Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components.

BACKGROUND: Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. METHODS: We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. RESULTS: Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r = 0.93, radiolucency to Lazarus r = 0.92 (P value <.001 for all). CONCLUSION: This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.

Assessment of thickness of roof of the glenoid fossa in dentate, edentulous, and partially edentulous subjects using cone beam computed tomography (CBCT) - a retrospective study.

OBJECTIVES: Studies have inferred a direct association between Temporomandibular joint disorders (TMD) and the integrity of the structures associated with it such as the Glenoid fossa thereby necessitating the requirement to measure the thickness of this oft ignored entity. This study was carried out to assess the thickness of the glenoid fossa roof in dentulous, edentulous, and partially edentulous subjects using archival Cone beam computed tomography (CBCT) images. METHOD: Analysis of CBCT data of 120 joints from 60 adult subjects without signs and symptoms of TMD was carried out. The scans were grouped based on the dental status as dentulous, edentulous, and partially edentulous and additionally into two sets as those below and above 40 years of age. The distance between the superior and inferior cortices of the glenoid fossa was measured indicating the thickness of the roof of the glenoid fossa in the coronal and sagittal planes, by three independent observers. Analysis of Variance (ANOVA) and Tukey's post hoc test were used to compare the association between the mean thickness of the glenoid fossa and the dentition status. A p ≤ 0.05 was considered to be significant. RESULTS: There was no significant association between the mean thickness of the glenoid fossa and the dentition of the study participants of all three groups, when assessed by the three observers, except the mean thickness on the right side in the sagittal section as measured by one observer. A thicker fossa was observed in edentulous subjects when compared to dentulous participants, and the difference was statistically significant (p = 0.035). CONCLUSION: The thickness of the roof of the glenoid fossa demonstrated no association with the dental status of the study participants and no age or sex related differences were noted.

Surgeon acceptance of an initial 3D glenoid preoperative plan: rates and risk factors.

BACKGROUND: Although the effect of 3-dimensional (3D) planning for total shoulder arthroplasty (TSA) on component positioning and patient outcomes has been increasingly studied, the effect of 3D planning on surgeon decision making has not been well studied. METHODS: A retrospective review was performed of a database containing TSA cases for which the glenoid component was planned with a commercially available 3D computed tomography software program (Virtual Implant Positioning; Arthrex, Inc.) from 2016 to 2019. A total of 6483 cases planned by 417 surgeons were included. The glenoid version (Vtech) and inclination (Itech) of the Virtual Implant Positioning technician plan as well as the surgeon's final plan for version (Vsurg) and inclination (Isurg) were extracted. When the version and/or inclination of the surgeon plan matched that of the technician, that variable was defined as "accepted." The rates of acceptance of Vtech and Itech were calculated and analyzed for association with implant type, native version and inclination, and running case count. A subgroup analysis of high-volume users (n > 30 cases) was analyzed to determine if any of the variables independently was associated with surgeon acceptance. RESULTS: There was a very high rate of matching of version (66%), inclination (72%), or both (55%) and a low rate (18%) where neither parameter of the glenoid plan matched that of the technician. In univariate analysis, as the case count and retroversion increased the rate of accepting of version dropped noticeably (70%-50% and 47%, respectively [ P< .0001]). The rate of accepting the plan for inclination did not vary much as case count changed. In the multivariate analysis, 23 of 56 high-volume surgeons had at least 1 independent factor associated with accepting the technician-planned glenoid version, and 5 surgeons had 2 independent factors. In the multivariate analysis of matching glenoid inclination, 27 of 56 high-volume surgeons had at least 1 independent factor associated with accepting the technician-planned glenoid version, and 9 surgeons had 2 or more independent factors. CONCLUSIONS: In a large database of TSAs with 3D-planned glenoids, there were high rates of cases with surgeon agreement with an initial plan provided by an industry technician: 66% in version, 72% in inclination, 55% for both version and inclination. Surgeon acceptance of the initial plan decreased as pathoanatomy increased and case count increased. Shoulder surgeons should be aware that an initial 3D preoperative plan provided by industry represents a potential source of cognitive bias in shoulder arthroplasty planning.

