Multichannel computed tomography (MCCT) analysis of glenoid erosion in shoulder hemiarthroplasty: preliminary clinical applications
Tóm tắt
Glenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term follow-up studies. Radiographic analysis is useful to depict glenoid erosion but does not evaluate accurately glenoid bone loss. Multichannel computed tomography (MCCT) allows scanning with submillimeter section thickness through dense areas of glenoid bone, despite the presence of metallic prostheses. In this preliminary study, we performed a MCCT analysis of glenoid erosion, in 15 patients with painful shoulder HA, at an average follow-up of 5.5 years. Clinical scores were retrospectively assessed at an early (1 year), medium (2.5 years), and late (5.5 years) follow-up. We analyzed the following glenoid features: articular line space (ALS), glenoid length (bone stock), glenoid version, morphology of erosion (concentric, superior ed inferior tilt), and gross bone defects. Glenoid was retroversed in 13 patients (minimum 0° maximum 8°), antiversed in 2 patients (2° and 6°). Erosion was described as concentric in 13 patients, eccentric (“superior tilt”) in 1 patient, biconcave in another patient. The mean glenoid length was 19.7 mm (min 16.4 max 22.7). Gross bone defects were described in six patients. The scores registered at latest follow-up showed a significant decrease compared with the values at 1 year (P < 0.001) and at 2.5 years (P < 0.001). The patients with glenoid erosion associated with gross defects and ALS ≤1.2 mm had lower scores for pain and lower scores for ROM (P < 0.01). Multidetector CT analysis establishes a new frontier in the postoperative management of shoulder arthroplasty, and its application in the glenoid analysis offers a significant contribution for the following reasons: qualitative and quantitative glenoid features are better seen because volume-rendering eliminates most streak artifacts and produces high-quality images; spatial information relative to the prosthetic devices and the relationship among hardware and bone can be better demonstrated; allows an accurate preoperative planning prior to starting with revision surgery.
Tài liệu tham khảo
Goldman RT, Kaval KJ, Cuomo F, Gallagher MA, Zuckerman JD (1995) Functional outcome after humeral head replacement for acute three- and four- part proximal humeral fractures. J Shoulder Elbow Surg 4:81–86
Green A, Barnard WL, Limbird RS (1998) Humeral head replacement for acute, four-part proximal humerus fractures. J Shoulder Elbow Surg 2:249–254
Boileau P, Chuinard C, Le Huec J, Walch G, Trojani C (2006) Proximal humerus fracture sequelae impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Surg 442:121–130
Sperling JW, Cofield RH, Rowland CM (1998) Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less: long-term results. J Bone Joint Surg 80A:464–473
Merolla G, Di Pietto F, Romano S, Paladini P, Campi F, Porcellini G (2008) Radiographic analysis of shoulder anatomical arthroplasty. Eur J Radiol 68:159–169
Merolla G, Paladini P, Campi F, Porcellini G (2008) Efficacy of anatomical prostheses in primary glenohumeral osteoarthritis. Chir Organi Mov 91:109–115
Farber JM (2004) CT arthrography and postoperative musculoskeletal imaging with multichannel computed tomography. Sem Muscul Skel Rad 8:157–166
Rydberg J, Liang Y, Teague SD (2004) Fundamentals of multichannel CT. Semin Muscul Skel Rad 8:137–146
Barrett JF, Keat N (2004) Artifacts in CT: recognition and avoidance. Radiographics 24:1679–1691
Bokor DJ, O’Sullivan MD, Hazan GJ (1999) Variability of measurement of glenoid version on computed tomography scan. J Shoulder Elbow Surg 8:595–598
Nyffeler RW, Jost B, Pfirrmann CWA, Gerber C (2003) Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg 12:493–496
Edwards TB, Boulahia A, Kempf J, Boileau P, Ne’moz C, Walch G (2004) Shoulder arthroplasty in patients with osteoarthritis and dysplastic glenoid morphology. J Shoulder Elbow Surg 13:1–4
Friedman RJ, Hawthorne KB, Genez BM (1992) The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am 74:1032–1037
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164
Richards RR, An KN, Bigliani LU, Friedman R, Gartsman JM, Gristina AG et al (1994) American shoulder and elbow surgeons: a standardized method for the assessment of the shoulder function. J Shoulder Elbow Surg 3:347–352
Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic shoulder arthroplasty. Clin Orthop 155:7–20
Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London
Armitage P, Berry G (1994) Statistical methods in medical research, 3rd edn. Blackwell, Oxford, pp 111–114
Parson IM, Millett PJ, Warner JP (2004) Glenoid wear after shoulder hemiarthroplasty: a quantitative analysis. Clin Orthop Rel Res 421:120–125
Merolla G, Nicoletti D, Casaburi P, Cavagna E, Campi F, Paladini P, Porcellini G (2009) Quantification of glenoid erosion in shoulder hemiarthroplasty: radiographic analysis and clinical considerations. J Orthop Traumatol 10:S41–S60
Merolla G, Campi F, Paladini P, Lollino N, Fauci F, Porcellini G (2009) Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty. Musculoskelet Surg 93:S29–S34