Preoperative planning to preserve glenoid subchondral bone in anatomical total shoulder replacement.

Background: Glenoid loosening remains a concern in anatomical total shoulder replacement. Preoperative planning software allows optimization of the component positioning, but the target orientation remains unclear due to conflicting optimization priorities. Commonly, the component is aligned to the prescribed version and inclination that reflect the population's average anatomy.

CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study.

Background And Purpose: CT micromotion analysis (CTMA) has been considered as an alternative to radiostereometry (RSA) for assessing early implant migration of orthopedic implants. We investigated the feasibility of CTMA to assess early migration and the progression of radiolucent lines in shoulder arthroplasties over 24 months using sequential low-dose CT scans.

Patients And Methods: 7 patients were included and underwent 9 primary total shoulder arthroplasties.

Novel robotic technology for the rapid intraoperative manufacture of patient-specific instrumentation allowing for improved glenoid component accuracy in shoulder arthroplasty: a cadaveric study.

Background: Accurate prosthesis placement in arthroplasty is an important factor in the long-term success of these interventions. Many types of guidance technology have been described to date often suffering from high costs, complex theater integration, time inefficiency, and problems with day-to-day usability. We present a novel, intraoperative robotics platform, capable of rapid, real-time manufacture of low-cost patient-specific guides while overcoming many of the issues with existing approaches.

Development and ex-vivo assessment of a novel patient specific guide and instrumentation system for minimally invasive total shoulder arthroplasty.

Objective: To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved?

Methods: A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment.

The Glenoid Vault Outer Cortex a new more accurate radiological reference for shoulder arthroplasty.

Introduction: Correct positioning of the glenoid component is an important determinant of outcome in shoulder arthroplasty. We describe and assess a new radiological plane of reference for improving the accuracy of glenoid preparation prior to component implantation - the Glenoid Vault Outer Cortex (GvOC) plane.

Methods: One hundred and five CT scans of normal scapulae were obtained.

Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups.

Background and purpose - CT (computed tomography) based methods have lately been considered an alternative to radiostereometry (RSA) for assessing early implant migration. However, no study has directly compared the 2 methods in a clinical setting. We estimated the precision and effective radiation dose of a CT-based method and compared it with marker-based RSA in 10 patients with hip arthroplasty.

Multiscale molecular profiling of pathological bone resolves sexually dimorphic control of extracellular matrix composition.

Collagen assembly during development is essential for successful matrix mineralisation, which determines bone quality and mechanocompetence. However, the biochemical and structural perturbations that drive pathological skeletal collagen configuration remain unclear. Deletion of vascular endothelial growth factor (VEGF; also known as VEGFA) in bone-forming osteoblasts (OBs) induces sex-specific alterations in extracellular matrix (ECM) conformation and mineralisation coupled to vascular changes, which are augmented in males.

The Bankart repair: past, present, and future.

Arthur Sidney Blundell Bankart was a London-based orthopedic surgeon who discovered the essential lesion in recurrent anterior shoulder instability in 1923. He pioneered a technique, the Bankart repair, to re-establish stability to the glenohumeral joint, without sacrificing native joint motion. In this article, the original Bankart repair is compared to the modern arthroscopic Bankart repair, accompanied by a surgical video of Blundell Bankart performing the Bankart repair in 1951, shortly before his death.

Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients.

Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex.

Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage.

Background: Hemiarthroplasty has clear advantages over alternative procedures and is used in 20% of all shoulder joint replacements. Because of cartilage wear, the clinical outcome of hemiarthroplasty is unreliable and controversial. This paper suggests that the optimal choice of prosthetic material may reduce cartilage degeneration and improve the reliability of the procedure.

Raman spectroscopy links differentiating osteoblast matrix signatures to pro-angiogenic potential.

Mineralization of bone is achieved by the sequential maturation of the immature amorphous calcium phase to mature hydroxyapatite (HA) and is central in the process of bone development and repair. To study normal and dysregulated mineralization in vitro, substrates are often coated with poly-l-lysine (PLL) which facilitates cell attachment. This study has used Raman spectroscopy to investigate the effect of PLL coating on osteoblast (OB) matrix composition during differentiation, with a focus on collagen specific proline and hydroxyproline and precursors of HA.

