 Hounsfield units (HU) (at 2.5 mm), compared with the posterior, anterior, and superior zones (P < .001). In the eccentric group, the SBD distribution was inhomogeneous. Mineralization was greatest in the posterior zone, 1,739.0 ± 172.6 HU (at 2.5 mm), followed by the inferior zone, 1,722.1 ± 186.6 HU (at 3 mm). CONCLUSION: This study represents the first study using CT-OAM to evaluate the 3-dimensional SBD distribution of the glenoid vault for different arthritic wear patterns. The study findings indicate that the SBD distribution is dependent on (1) depth from the articular surface, (2) topographic zone, and (3) wear pattern. CT-OAM may be an effective tool to assist in preoperative planning for shoulder arthroplasty.
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