[논문]Radiologic Comparison of Humeral Position according to the Implant Designs Following Reverse Shoulder Arthroplasty: Analysis between Medial Glenoid/Medial Humerus, Lateral Glenoid/Medial Humerus, and Medial Glenoid/Lateral Humerus Designs

Cho, Nam Su; Nam, Ju Hyun; Hong, Se Jung; Kim, Tae Wook; Lee, Myeong Gu; Ahn, Jung Tae; Rhee, Yong Girl

doi:10.5397/cise.2018.21.4.192

Radiologic Comparison of Humeral Position according to the Implant Designs Following Reverse Shoulder Arthroplasty: Analysis between Medial Glenoid/Medial Humerus, Lateral Glenoid/Medial Humerus, and Medial Glenoid/Lateral Humerus Designs 원문보기

Clinics in shoulder and elbow, v.21 no.4, 2018년, pp.192 - 199

Cho, Nam Su (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Nam, Ju Hyun (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Hong, Se Jung (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Kim, Tae Wook (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Lee, Myeong Gu (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Ahn, Jung Tae (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) , Rhee, Yong Girl (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)

Abstract ▼ AI-Helper

Background: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. Methods: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation ($LHO^{COR}$), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. Results: The increment in postoperative AED was $19.92{\pm}3.93mm$ in group A, $24.52{\pm}5.25mm$ in group B, and $25.97{\pm}5.29mm$ in group C, respectively (p=0.001). The increment in postoperative LHO was $0.13{\pm}6.30mm$, $8.00{\pm}12.14mm$, and $7.42{\pm}6.88mm$, respectively (p=0.005). The increment in postoperative $LHO^{COR}$ was $20.76{\pm}6.06mm$, $22.04{\pm}5.15mm$, and $28.11{\pm}4.14mm$, respectively (p=0.002). Conclusions: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and $LHO^{COR}$ between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.

주제어

표/그림 (11)

그림 A Fig. 1. Preoperative (A) and postoperative (B) acromiohumeral distance (AHD).
그림 A Fig. 2. Preoperative (A) and postoperative (B) acromioepiphyseal distance (AED).
그림 Fig. 3. Preoperative (A) and postoperative (B) lateral humeral offset (LHO). AHD: acromiohumeral distance.
그림 Fig. 4. Preoperative (A) and postoperative (B) lateral humeral offset from the center of rotation (LHO^COR). AHD: acromiohumeral distance.
그림 A Fig. 5. Preoperative (A) and postoperative (B) deltoid length.
표 Table 1. Group A (MGMH)
표 Table 2. Group B (LGMH)
표 Table 3. Group C (MGLH)
표 Table 4. Preoperative and Postoperative Comparison among Groups A, B, and C
표 Table 5. Comparison of Differences in Increment among Groups A, B, and C
표 Table 6. Multiple Comparisons

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문제 정의

To date, the impacts of RSA design on postoperative humeral position are not been well-studied. This study was therefore undertaken to radiologically analyze the effect of different RSA designs on humeral position following RSA. Considering the characteristics of all three designs, we hypothesized that there would be differences between the 3 groups (the MGLH group, LGMH group, and MGMH group) for lateral humeral offset (LHO), and the MGLH group would have greater LHO from the COR (LHO^COR).

가설 설정

This study was therefore undertaken to radiologically analyze the effect of different RSA designs on humeral position following RSA. Considering the characteristics of all three designs, we hypothesized that there would be differences between the 3 groups (the MGLH group, LGMH group, and MGMH group) for lateral humeral offset (LHO), and the MGLH group would have greater LHO from the COR (LHO^COR).

제안 방법

1), acromioepiphyseal distance (AED), LHO, LHO^COR, and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. All parameters were evaluated twice by a single observer to assess repeatability of the measurements. Intraobserver reproducibility was based on the data acquired during the measurement series.
All patients underwent preoperative and postoperative radiologic examinations. All radiographic measurements were performed on a true anteroposterior view of each patient.
All patients underwent preoperative and postoperative radiologic examinations. All radiographic measurements were performed on a true anteroposterior view of each patient. The acromiohumeral distance (AHD) (Fig.
Minor changes in arm position or shoulder angle could affect each measurement. Despite several limitations of this study, the results of the current study can be coherent because this study is a single-surgeon series performing all three different designs of operations in the same standardized method.
Second, the number of patients included in this study is small. Only 6 patients were included in group B. In addition, although both bony-increased offset and metallic offset can be used for RSA using the LGMH design, this study used only the bony-increased offset. Also, a centric or an eccentric humeral tray configuration can be used for artificial joint surgery using the MGLH design, and while using the eccentric humeral tray configuration, the dial can be rotated in different directions depending on the situation of each individual case at the time of operation.
Moreover, some studies have reported the results of each design individually, but, to our knowledge, no clinical study has compared the radiologic measurements of all three designs simultaneously. Therefore, this study was undertaken to evaluate the imaging data obtained from surgeries performed using all three designs, all executed by a single surgeon.

대상 데이터

Patients preoperatively diagnosed as glenohumeral arthritis (1 case), secondary glenohumeral arthritis due to infection sequelae or trauma (2 cases), four-part proximal humerus fracture (3 cases), or osteonecrosis of humeral head (1 case) were excluded from the study. Finally, a total of 50 patients (10 male and 40 female) were included in this study. The mean patient age at the time of operation was 75.
Of the 50 patients included in the final analysis, 33 patients (group A: MGMH) underwent RSA using the Aequalis system (Wright, Inc., Bloomington, MN, USA), 6 patients (group B: LGMH) with Aequalis system using bony increased offset (Wright, Inc.), and 11 patients (group C: MGLH) with Aequalis Ascend Flex system (Wright, Inc.).
Totally, 57 shoulders (57 patients) that underwent primary RSA for irreparable rotator cuff tear or cuff tear arthropathy between September 2009 and April 2017 were enrolled for this study and retrospectively analyzed. Patients preoperatively diagnosed as glenohumeral arthritis (1 case), secondary glenohumeral arthritis due to infection sequelae or trauma (2 cases), four-part proximal humerus fracture (3 cases), or osteonecrosis of humeral head (1 case) were excluded from the study.

데이터처리

The Wilcoxon signed-rank test was used for data analysis between the preoperative and postoperative measurements of each group. Kruskal-Wallis test with a Tukey post hoc comparison analyzed the data between the three groups. Significance was set at a level of 0.

성능/효과

095). The multiple comparisons revealed no statistically significant differences between group B and C, but there were significant differences between groups A and B in the increment of LHO, and between groups A and C in increments of AED, LHO, and LHO^COR (Table 6).
999 for average measurements. The results demonstrate good to excellent intra-observer reproducibility, indicating that all measurements can be performed with good repeatability.

참고문헌 (30)

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