Sunday, May 1, 2011

Shoulder arthritis articles from JSES - April - humeral head center, hemiarthroplasty for dysplasia, glenoid component failure

A reproducible and practical method for documenting the position of the humeral head center relative to the scapula on standardized plain radiographs. In this article our shoulder fellows Mercer and Saltzman describe a method by which the change in position of the prosthetic humeral head in relation to the scapula can be determined with time. This technique can be used to answer critical questions such as "What is the wear rate of plastic glenoid socket replacements with time after a total shoulder?" or "How does the bone of the glenoid hold up after a ream and run procedure?

Hemiarthroplasty for osteoarthritis in shoulder with dysplastic morphology suggests that replacing the humeral component alone, rather than performing a total shoulder replacement may be the preferable approach for managing shoulders that did not develop normally.

Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years. In this paper our respected colleagues Walch and Boileau along with others provide a four center study of total shoulder replacement with a single component design of polyethylene glenoid. The clinical results were excellent with a 98% survivorship without surgical revision at 10 years.

When radiographic loosening was used as the endpoint, the survivorship was 100% at five years and 52% at 10 years.

The authors discovered that excessive glenoid reaming may be associated with an increased rate of glenoid component failure possibly because of the removal of the strong subchondral bone at the surface of glenoid. They also pointed out the need for long term followup using both X-rays and clinical criteria to evaluate the value of possible advances in the technique and components used in total shoulder arthroplasty.


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