Computer navigation leads to more accurate glenoid targeting during total shoulder arthroplasty compared with 3-dimensional preoperative planning alone.

BACKGROUND: Commercially available preoperative planning software is now widely available for shoulder arthroplasty. However, without the use of patient-specific guides or intraoperative visual guidance, surgeons have little in vivo feedback to ensure proper execution of the preoperative plan. The purpose of this study was to assess surgeons' ability to implement a preoperative plan in vivo during shoulder arthroplasty. METHODS: Fifty primary shoulder arthroplasties from a single institution were retrospectively reviewed. All surgical procedures were planned using a commercially available software package with both multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. Following registration of intraoperative visual navigation trackers, the surgeons (1 attending and 1 fellow) were blinded to the computer navigation screen and attempted to implement the plan by simulating placement of a central-axis guide pin. Malposition was assessed (>4 mm of displacement or >10° error in version or inclination). Data were then blinded, measured, and evaluated. RESULTS: Mean displacement from the planned starting point was 3.2 ± 2.0 mm. The mean error in version was 6.4° ± 5.6°, and the mean error in inclination was 6.6° ± 4.9°. Malposition was observed in 48% of cases after preoperative planning. Malposition errors were more commonly made by fellow trainees vs. attending surgeons (58% vs. 38%, P = .047). CONCLUSIONS: Despite preoperative planning, surgeons of various training levels were unable to reproducibly replicate the planned component position consistently. Following completion of fellowship training, significantly less malposition resulted. Even in expert hands, the orientation of the glenoid component would have been malpositioned in 38% of cases. This study further supports the benefit of guided surgery for accurate placement of glenoid components, regardless of fellowship training.

Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons.

BACKGROUND: Preoperative planning software is gaining utility in reverse total shoulder arthroplasty (RTSA), particularly when addressing pathologic glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning a series of RTSA cases to identify differences in how surgeons consider optimal implant placement. This may help identify opportunities to establish consensus when correlating plan differences with clinical data. METHODS: A total of 49 computed tomography scans from actual RTSA cases were planned for RTSA by 9 fellowship-trained shoulder surgeons using the same platform (Exactech GPS, Exactech Inc., Gainesville, FL, USA). Each case was planned a second time 6-12 weeks later. Variability within and between surgeons was measured for implant selection, version correction, inclination correction, and implant face position. Interclass correlation coefficients, and Pearson and Light's kappa coefficient were used for statistical analysis. RESULTS: There was considerable variation in the frequency of augmented baseplate selection between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability ranged from 0.43 for version, 0.42 for inclination, and 0.25 for baseplate type. Pearson coefficients for intrasurgeon variability were 0.34 for version and 0.30 for inclination. Light's kappa coefficient for baseplate type was 0.61. CONCLUSIONS: This study demonstrates substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. Although average differences between plans were relatively small, there were large differences in specific cases suggesting little consensus on optimal planning parameters and opportunities to establish guidelines based on glenoid pathoanatomy. The correlation of preoperative planning with clinical outcomes will help to establish such guidelines.

Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population.

PURPOSE: In this study, our aim was to evaluate the glenoid version, height, and width measurements based on gender, side, age, height, and hand dominance in the Turkish population using computed tomography (CT) images. METHODS: In our study, CT images of 140 patients (62 females and 78 males; mean age: 39.6 years) who had no shoulder complaints were evaluated retrospectively. Glenoid version (GV), AP diameter (width), and SI diameter (height) on both shoulders were measured on the CT images. Correlations between patient gender, side, age, height, and hand dominance and the GV and size were evaluated. RESULTS: The right shoulder had a mean GV of -0.93 ± 7.80 degrees and the left shoulder had a GV of -0.88 ± 6.63 degrees (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (. CONCLUSION: Hand dominance had an effect on the glenoid version, while patient gender, age, and height had an effect on the glenoid size. The glenoid width in the Turkish population was similar to that of the European and American populations, and the glenoid height was similar to that of the Asian population. Our GV values were similar to those of the Asian population and more anteverted compared to the Western population. We believe that our findings will be useful in preoperative planning and in the production of implants for our population.

