Sequential 3-dimensional computed tomography analysis of implant position following total shoulder arthroplasty
These authors sought to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up in 20 patients having primary TSA.
These authors sought to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up in 20 patients having primary TSA.
Fourteen patients had a standard anchor peg glenoid component and 6 had a posteriorly augmented glenoid component (Global STEPTECH).
Each patient had a CT scan of the shoulder before surgery, within 2 weeks of surgery, and at a minimum of 2-years after surgery. 7 of the 20 glenoids showed evidence of component shift and/or grade 1 central peg osteolysis on the third scan were considered at risk of loosening: 6 had component shift (3 with increased inclination alone, 1 had increased retroversion alone, and 2 had both increased inclination and retroversion).
Significantly more patients with glenoid component shift had grade 1 central peg osteolysis 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.
As shown in the table below, more severe types of glenoid pathology did not have a greater chance of being at risk
of the 11 Walch type A glenoids, 4 (36%) were at risk
of the 5 Walch B glenoids, 1 (20%) was at risk
of the 2 Walch C glenoids, none (0%) were at risk
of the 2 "other" glenoid types, both (100%) were at risk.
Of the 14 standard glenoid components 4 (29%) were at risk
Of the 6 StepTech posteriorly augmented glenoid components 3 (50%) were at risk.
This article demonstrates an intense (3 CT scans per shoulder) effort to evaluate the radiographic changes in the glenoid component after total shoulder arthroplasty. Interestingly, the results in 20 shoulders do not suggest that more severe forms of glenoid pathology are associated with a greater chance of the component being "at risk" and do not suggest that augmented glenoid components have less chance of the glenoid being at risk
While the paper suggests that sequential 3D CT imaging has the potential to be useful and clinically applicable for evaluating TSA component position over time, the cost, radiation exposure, and Human Subjects considerations would seem to limit this utility.
=====
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
