Eric T Ricchetti1, Bong-Jae Jun2, Richard A Cain2, Ari Youderian2, Eric J Rodriguez2, David Kusin2, Naveen Subhas3, Thomas E Patterson2, Joseph P Iannotti2. 1. Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ricchee@ccf.org. 2. Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Diagnostic Radiology, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: Detection of postoperative component position and implant shift following total shoulder arthroplasty (TSA) can be challenging using routine imaging. The purpose of this study was to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. METHODS: Twenty patients underwent primary TSA with sequential CT scanning of the shoulder: a preoperative study, an immediate postoperative study within 2 weeks of surgery, and a postoperative study performed at minimum 2-year follow-up (CT3). Postoperative glenoid component position and central peg osteolysis were assessed across the immediate postoperative CT scan and CT3. Glenoids with evidence of component shift and/or grade 1 central peg osteolysis on CT3 were considered at risk of loosening. RESULTS: Of the patients, 7 (35%) showed evidence of glenoid components at risk of loosening on CT3, 6 with component shift (3 with increased inclination alone, 1 with increased retroversion alone, and 2 with both increased inclination and retroversion). Significantly more patients with glenoid component shift had grade 1 central peg osteolysis on CT3 compared with those without shift (83% vs 7%, P = .002). One clinical failure occurred, with the patient undergoing revision to reverse TSA for rotator cuff deficiency. CONCLUSIONS: Three-dimensional CT imaging analysis following TSA identified changes in glenoid component position over time, with inclination being the most common direction of shift and grade 1 central peg osteolysis commonly associated with shift. These findings raise concern for glenoids at risk of loosening, but further follow-up is needed to determine the long-term clinical impact of these findings.
BACKGROUND: Detection of postoperative component position and implant shift following total shoulder arthroplasty (TSA) can be challenging using routine imaging. The purpose of this study was to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. METHODS: Twenty patients underwent primary TSA with sequential CT scanning of the shoulder: a preoperative study, an immediate postoperative study within 2 weeks of surgery, and a postoperative study performed at minimum 2-year follow-up (CT3). Postoperative glenoid component position and central pegosteolysis were assessed across the immediate postoperative CT scan and CT3. Glenoids with evidence of component shift and/or grade 1 central pegosteolysis on CT3 were considered at risk of loosening. RESULTS: Of the patients, 7 (35%) showed evidence of glenoid components at risk of loosening on CT3, 6 with component shift (3 with increased inclination alone, 1 with increased retroversion alone, and 2 with both increased inclination and retroversion). Significantly more patients with glenoid component shift had grade 1 central pegosteolysis on CT3 compared with those without shift (83% vs 7%, P = .002). One clinical failure occurred, with the patient undergoing revision to reverse TSA for rotator cuff deficiency. CONCLUSIONS: Three-dimensional CT imaging analysis following TSA identified changes in glenoid component position over time, with inclination being the most common direction of shift and grade 1 central pegosteolysis commonly associated with shift. These findings raise concern for glenoids at risk of loosening, but further follow-up is needed to determine the long-term clinical impact of these findings.
Authors: Frederick A Matsen; Joseph P Iannotti; R Sean Churchill; Lieven De Wilde; T Bradley Edwards; Matthew C Evans; Edward V Fehringer; Gordon I Groh; James D Kelly; Christopher M Kilian; Giovanni Merolla; Tom R Norris; Giuseppe Porcellini; Edwin E Spencer; Anne Vidil; Michael A Wirth; Stacy M Russ; Moni Neradilek; Jeremy S Somerson Journal: Int Orthop Date: 2018-12-03 Impact factor: 3.075
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