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Progressive glenoid bone loss caused by erosion in humeral head resurfacing

Progressive Glenoiderosion nach Implantation einer zementfreien Oberflächenersatzprothese der Schulter

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Abstract

Background

Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon.

Objectives

The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors.

Materials and methods

We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X‑rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion.

Results

We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74–0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9 mm at more than 5 years’ follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%.

Conclusions

Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.

Zusammenfassung

Hintergrund

Der zementfreie Oberflächenersatz der Schulter stellt eine Alternative zur konventionellen anatomischen Schaftprothese dar. Eine bekannte Komplikation der Hemiendoprothetik ist die Glenoiderosion, ein Substanzverlust der Schultergelenkpfanne.

Ziel der Arbeit

Ziel unserer Arbeit war die Validierung einer radiologischen Messmethode zur Quantifizierung der Glenoiderosion nach Implantation eines Oberflächenersatz der Schulter. Zudem sollten der zeitliche Verlauf und prognostische Faktoren des progredienten Pfannensubstanzverlusts aufgedeckt werden.

Material und Methoden

Es wurde eine retrospektive klinische und radiologische Analyse von 38 Oberflächenersatzprothesen im Mittel 65,4 ± 43 Monate postoperativ durchgeführt. Anhand eines standardisierten Protokolls wurden der Constant-Score, das aktive Bewegungsausmaß sowie Röntgenparameter bestimmt. Die radiologische Messung der Glenoiderosion erfolgte durch 3 unabhängige Untersucher.

Ergebnisse

Eine fortschreitende Glenoiderosion konnte in allen Fällen nachgewiesen werden und betrug 5 Jahre postoperativ im Mittel 5,5 ± 3,9 mm. Insbesondere männliche Patienten zeigten einen erhöhten Glenoidsubstanzverlust innerhalb der ersten 5 Jahre (p < 0,04). Die Messmethode zur Bestimmung der Glenoiderosion wies eine gute Interobserver-Reliabilität auf (ICC 0,74–0,78). Im Gesamtkollektiv verbesserte sich der Constant-Score von 20,2 ± 13 Punkten auf 55,4 ± 23,6 Punkte, wobei ein niedrigeres Alter mit besseren funktionellen Ergebnissen korrelierte (p = 0,03). Die Revisionsrate aufgrund schmerzhafter Glenoiderosion betrug 37 %.

Diskussion

Nach Implantation einer Schulterkappenprothese kann regelmäßig das Auftreten einer Glenoiderosion beobachtet werden. Eine schmerzhafte Glenoiderosion mit resultierendem Funktionsverlust führt zu hohen Revisionsraten.

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Abbreviations

A:

Glenoid depth

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

PACS:

Picture archiving and communication system

R:

Distance spinoglenoidal notch to joint line

R′:

Distance humeral center of rotation to joint line

R*:

Distance joint line to lateral edge of acromion

SD:

Standard deviation

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Authors and Affiliations

  1. Klinik für Schulter- und Ellenbogenchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany

    B. S. Werner, A. Abdelkawi, R. Hudek & F. Gohlke

  2. Orthopädisches Zentrum, Friedrichshafen, Germany

    J. Stehle

  3. Orthopädische Universitätsklinik König Ludwig Haus, Würzburg, Germany

    P. Plumhoff

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  1. B. S. Werner
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Correspondence to B. S. Werner.

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Conflict of interest

B.S. Werner and F. Gohlke declare to be under consultancy contracts with Wright/Tornier. J. Stehle, A. Abdelkawi, P. Plumhoff, and R. Hudek declare that they have no competing interests.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all patients included in the study.

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Werner, B.S., Stehle, J., Abdelkawi, A. et al. Progressive glenoid bone loss caused by erosion in humeral head resurfacing. Orthopäde 46, 1028–1033 (2017). https://doi.org/10.1007/s00132-017-3483-6

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