Humeral head arthroplasty and its ability to restore original humeral head geometry

Fraser Harrold; Carlos Wigderowitz

doi:10.1016/j.jse.2012.01.027

Humeral head arthroplasty and its ability to restore original humeral head geometry

Fraser Harrold
, Carlos Wigderowitz

Research output: Contribution to journal › Article › peer-review

31 Citations (Scopus)

Abstract

Background: Modern prosthetic components are designed to enable restoration of proximal humeral morphology, provided that a precise osteotomy of the humeral head at the level of the anatomic neck is performed. To determine whether a simulated osteotomy and replacement arthroplasty with an idealized implant were able to restore original head geometry.

Materials and methods: A handheld digitizer and surface laser scanner were used to digitize 24 humeri. Computer models were used to simulate an osteotomy, performed at the anterior cartilage-metaphyseal interface, and reconstruct the head with a spherical prosthetic head. The head diameter, radius of curvature, and inclination and retroversion angles were calculated for each specimen and compared with the original humeral head.

Results: The simulated osteotomy resulted in a 4.8 degrees decrease in inclination (P <.01) and 11.3 degrees increase in retroversion (P <.001). The radius of curvature in the coronal plane was not significantly different (P = .284). However, in the axial plane, the prosthesis was significantly larger than the original head for both head diameter (P <.001) and radius of curvature (P <.05). Discussion: The study suggests that the humeral head is not a perfect segment of a sphere and an osteotomy along the anterior cartilage-metaphyseal interface does not remove only the proximal humeral articular surface. Even with a fully adaptable prosthetic implant, replacement arthroplasty is not able to restore original head geometry.

Conclusions: Alterations to head geometry with the osteotomy described may alter the line of force through the prosthetic joint, producing eccentric loading at the glenoid, and contribute to early failure.

Original language	English
Pages (from-to)	115-121
Number of pages	7
Journal	Journal of shoulder and elbow surgery
Volume	22
Issue number	1
Early online date	14 May 2012
DOIs	https://doi.org/10.1016/j.jse.2012.01.027
Publication status	Published - 2013

Keywords

osteotomy
humerus
RETROVERSION
PROSTHETIC DESIGN
PROXIMAL HUMERUS
TOTAL SHOULDER ARTHROPLASTY
REPLACEMENT
OSTEOARTHRITIS
COMPLICATIONS
CONTACT
geometry
GLENOHUMERAL JOINT
ARTICULAR GEOMETRY
anatomy
Shoulder
arthroplasty

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10.1016/j.jse.2012.01.027

Cite this

@article{c5afc4380c924840a4c0b52849f4a781,

title = "Humeral head arthroplasty and its ability to restore original humeral head geometry",

abstract = "Background: Modern prosthetic components are designed to enable restoration of proximal humeral morphology, provided that a precise osteotomy of the humeral head at the level of the anatomic neck is performed. To determine whether a simulated osteotomy and replacement arthroplasty with an idealized implant were able to restore original head geometry.Materials and methods: A handheld digitizer and surface laser scanner were used to digitize 24 humeri. Computer models were used to simulate an osteotomy, performed at the anterior cartilage-metaphyseal interface, and reconstruct the head with a spherical prosthetic head. The head diameter, radius of curvature, and inclination and retroversion angles were calculated for each specimen and compared with the original humeral head.Results: The simulated osteotomy resulted in a 4.8 degrees decrease in inclination (P <.01) and 11.3 degrees increase in retroversion (P <.001). The radius of curvature in the coronal plane was not significantly different (P = .284). However, in the axial plane, the prosthesis was significantly larger than the original head for both head diameter (P <.001) and radius of curvature (P <.05). Discussion: The study suggests that the humeral head is not a perfect segment of a sphere and an osteotomy along the anterior cartilage-metaphyseal interface does not remove only the proximal humeral articular surface. Even with a fully adaptable prosthetic implant, replacement arthroplasty is not able to restore original head geometry.Conclusions: Alterations to head geometry with the osteotomy described may alter the line of force through the prosthetic joint, producing eccentric loading at the glenoid, and contribute to early failure.",

keywords = "osteotomy, humerus, RETROVERSION, PROSTHETIC DESIGN, PROXIMAL HUMERUS, TOTAL SHOULDER ARTHROPLASTY, REPLACEMENT, OSTEOARTHRITIS, COMPLICATIONS, CONTACT, geometry, GLENOHUMERAL JOINT, ARTICULAR GEOMETRY, anatomy, Shoulder, arthroplasty",

author = "Fraser Harrold and Carlos Wigderowitz",

year = "2013",

doi = "10.1016/j.jse.2012.01.027",

language = "English",

volume = "22",

pages = "115--121",

journal = "Journal of shoulder and elbow surgery",

issn = "1058-2746",

publisher = "Elsevier",

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T1 - Humeral head arthroplasty and its ability to restore original humeral head geometry