Quantitative in vivo assessment of bone allograft viability using 18F-fluoride PET/CT after glenoid augmentation in reverse shoulder arthroplasty: a pilot study.

BACKGROUND: Success after glenoid bone augmentation in total shoulder arthroplasty depends on osseous integration and non-resorption. Standard imaging techniques, such as computed tomography (CT) and X-rays, cannot quantify bone viability. Therefore, we introduce a new technique to assess graft viability using 18F-sodium fluoride (18F-NaF) PET-CT for femoral allografts in reverse total shoulder arthroplasty (RSA). MATERIALS AND METHODS: Patient charts were reviewed following glenoid augmentation using femoral allografts in reverse total shoulder arthroplasty. A total of seven patients were included in this study. 18F-NaF PET-CT was used to assess graft viability and graft fusion. Semiquantitative assessment of 18F-NaF uptake was performed by means of a standardized uptake value (SUV). Radiographs were used to assess fusion. The mean age of the patients at the time of follow-up was 83.4 years (range 79-92), and the mean follow-up was 44.4 months. RESULTS: Viability and fusion were confirmed in all allografts using semiquantitative analysis of 18F-NaF PET-CT by means of standardized uptake value (SUVmax). Metabolic activity of medullary region of a vertebral spine was defined as a reference background. The mean value of maximum tracer activity in the allograft was not statistically different from native bone in the reference vertebrae (p = 0.14). CONCLUSIONS: 18F-NaF PET-CT is a practicable tool to quantitatively assess viability in large bone allografts after glenoid augmentation in RSA. The study shows viability and fusion in all allografts. LEVEL OF EVIDENCE: Level IV, treatment study.

Clinical outcomes and radiologic assessment of a modified suture button arthroscopic Latarjet procedure.

BACKGROUND: As several neurologic and hardware complications have been reported with screw fixation. Suture buttons are used to serve as an alternative to screw fixation to obtain better outcome and to reduce the complication. The purpose of this study was to observe the clinical outcomes and make the radiologic assessment of a modified suture button (MSB) arthroscopic Latarjet procedure. METHODS: A total of ninty-one patients with recurrent shoulder joint dislocation who underwent MSB arthroscopic Latarjet procedure was retrospectively reviewed. Fifty cases identified from the chart review met the inclusion criteria. The clinical outcomes and position of the grafts, glenohumeral degeneration, and graft healing condition were assessed postoperatively in a follow-up with at least one and half of a year. RESULTS: All the fifty patients were satisfied with their clinical outcome. The overall complication rate was 4% in this study. The mean visual analog scale score, the affected shoulder active mobility in Ers(external rotation at the side), Era(external rotation in abduction) decreased significantly; the ASES score, Rowe score, Walch-Duplay score improved significantly. CT scans in the sagittal view showed that grafts in 88% of cases were in good position, grafts in 12% of cases were fixed too superiorly and inferiorly. In the axial view grafts in forty cases were flush with the glenoid rim, ten were considered as too lateral. The ten grafts became remodeled and were more flush with the glenoid rim in the follow-up. CONCLUSIONS: The MSB arthroscopic Latarjet procedure provides excellent outcome with few complications, and no degenerative changes were observed in the follow-up. Moreover, the graft fixed too laterally presented a phenomenon of remodeling and became flush with the glenoid rim over time.

Multilevel glenoid morphology and retroversion assessment in Walch B2 and B3 types.

