TY - JOUR
T1 - A novel osteotomy in shoulder joint replacement based on analysis of the cartilage/metaphyseal interface
AU - Harrold, Fraser
AU - Malhas, Amar
AU - Wigderowitz, Carlos
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/11
Y1 - 2014/11
N2 - Background: The accuracy of reconstruction is thought to impact on functional outcome following glenohumeral joint arthroplasty. The objective of this study was to define an area of minimal anatomic variation at the cartilage/metaphyseal interface of the proximal humerus to optimize the osteotomy of the humeral head, enabling accurate reconstruction with a prosthetic component. Methods: Hand held digitization and 3D surface laser scanning techniques were used to digitize 24 cadaveric arms and determine the normal geometry. Each humeral head was then examined to identify the most consistent anatomical landmarks for the ideal osteotomy plane to optimize humeral component positioning. Findings: The novel, posterior referencing, osteotomy resulted in a mean increase in retroversion of only 0.4° when compared to the original geometry. A traditional anterior referencing osteotomy, by comparison, produced a mean increase in retroversion of 11°. In addition, the novel osteotomy only increased axial diameter by 0.71 mm and head height by 0.02 mm compared to an anterior referencing osteotomy (3.0 mm and 2.7 mm respectively). Interpretation: The traditional osteotomy, referencing the anterior border of the cartilage/metaphyseal interface potentially resulted in an increase in prosthetic head size and retroversion. The novel osteotomy, referencing from the posterior cartilage/metaphyseal interface enabled a more accurate recovery of head geometry. Importantly, the increase in retroversion created by the traditional osteotomy was not replicated with the novel technique. Referencing from the posterior cartilage/metaphyseal interface produced a more reliable osteotomy, more closely matching the original humeral geometry. Level of Evidence: Basic Science, Anatomic study, Computer model.
AB - Background: The accuracy of reconstruction is thought to impact on functional outcome following glenohumeral joint arthroplasty. The objective of this study was to define an area of minimal anatomic variation at the cartilage/metaphyseal interface of the proximal humerus to optimize the osteotomy of the humeral head, enabling accurate reconstruction with a prosthetic component. Methods: Hand held digitization and 3D surface laser scanning techniques were used to digitize 24 cadaveric arms and determine the normal geometry. Each humeral head was then examined to identify the most consistent anatomical landmarks for the ideal osteotomy plane to optimize humeral component positioning. Findings: The novel, posterior referencing, osteotomy resulted in a mean increase in retroversion of only 0.4° when compared to the original geometry. A traditional anterior referencing osteotomy, by comparison, produced a mean increase in retroversion of 11°. In addition, the novel osteotomy only increased axial diameter by 0.71 mm and head height by 0.02 mm compared to an anterior referencing osteotomy (3.0 mm and 2.7 mm respectively). Interpretation: The traditional osteotomy, referencing the anterior border of the cartilage/metaphyseal interface potentially resulted in an increase in prosthetic head size and retroversion. The novel osteotomy, referencing from the posterior cartilage/metaphyseal interface enabled a more accurate recovery of head geometry. Importantly, the increase in retroversion created by the traditional osteotomy was not replicated with the novel technique. Referencing from the posterior cartilage/metaphyseal interface produced a more reliable osteotomy, more closely matching the original humeral geometry. Level of Evidence: Basic Science, Anatomic study, Computer model.
KW - Shoulder
KW - Arthroplasty
KW - Osteotomy
KW - Anatomy
KW - Humerus
KW - geometry
UR - http://www.scopus.com/inward/record.url?scp=84906803746&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiomech.2014.08.008
DO - 10.1016/j.clinbiomech.2014.08.008
M3 - Article
C2 - 25195075
SN - 0268-0033
VL - 29
SP - 1032
EP - 1038
JO - Clinical Biomechanics
JF - Clinical Biomechanics
IS - 9
ER -