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AU - Wigderowitz, Carlos

PY - 2013

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N2 - Background: Modern prosthetic components are designed to enable restoration of proximal humeral morphology, provided that a precise osteotomy of the humeral head at the level of the anatomic neck is performed. To determine whether a simulated osteotomy and replacement arthroplasty with an idealized implant were able to restore original head geometry.Materials and methods: A handheld digitizer and surface laser scanner were used to digitize 24 humeri. Computer models were used to simulate an osteotomy, performed at the anterior cartilage-metaphyseal interface, and reconstruct the head with a spherical prosthetic head. The head diameter, radius of curvature, and inclination and retroversion angles were calculated for each specimen and compared with the original humeral head.Results: The simulated osteotomy resulted in a 4.8 degrees decrease in inclination (P <.01) and 11.3 degrees increase in retroversion (P <.001). The radius of curvature in the coronal plane was not significantly different (P = .284). However, in the axial plane, the prosthesis was significantly larger than the original head for both head diameter (P <.001) and radius of curvature (P <.05). Discussion: The study suggests that the humeral head is not a perfect segment of a sphere and an osteotomy along the anterior cartilage-metaphyseal interface does not remove only the proximal humeral articular surface. Even with a fully adaptable prosthetic implant, replacement arthroplasty is not able to restore original head geometry.Conclusions: Alterations to head geometry with the osteotomy described may alter the line of force through the prosthetic joint, producing eccentric loading at the glenoid, and contribute to early failure.

AB - Background: Modern prosthetic components are designed to enable restoration of proximal humeral morphology, provided that a precise osteotomy of the humeral head at the level of the anatomic neck is performed. To determine whether a simulated osteotomy and replacement arthroplasty with an idealized implant were able to restore original head geometry.Materials and methods: A handheld digitizer and surface laser scanner were used to digitize 24 humeri. Computer models were used to simulate an osteotomy, performed at the anterior cartilage-metaphyseal interface, and reconstruct the head with a spherical prosthetic head. The head diameter, radius of curvature, and inclination and retroversion angles were calculated for each specimen and compared with the original humeral head.Results: The simulated osteotomy resulted in a 4.8 degrees decrease in inclination (P <.01) and 11.3 degrees increase in retroversion (P <.001). The radius of curvature in the coronal plane was not significantly different (P = .284). However, in the axial plane, the prosthesis was significantly larger than the original head for both head diameter (P <.001) and radius of curvature (P <.05). Discussion: The study suggests that the humeral head is not a perfect segment of a sphere and an osteotomy along the anterior cartilage-metaphyseal interface does not remove only the proximal humeral articular surface. Even with a fully adaptable prosthetic implant, replacement arthroplasty is not able to restore original head geometry.Conclusions: Alterations to head geometry with the osteotomy described may alter the line of force through the prosthetic joint, producing eccentric loading at the glenoid, and contribute to early failure.

KW - osteotomy

KW - humerus

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KW - PROSTHETIC DESIGN

KW - PROXIMAL HUMERUS

KW - TOTAL SHOULDER ARTHROPLASTY

KW - REPLACEMENT

KW - OSTEOARTHRITIS

KW - COMPLICATIONS

KW - CONTACT

KW - geometry

KW - GLENOHUMERAL JOINT

KW - ARTICULAR GEOMETRY

KW - anatomy

KW - Shoulder

KW - arthroplasty

U2 - 10.1016/j.jse.2012.01.027

DO - 10.1016/j.jse.2012.01.027

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SN - 1058-2746

VL - 22

SP - 115

EP - 121

JO - Journal of shoulder and elbow surgery

JF - Journal of shoulder and elbow surgery

IS - 1

ER -

Humeral head arthroplasty and its ability to restore original humeral head geometry

Abstract

Keywords

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