OBJECTIVE: A major factor that impacts the long-term outcome and complication rates of total shoulder arthroplasty is the preoperative posterior glenoid bone loss quantified by glenoid retroversion. The purpose of this study was to assess if glenoid retroversion varies significantly at different glenoid heights in Walch B2 and B3 glenoids. MATERIALS AND METHODS: Patients with B2 and B3 glenoid types were included following retrospective review of 386 consecutive CT shoulder studies performed for arthroplasty preoperative planning. True axial CT reconstructions were created using a validated technique. Two readers independently measured the glenoid retroversion angles according to the Friedman method using the "intermediate" glenoid at three glenoid heights: 75% (upper), 50% (equator), and 25% (lower). The variances between the three levels for a given patient were calculated. RESULTS: Twenty-nine B2 and 8 B3 glenoid types were included. There was no significant difference in variance of glenoid version among the three levels in B2 or B3 groups. The mean variance in retroversion degree between equator-lower, upper-equator, and upper-lower glenoid was - 0.4, 0.3, and - 0.2 for B2; and - 0.2, 1.9, and 1.9 for B3 glenoid, respectively. The level of inter-reader agreement was fair to good for variance at equator-lower, and good to excellent for upper-equator and upper-lower glenoid. CONCLUSIONS: Glenoid version can be accurately measured at any level between 25 and 75% of glenoid height for Walch B2 and B3. We recommend that the glenoid equator be used as the reference to assure consistent and reliable version measurements in this group of patients.

Superior glenoid inclination and glenoid bone loss : Definition, assessment, biomechanical consequences, and surgical options.

Correct anatomical alignment of the glenoid component is of central importance for wear and loosening in shoulder endoprostheses. The aim of this article is to review and clarify the biomechanical and clinical effects of incorrect glenoid inclination in reverse and anatomical joint replacements. Based on the literature and on our own work, statements are made about the following: (1) the glenoid inclination of a normal glenoid, a degenerative glenoid and a glenoid implant, and the consequences if superior inclination is too large, and (2) the surgical technique as well as tips and tricks for correct adjustment of the inclination. The inclination of the glenoid plane is a morphological parameter of the scapula with high individual variation and is best measured using reformatted computed tomography using three-dimensional software for reconstruction and evaluation. The standard value is between 0 and 10°. Excessive superior inclination promotes translation of the humeral head and the formation of rotator cuff tears-in a degenerative glenoid, to superior wear. The correct amount of superior inclination of the glenoid component is essential for the survival of the implant. Positioning without excessive superior inclination is therefore mandatory. Precise preoperative determination of glenoid inclination and wear is important in order to correctly plan the positioning of an implant. This serves as the basis for deciding whether a bone graft or patient-specific instrumentation is necessary. Thus, the surgeon also has prognostic parameters for the anticipation of possible complications as a result of the bone defect and abnormal orientation. However, the evaluation must always include the position of the scapula in these considerations.

Three-dimensional assessment of the normal Japanese glenoid and comparison with the normal French glenoid.

INTRODUCTION: In 2014, reverse total shoulder arthroplasty was approved in Japan. We were concerned that the base plate might be incompatible with Japanese who were generally smaller than Westerners. Therefore, we investigated the dimensions and morphology of the normal Japanese glenoid and compared with the normal French glenoid. MATERIALS AND METHODS: One hundred Japanese shoulders without glenoid lesions (50 men and 50 women) were investigated and compared with 100 French shoulders (50 men and 50 women). Computed tomography was performed with 3-dimensional image reconstruction and images were analyzed using Glenosys software. Glenoid parameters (width, height, retroversion and inclination) were compared between Japanese and French subjects. RESULTS: In Japanese subjects, the mean glenoid width was 25.5mm, height was 33.3mm, retroversion was 2.3° and inclination was 11.6° superiorly. In French subjects, the mean glenoid width was 26.7mm, height was 35.4mm, retroversion was 6.0° and inclination was 10.4° superiorly. Glenoid width and height were significantly smaller in Japanese subjects than French subjects (P=0.001 and P<0.001), while retroversion was significantly greater in French subjects (P<0.001). There was no significant difference of inclination. CONCLUSIONS: These findings will help surgeons to identify suitable patients for RSA and perform the procedure with appropriate preoperative planning. LEVEL OF EVIDENCE: IV: retrospective or historical series.

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment.

OBJECTIVE: To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). MATERIALS AND METHODS: The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). RESULTS: Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. CONCLUSIONS: Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

Description and reproducibility assessment of a new computerised tomography scan index to measure the glenoid orientation in relation to the anterior glenoid surface.

