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Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

No correlation between radiolucency and biomechanical stability of keeled and pegged glenoid components

Authors: Andreas Voss, Knut Beitzel, Elifho Obopilwe, Stefan Buchmann, John Apostolakos, Jessica Di Venere, Michael Nowak, Mark P. Cote, Anthony A. Romeo, Augustus D. Mazzocca

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

The purpose of this study was to examine biomechanical properties and the degree of radiolucency of two cemented basic glenoid designs for total shoulder arthroplasty. Our hypothesis was that a component with increased micro-motion in the laboratory at time zero would also exhibit a greater amount of radiolucency in patients at a minimum of 2 years post total shoulder arthroplasty.

Methods

Thirty cadaveric shoulders were divided into 2 groups (keel vs. peg). The glenoid components were first loaded with a single axial eccentric force of 196 N in all orientations and then with a transversal load of 49 N to simulate in vivo loads with abduction. Displacement of the glenoid component was determined with four different linear variable-differential transducers. In the second phase, 56 antero-posterior x-rays of 52 patients with either the same keeled (n = 24) or pegged (n = 32) glenoid component with a minimum of 24 months follow-up were evaluated for radiolucency.

Results

Biomechanically the pegged glenoid showed a significant increase in micro-motion during eccentric axial loading as well as during combined loading in the anterior, posterior, and inferior position as compared to the keeled glenoid (p < 0.05). In contrast all results were significant with greater radiolucency for the keeled glenoid component (p = 0.001).

