None of the patients was lost ... Cranial migration of the humeral head was measured ac- cording to ... taken not to destroy the subchondral bone of the glenoid.
International Orthopaedics (SICOT) DOI 10.1007/s00264-014-2540-6
ORIGINAL PAPER
Results of cementless humeral head resurfacing with cemented glenoid components Patric Raiss & Manuela Weiter & Boris Sowa & Felix Zeifang & Markus Loew
Received: 28 July 2014 / Accepted: 15 September 2014 # SICOT aisbl 2014
Abstract Purpose The aim of this study was to analyse the short- and medium-term clinical and radiographic results of cementless humeral head resurfacing in combination with a cemented glenoid component. Methods Thirty-five patients with a mean age of 65 years (range 42–84) and a mean follow-up of three years (two to six) were followed up. The Constant score with its subgroups as well as shoulder motions and complications were recorded. Radiographs in two planes were analysed for loosening of the components. Results Mean Constant score improved from 29 points (6–63) to 70 points (41–89; p12 points was defined as a loosened component.
Fig. 1 Anterior-posterior radiograph of the right shoulder of a 67-yearold woman with a primary osteoarthritis, narrowing of the joint space and a large inferior osteophyte
Radiolucent lines around the humeral head resurfacing arthroplasties were also analysed. Moreover, radiographs were checked for any change of implant position, e.g. tilt and/or subsidence. The immediate postoperative radiographs were compared with the most recent ones in order to detect loosening or a change of implant position. Cranial migration of the humeral head was measured according to the method of Torchia et al. [18] and was graded mild if the centre of the surface replacement arthroplasty had migrated less than 25 % relative to the glenoid, moderate if the migration was between 25 and 50 %, and severe if the migration was >50 %. Operative technique and implants In all cases the deltopectoral approach was used. The proximal part of the pectoralis major tendon was incised between 1 and 2 cm and was repaired at the end of the procedure. The subscapularis tendon was tenotomised and detached from the lesser tuberosity, leaving a 0.5–1 cm stump at the tuberosity. The glenohumeral ligaments were released and a
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Fig. 3 Anterior-posterior radiograph of the same patient as in Figs. 1 and 2 treated with a hybrid total shoulder arthroplasty three days after surgery
Fig. 2 Axillary radiograph of the same women as in Fig. 1
tenodesis of the long head of the biceps was performed. The labrum was resected from antero-inferior to postero-inferior. The humeral head was dislocated, and osteophytes were resected with bone scissors. The humeral head was prepared according to the manufactures recommendation. A central pin was inserted in the humeral head using a drill guide after the surgeon had chosen the position and the inclination of the implant. The drill guide was then removed and a cannulated and hemispherical reamer was used to prepare the humeral head. After removal of the subchondral bone a trial component was inserted to check the correct position. The component was then removed and a Fukuda retractor was placed at the posterior glenoid wall. The arm was rotated externally and the middle of the glenoid was marked with a bovie. A drill pin was placed in the centre of the glenoid and the surface was reamed with curved reamers of increasing size. Care was taken not to destroy the subchondral bone of the glenoid. Three drill holes were placed in a line and the bridges between
the holes were broken with a rongeur. The bone was impacted into the keel-slot with an impactor. A trial glenoid component was inserted and the bone was cleaned by pulsatile lavage. The bone was then dried with sponges and cement was placed into the keel slot with a syringe in retrograde fashion. The component was inserted and held in place until the cement cured. The remaining cement around the component was removed. The humeral head was then dislocated and the original cementless humeral surface replacement arthroplasty was impacted onto the humeral head. This implant has a hemispherical surface and is available in 12 sizes. Primary fixation is achieved by a tapered, tri-fin, antirotational stem in one of three lengths. Moreover, there is a diamond-shaped area of macrotexture at the inner surface for enhanced primary fixation. There is a plasma-sprayed titanium and hydroxyapatite coating for secondary bone ingrowth. After placement of the implants the subscapularis tendon was repaired with five non-absorbable sutures and the wound was closed in two layers. Drains were removed after one to two days and the arm was placed in abduction braces for four weeks postoperatively.
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Fig. 5 Anterior-posterior radiograph of the same patient as in Figs. 1, 2, 3, and 4 three years after surgery. There is no evidence for loosening or change of implant position of the glenoid or humeral component
Results Clinical results
Fig. 4 Axillary radiograph three days after arthroplasty
Physiotherapy was started at day two and was continued for six weeks with shoulder flexion and abduction limited to 60° and external rotation to 0° in an active-assistive fashion. Statistics The paired T-test was used for statistical analysis, assessing paired preoperative and postoperative Constant scores (overall and subgroups) as well as shoulder joint motion (flexion, abduction and internal/external rotation). A two-tailed p value of