PURPOSE: To propose and to assess the reproducibility of a new method (GO [glenoid orientation] index) for the estimation of the glenoid orientation in relation to the anterior surface of the glenoid. METHODS: This is a retrospective study on computed tomography (CT) scan. The GO index was defined as the angle formed by a line perpendicular to the tangent to the anterior surface of the scapula and the glenoid line (which is defined as the line connecting the anterior and the posterior rim of the glenoid). The measurements were performed at the level of the glenoid where its diameter is the greatest. Two independent observers performed each measurement twice. The intra- and inter-observer reproducibility was evaluated by the Pearson coefficient (r) and the intra-class correlation coefficient (ρ, ICC). The correlation between GO index and glenoid version as described by Friedman was also studied. RESULTS: Seventy-eight CT scans were analysed, 38 shoulders with glenohumeral arthritis and 40 healthy shoulders, 32 females/46 males, mean age 53.9 ± 22.7 years. The measures were all highly correlated (r > 0.50, p = 0.00001). The intra- and inter-observer reproducibility was good to excellent (0.71 < ρ < 0.84, p = 0.00001). GO index was 26.9 ± 6.3°, 28.4 ± 6° in the group with glenohumeral osteoarthritis and 25.5 ± 6.4° in the healthy group, p = 0.04. The glenoid version was -0.8 ± 7.9° in the group with glenohumeral osteoarthritis and -3.9 ± 6° in the healthy group, p = 0.05. No agreement was found between the glenoid version and GO index. CONCLUSIONS: GO index is simple and reproducible. It could be very useful for the pre-operative planning and intra-operative positioning of the implants in total shoulder arthroplasty.

Improved Visualization and Assessment of Condylar Position in the Glenoid Fossa for Different Occlusions: A CBCT Study.

INTRODUCTION: The position of the condyle in the glenoid fossa plays an important role in the stability of occlusion after orthodontic treatment. Cone beam computed tomography (CBCT) provides an optimal imaging of the osseous components of the temporomandibular joint (TMJ) and give a full size truly three-dimensional (3D) description in real anatomical size. The present study aimed to visualize and compare the position of condyle in the glenoid fossa for different occlusions by using CBCT Materials and methods: Cone beam computed tomographic images of 45 subjects, aged 18 to 42 years, were evaluated. Subjects were equally divided into three groups according to the A point, nasion, B point (ANB) angle. RESULTS: In the sagittal plane, condyle is positioned nonconcen-trically; positioned anteriosuperiorly in class I and III occlusions and lies posteriosuperiorly in class II occlusion. In the frontal plane, condyle is positioned centrally (mediolaterally) in all the three types of occlusions. In the axial plane, the parameters showed significant difference between the different occlusions. No statistical significant distinction could be made in the position of the condyle when comparing the right and left joints. CONCLUSION: The position of condyle in glenoid fossa influences sagittal, transverse, and vertical relationships of the jaws which eventually contribute to development of various malocclusions. Nonconcentricity is the feature of the condyle in the sagittal plane in different malocclusions. CLINICAL SIGNIFICANCE: An important consideration in orthodontic treatment is the recognition of the importance that the dentition should be in harmony with the related musculoskeletal structures. Therefore, the condylar position is an important concern in maintaining or restoring temporomandibular harmony with the dentition and the position of the condyle in the glenoid fossa plays an important role in the stability of occlusion after orthodontic treatment.

Influence of scapular tilt on radiographic assessment of the glenoid component after total shoulder arthroplasty: which radiographic landmarks are reliable?