Accuracy and precision of a CT method for assessing migration in shoulder arthroplasty: an experimental study.

Background: Radiostereometric analysis (RSA) is the gold standard to measure early implant migration which is a predictive factor for implant survival.

Purpose: To validate an alternative computed tomography (CT) technique to measure implant migration in shoulder arthroplasty.

Material And Methods: A cadaver proximal humerus and a scapula, which had tantalum beads incorporated within them, were prepared to accept a short-stemmed humeral component and a two-pegged glenoid component of a commercial total shoulder arthroplasty (TSA) system.

The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology.

Background: The aim of this study was to examine the effect of arm position on proximal humerus fracture configuration and to determine whether cortical thinning would predispose to fracture propagation and more complex patterns of injury.

Methods: A drop test rig was designed to simulate falls onto an outstretched arm ('parachute reflex'). Thirty-one cadaveric specimens underwent computer tomography scanning and cortical thicknesses mapping.

The influence of full-thickness supraspinatus tears on abduction moments: the importance of the central tendon.

Background: Detachment of the central tendon of the supraspinatus from its insertion is considered to be crucial to functional deficit. The aim of the present study was to assess the function of the supraspinatus in terms of abduction moments by introducing different tear configurations to assess the functional effect of the central tendon insertion.

Methods: Ten fresh frozen shoulders from five cadavers were prepared for testing.

Cortical thickness analysis of the proximal humerus.

Background: Structural changes within the proximal humerus influence the mechanical properties of the entire bone and predispose to low-energy fractures with complex patterns. The aim of the present study was to measure the cortical thickness in different regions of the proximal humerus.

Methods: Thirty-seven proximal humeri were analyzed using novel engineering software to determine cortical thickness in 10 distinct anatomical zones.

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis.

Introduction: Total Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30-50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning.

A lightweight sensing platform for monitoring sleep quality and posture: a simulated validation study.

Background: The prevalence of self-reported shoulder pain in the UK has been estimated at 16%. This has been linked with significant sleep disturbance. It is possible that this relationship is bidirectional, with both symptoms capable of causing the other.

Simulation of bone-determined range of motion in proximal humeral fractures.

Background: Predicting the outcome following fractures of the proximal humerus is an important consideration when effectively counselling patients and planning treatment. The purpose of the present study was to analyze different proximal humeral fracture configurations, using a computerized simulation model, aiming to predict the range of motion (ROM).

Methods: The computer tomography scans of 79 proximal humeral fractures were analyzed using a customized software system that simulated the range of movement at the glenohumeral joint.

The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions.

Introduction: One hundred years ago, before Bankart, Latarjet or Bristow, Eden and Hybbinette developed a procedure to treat anterior shoulder instability and currently, this eponymous term is known by every shoulder surgeon. The purpose of this review is to summarise the historical "Eden-Hybbinette" procedure and its evolutions during the last century and discuss results.

Method: On the centenary of the first publication on the "Eden-Hybbinette procedure", a search was conducted on Medline, Google Scholar and in the grey literature, to find its initial concept and description, and the evolutions.

Cadaveric study validating in vitro monitoring techniques to measure the failure mechanism of glenoid implants against clinical CT.

Definite glenoid implant loosening is identifiable on radiographs, however, identifying early loosening still eludes clinicians. Methods to monitor glenoid loosening in vitro have not been validated to clinical imaging. This study investigates the correlation between in vitro measures and CT images.

Treatment of the Fixation Surface Improves Glenoid Prosthesis Longevity in vitro.

Unlabelled: Many commercial cemented glenoid components claim superior fixation designs and increased survivability. However, both research and clinical studies have shown conflicting results and it is unclear whether these design variations do improve loosening rates. Part of the difficulty in investigating fixation failure is the inability to directly observe the fixation interface, a problem addressed in this study by using a novel experimental set-up.