Conclusion

While the pegged component exhibited a greater amount of micro-motion during biomechanical testing, radiolucency was greater in patients with a keeled component. These findings provide support for both components from different perspectives and highlight the need for well-constructed studies to determine whether glenoid design has an effect on clinical outcome, because influences are multifactorial and biomechanical forces may not recreate forces seen in vivo.
Literature
1.
go back to reference Papadonikolakis A, Neradilek MB, Matsen 3rd FA. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am. 2013;95(24):2205–12.CrossRefPubMed Papadonikolakis A, Neradilek MB, Matsen 3rd FA. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am. 2013;95(24):2205–12.CrossRefPubMed
2.
go back to reference Bohsali KI, Wirth MA, Rockwood Jr CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–92.PubMed Bohsali KI, Wirth MA, Rockwood Jr CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–92.PubMed
3.
go back to reference Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg. 2006;15(1):19–22.CrossRefPubMed Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg. 2006;15(1):19–22.CrossRefPubMed
4.
go back to reference Collins D, Tencer A, Sidles J, Matsen 3rd F. Edge displacement and deformation of glenoid components in response to eccentric loading. The effect of preparation of the glenoid bone. J Bone Joint Surg Am. 1992;74(4):501–7.CrossRefPubMed Collins D, Tencer A, Sidles J, Matsen 3rd F. Edge displacement and deformation of glenoid components in response to eccentric loading. The effect of preparation of the glenoid bone. J Bone Joint Surg Am. 1992;74(4):501–7.CrossRefPubMed
5.
go back to reference Edwards TB, Labriola JE, Stanley RJ, O’Connor DP, Elkousy HA, Gartsman GM. Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: a prospective randomized study. J Shoulder Elbow Surg. 2010;19(2):251–7.CrossRefPubMed Edwards TB, Labriola JE, Stanley RJ, O’Connor DP, Elkousy HA, Gartsman GM. Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: a prospective randomized study. J Shoulder Elbow Surg. 2010;19(2):251–7.CrossRefPubMed
6.
go back to reference Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH. Pegged versus keeled glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(5):726–33.CrossRefPubMed Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH. Pegged versus keeled glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(5):726–33.CrossRefPubMed
7.
go back to reference Anglin C, Wyss UP, Nyffeler RW, Gerber C. Loosening performance of cemented glenoid prosthesis design pairs. Clin Biomech. 2001;16(2):144–50.CrossRef Anglin C, Wyss UP, Nyffeler RW, Gerber C. Loosening performance of cemented glenoid prosthesis design pairs. Clin Biomech. 2001;16(2):144–50.CrossRef
8.
go back to reference Neer 2nd CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 1974;56(1):1–13.CrossRefPubMed Neer 2nd CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 1974;56(1):1–13.CrossRefPubMed
9.
go back to reference Lazarus MD, Jensen KL, Southworth C, Matsen 3rd FA. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84-A(7):1174–82.CrossRefPubMed Lazarus MD, Jensen KL, Southworth C, Matsen 3rd FA. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84-A(7):1174–82.CrossRefPubMed
10.
go back to reference Altman D. Practical statistics for medical research. London: Chapman and Hall; 1991. Altman D. Practical statistics for medical research. London: Chapman and Hall; 1991.
11.
go back to reference Anglin C, Tolhurst P, Wyss UP, Pichora DR. Glenoid cancellous bone strength and modulus. J Biomech. 1999;32(10):1091–7.CrossRefPubMed Anglin C, Tolhurst P, Wyss UP, Pichora DR. Glenoid cancellous bone strength and modulus. J Biomech. 1999;32(10):1091–7.CrossRefPubMed
12.
go back to reference Checroun AJ, Hawkins C, Kummer FJ, Zuckerman JD. Fit of current glenoid component designs: an anatomic cadaver study. J Shoulder Elbow Surg. 2002;11(6):614–7.CrossRefPubMed Checroun AJ, Hawkins C, Kummer FJ, Zuckerman JD. Fit of current glenoid component designs: an anatomic cadaver study. J Shoulder Elbow Surg. 2002;11(6):614–7.CrossRefPubMed
13.
go back to reference Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.CrossRefPubMed Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.CrossRefPubMed
14.
go back to reference Yongpravat C, Lester JD, Saifi C, Trubelja A, Greiwe RM, Bigliani LU, et al. Glenoid morphology after reaming in computer-simulated total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(1):122–8.CrossRefPubMed Yongpravat C, Lester JD, Saifi C, Trubelja A, Greiwe RM, Bigliani LU, et al. Glenoid morphology after reaming in computer-simulated total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(1):122–8.CrossRefPubMed
15.
go back to reference Matsen 3rd FA, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90(4):885–96.CrossRefPubMed Matsen 3rd FA, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90(4):885–96.CrossRefPubMed
16.
go back to reference Friedman RJ, Laberge M, Dooley RL, O’Hara AL. Finite element modeling of the glenoid component: Effect of design parameters on stress distribution. J Shoulder Elbow Surg. 1992;1(5):261–70.CrossRefPubMed Friedman RJ, Laberge M, Dooley RL, O’Hara AL. Finite element modeling of the glenoid component: Effect of design parameters on stress distribution. J Shoulder Elbow Surg. 1992;1(5):261–70.CrossRefPubMed
17.
go back to reference Orr TE, Carter DR, Schurman DJ. Stress analyses of glenoid component designs. Clin Orthop Relat Res. 1988;232:217–24. Orr TE, Carter DR, Schurman DJ. Stress analyses of glenoid component designs. Clin Orthop Relat Res. 1988;232:217–24.
18.
go back to reference Lacroix D, Murphy LA, Prendergast PJ. Three-dimensional finite element analysis of glenoid replacement prostheses: a comparison of keeled and pegged anchorage systems. J Biomech Eng. 2000;122(4):430–6.CrossRefPubMed Lacroix D, Murphy LA, Prendergast PJ. Three-dimensional finite element analysis of glenoid replacement prostheses: a comparison of keeled and pegged anchorage systems. J Biomech Eng. 2000;122(4):430–6.CrossRefPubMed
19.
go back to reference Gartsman GM, Elkousy HA, Warnock KM, Edwards TB, O’Connor DP. Radiographic comparison of pegged and keeled glenoid components. J Shoulder Elbow Surg. 2005;14(3):252–7.CrossRefPubMed Gartsman GM, Elkousy HA, Warnock KM, Edwards TB, O’Connor DP. Radiographic comparison of pegged and keeled glenoid components. J Shoulder Elbow Surg. 2005;14(3):252–7.CrossRefPubMed
20.
go back to reference Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg. 1997;6(6):495–505.CrossRefPubMed Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg. 1997;6(6):495–505.CrossRefPubMed
21.
go back to reference Walch G, Young AA, Boileau P, Loew M, Gazielly D, Mole D. 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. 2012;94(2):145–50.CrossRefPubMed Walch G, Young AA, Boileau P, Loew M, Gazielly D, Mole D. 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. 2012;94(2):145–50.CrossRefPubMed
22.
go back to reference Gazielly DF, Scarlat MM, Verborgt O. Long-term survival of the glenoid components in total shoulder replacement for arthritis. Int Orthop. 2015;39(2):285–9.CrossRefPubMed Gazielly DF, Scarlat MM, Verborgt O. Long-term survival of the glenoid components in total shoulder replacement for arthritis. Int Orthop. 2015;39(2):285–9.CrossRefPubMed
23.
go back to reference Papadonikolakis A, Matsen 3rd FA. 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. 2014;96(12):1041–7.CrossRefPubMed Papadonikolakis A, Matsen 3rd FA. 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. 2014;96(12):1041–7.CrossRefPubMed
24.
go back to reference Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D. Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg. 2002;11(4):351–9.CrossRefPubMed Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D. Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg. 2002;11(4):351–9.CrossRefPubMed
25.
go back to reference Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18(6):859–63.CrossRefPubMed Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18(6):859–63.CrossRefPubMed
26.
go back to reference Fox TJ, Foruria AM, Klika BJ, Sperling JW, Schleck CD, Cofield RH. Radiographic survival in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(9):1221–7.CrossRefPubMed Fox TJ, Foruria AM, Klika BJ, Sperling JW, Schleck CD, Cofield RH. Radiographic survival in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(9):1221–7.CrossRefPubMed
27.
go back to reference Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg. 2002;11(2):130–5.CrossRefPubMed Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg. 2002;11(2):130–5.CrossRefPubMed
Metadata
Title
No correlation between radiolucency and biomechanical stability of keeled and pegged glenoid components
Authors
Andreas Voss
Knut Beitzel
Elifho Obopilwe
Stefan Buchmann
John Apostolakos
Jessica Di Venere
Michael Nowak
Mark P. Cote
Anthony A. Romeo
Augustus D. Mazzocca
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1550-0

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