BACKGROUND: Total shoulder arthroplasty has been shown to improve function and to reduce pain in cases of osteoarthritis. To assess loosening of the glenoid component, serial evaluation of frontal plane radiographs of the scapula has been established as the "gold standard." The aim of this study was to evaluate the reliability of different bone landmarks when the scapula is tilted compared with the ideal view. METHODS: Glenoid components were implanted into 6 human cadaveric scapulae. Radiographs were taken exactly anterior-posterior in the frontal plane as well as craniocaudal tilted (±15° and ±30°) and mediolateral tilted (±10° and ±20°). The following landmarks were evaluated: lateral margin of the scapula, medial margin of the scapula, floor of the fossa supraspinatus line, spine of the scapula line, glenoid fossa line, and coracoid base line. RESULTS: In evaluating the inclination of the glenoid component, the medial margin of the scapula had the best intraobserver and interobserver reliability with a variance for each of 2° ± 1° (P < .0001), whereas the lateral margin of the scapula had an acceptable intraobserver and interobserver reliability with a variance of 4° ± 1° and 3° ± 1°. In measuring medial migration, the glenoid fossa line had a significantly lower intraobserver and interobserver reliability than the coracoid base line (each 1 ± 0 mm vs. 3 ± 1 mm and 3 ± 2 mm; P < .0001). CONCLUSION: To assess the inclination of the glenoid component, the medial margin of the scapula has proven best, and the lateral margin of the scapula has acceptable reliability. For measuring medial migration, the coracoid base line has proven acceptable reliability, whereas the glenoid fossa line would be subject to change when osteolysis occurs at the glenoid.

Three-dimensional assessment of maxillary protraction with miniplates in patients with cleft lip and palate / Avaliação tridimensional da protração ortopédica da maxila com miniplacas em pacientes com fissura labiopalatina

The aim of this study was to assess maxillary, mandibular and glenoid fossa changes after bone anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). Methods: The experimental group comprised 24 patients with UCLP and maxillary sagittal deficiency with a mean initial age of 11.8 years. Cone-beam computed tomography (CBCT) exams of 24 patients with UCLP taken before (T1) and 18 months (T1) after beginning BAMP therapy were selected from the files of the Hospital of Rehabilitation of Craniofacial Anomalies. CBCTs were superimposed at the cranial base. Three-dimensional displacements of landmarks placed in surface models were quantified and visualized in color-coded maps and semi-transparency superimpositions. Kolmogorov-smirnov test was used to calculate distribution of normality. Paired t test was used to compare cleft and non-cleft sides (p<0.05). Results: A point and non-cleft central incisor displaced toward anterior (1.66mm), inferior (1.21mm) and to the cleft side. Orbitale, Infraorbitale foramen and maxillary first permanent molar displaced similarly toward anterior, inferior and medial direction. The zygoma displaced similarly toward anterior and inferior, however the cleft side showed a significantly greater lateral displacement compared to the non-cleft side. The superior concavity of the glenoid fossa showed symmetrical displacement toward anterior, lateral and superior, while the anterior and posterior eminences showed symmetrical displacements toward anterior, lateral and inferior. The mandible showed an overall symmetrical inferior and posterior displacement except for the medial pole of the condyle, which showed a significantly greater lateral displacement on the cleft side. Conclusions: Maxilla showed an anterior and inferior displacement. The glenoid fossa and the overall mandible symmetrically displaced downward and backward. The zygoma of the cleft side was the only maxillary landmark to show significantly greater lateral displacement than the non-cleft side, as well as the medial pole of the condyle on the cleft side.(AU)

O objetivo deste trabalho foi avaliar as alterações da maxila, mandíbula e fossa glenóide após o tratamento com protração maxilar ancorada em osso (BAMP) em pacientes com fissura unilateral completa de lábio e palato (UCLP). Métodos: o grupo experimental foi composto por 24 pacientes com UCLP e deficiência sagital de maxila com idade inicial de 11,8 anos. Foram selecionados exames de tomografia computadorizada de feixe cônico (CBCT) de 24 pacientes com fissura UCLP realizadas antes e após 18 meses de terapia com BAMP pertencentes ao Hospital de Reabilitação de Anomalias Craniofaciais. Os exames de CBCT foram sobrepostos pela base do crânio. Deslocamentos tridimensionais foram mensurados por meio de pontos colocados em modelos de superfície, bem como foram visualizados em mapas coloridos e sobreposições de semi-transparência. A distribuição de normalidade foi calculada por meio do teste de Kolmogorov-Smirnov. A comparação entre os lados com e sem fissura foi realizada por meio do teste t pareado (p<0.05). Resultados: O ponto A e o incisivo central superior do lado sem fissura deslocaram para anterior (1.66mm), inferior (1.21mm) e para o lado da fissura. Os pontos Orbitário, Forame Infra-orbitário e os primeiros molares permanentes superiores se deslocaram simetricamente para anterior, inferior e medial. O ponto Zigomático deslocou simetricamente para anterior e inferior, porém o lado da fissura apresentou um deslocamento significantemente maior para lateral comparado ao lado sem fissura. A concavidade superior da fossa glenóide apresentou um deslocamento simétrico para anterior, lateral e superior. As eminências anterior e posterior da fossa glenóide apresentaram um deslocamento simétrico para anterior, lateral e inferior. No geral, não houve diferença estatisticamente significante entre os lados com e sem fissura para o deslocamente inferior e posterior da mandíbula. O polo medial do côndilo foi o único ponto em que o lado da fissura apresentou um deslocamento significantemente maior para lateral quando comparado ao lado sem fissura. Conclusões: A maxila mostrou um deslocamento simétrico para anterior e inferior. A fossa glenóide e a mandíbula mostraram um deslocamento simétrico para inferior e para trás. Entretanto, os pontos zigomático e polo medial apresentaram um deslocamento lateral significantemente maior no lado da fissura.(AU)

Like father, like son: assessment of the morphological affinities of A.L. 288-1 (A. afarensis), Sts 7 (A. africanus) and Omo 119-73-2718 (Australopithecus sp.) through a three-dimensional shape analysis of the shoulder joint.

The postcranial evidence for the Australopithecus genus indicates that australopiths were able bipeds; however, the morphology of the forelimbs and particularly that of the shoulder girdle suggests that they were partially adapted to an arboreal lifestyle. The nature of such arboreal adaptations is still unclear, as are the kind of arboreal behaviors in which australopiths might have engaged. In this study we analyzed the shape of the shoulder joint (proximal humerus and glenoid cavity of the scapula) of three australopith specimens: A.L. 288-1 (A. afarensis), Sts 7 (A. africanus) and Omo 119-73-2718 (Australopithecus sp.) with three-dimensional geometric morphometrics. The morphology of the specimens was compared with that of a wide array of living anthropoid taxa and some additional fossil hominins (the Homo erectus specimen KNM-WT 15000 and the H. neanderthalensis specimen Tabun 1). Our results indicate that A.L. 288-1 shows mosaic traits resembling H. sapiens and Pongo, whereas the Sts 7 shoulder is most similar to the arboreal apes and does not present affinities with H. sapiens. Omo 119-73-2718 exhibits morphological affinities with the more arboreal and partially suspensory New World monkey Lagothrix. The shoulder of the australopith specimens thus shows a combination of primitive and derived traits (humeral globularity, enhancement of internal and external rotation of the joint), related to use of the arm in overhead positions. The genus Homo specimens show overall affinities with H. sapiens at the shoulder, indicating full correspondence of these hominin shoulders with the modern human morphotype.

The effects of glenoid wear patterns on patients with osteoarthritis in total shoulder arthroplasty: an assessment of outcomes and value.

BACKGROUND: Despite the success of total shoulder arthroplasty (TSA), concerns remain about the longevity of the implant, in particular, glenoid component survivorship. The purpose of this study was to determine whether preoperative glenoid wear patterns affect clinical outcomes and value in patients undergoing TSA. METHODS: A comparative cohort study was conducted of 309 patients with a total of 344 TSA procedures, performed for primary glenohumeral osteoarthritis. Computed tomography scans were obtained in all patients, with preoperative glenoid wear pattern characterized as either concentric (n = 196; follow-up time, 49.2 months) or eccentric (n = 148; follow-up time, 52.3 months) according to a modified Levine classification. A clinical, radiographic, and economic assessment was performed between the 2 wear patterns. RESULTS: There was no significant difference in American Shoulder and Elbow Surgeons (ASES) score in the concentric group (80.8 ± 20.8) compared with the eccentric group (77.6 ± 21.2) at final follow-up (P = .159). Range of motion and final visual analog scale for pain score were similar between the 2 groups. Radiographic evidence of gross glenoid loosening was significantly lower in the concentric group [11 of 195 (5.6%)] compared with the eccentric group [18 of 147 (12.2%)] (P = .030). Revision rates were similar between the concentric group [4 of 195 (2.0%)] and the eccentric group [3 of 147 (2.0%)]. A value assessment also showed no significant difference between the concentric and eccentric groups [concentric 26.1 vs. eccentric 25.5 (ΔASES score/$10,000 hospital cost) (P = .479)]. CONCLUSIONS: Similar clinical results and value can be expected with both concentric and eccentric glenoid wear patterns in TSA. Concerns arise, however, as the eccentric group demonstrated a more than 2-fold increased rate of glenoid component loosening compared with the concentric group.

Assessment of approximate glenoid size in Thai people.

BACKGROUND: The loosening of the glenoid baseplate component is one of the most common complications after reverse total shoulder arthroplasty. The mismatch between size of baseplate and glenoid in Thai People may result in improper baseplate screw fixation and lead to early loosening of the glenoid component. Knowing of the glenoid size will guide the surgeon in placing or choosing the proper size glenoid baseplate to improve screw fixation strength. OBJECTIVE: Study the size ofglenoid in Thai people and compare with previous studies. MATERIAL AND METHOD: The authors measured the glenoid size in anteroposterior and superoinferior directions, the data were recorded in term of mean and standard deviation. The present data were then compared with the previous glenoid studies to identify the differences in size between Thai people and others. RESULTS: Among 160 patients with the mean age of 58.2 +/- 14.2 years, the overall glenoid sizefor the entire study group were 32.3 +/- 3.2 mm and 24.4 +/- 3.2 mm in superoinferior (SI) and anteroposterior (AP) directions, respectively. The male glenoid size were 35.6 +/- 2.6 mm and 26.7 +/- 2.5 mm in SI andAP directions, respectively. The female glenoid SI diameter were 31.0+1.9 mm and in AP diameter were 22.0 +/- 1.7 mm. The glenoid size in Thai people was significantly smaller than the glenoid size from previous studies in Caucasians. CONCLUSION: The overall glenoid size in Thai people was significantly smaller than the previous studies in Caucasians. The female glenoid was also smaller than with the male. These findings alert surgeons to choose the proper glenoid baseplate design to avoid an overhang problem and improve screw fixation, especially in Thaifemale patients.

3D CT assessment of the relationship between humeral head alignment and glenoid retroversion in glenohumeral osteoarthritis.

BACKGROUND: Glenoid bone loss associated with advanced glenohumeral arthritis is frequently accompanied by subluxation of the humeral head with subsequent inferior outcomes of shoulder arthroplasty. We hypothesized that the relationship between the center of the humeral head and the perpendicular to the glenoid fossa plane differs from, and is independent of, the relationship between the center of the humeral head and the plane of the scapula. METHODS: Three-dimensional computed tomography (3D CT) imaging was performed on sixty patients with advanced osteoarthritis and fifteen controls with no osteoarthritis to define the baseline relationship between the center of the humeral head and the perpendicular to the glenoid fossa plane and the plane of the scapula. Correlations between these variables and the amount of bone loss and glenoid version were assessed. RESULTS: There was a strong linear relationship (p < 0.001) between glenoid retroversion and the center of the humeral head in relation to the center line of the scapula (humeral-scapular alignment). Humeral head alignment in relation to the glenoid plane (humeral-glenoid alignment) was variable and not strongly correlated with the amount of glenoid retroversion. The average glenoid retroversion for the normal shoulders was -3.5°, and the average humeral-scapular alignment offset percentage was -2.3%. The average humeral-glenoid alignment offset for the normal shoulders was 0.5 mm with an average humeral-glenoid alignment offset percentage of 0.9%. CONCLUSIONS: The location of the humeral head in relation to the glenoid can be defined as displacement from the plane of the scapula and from the perpendicular of the glenoid plane. These two measures are independent of one another. The data suggest that each measurement may represent a different effect on glenoid loading. CLINICAL RELEVANCE: The importance of this study is that it presents quantitative data and clear guidelines to define two measurements of glenohumeral alignment as separate and important variables. The clinical relevance of these methods will be further defined when they are correlated with clinical outcomes.