The current use of a spherical prosthetic humeral head in total shoulder arthroplasty results in an imprecise restoration of the native geometry and improper placement of the center of rotation, maintained in a constant position, in comparison to the native head and regardless of glenoid component conformity. A radially-mismatched spherical head to allow gleno-humeral translation is a trade-off that decreases the contact area on the glenoid component, which may cause glenoid component wear. This finding suggests that the use of a non-spherical head with a more conforming glenoid component may reduce the risk of glenoid component wear by allowing gleno-humeral translation while increasing the contact area. A non-spherical prosthetic head more accurately replicates the head shape, rotational range of motion and gleno-humeral joint kinematics than a spherical prosthetic head, compared with the native humeral head. The combination of inversion of the bearing materials with the non-spherical configuration of the humeral head may thus decrease polyethylene wear. Aim of the present study is to evaluate in vitro wear behaviour of an all-polyethylene elliptical humeral head component against a metallic glenoid component in an anatomic configuration. The prosthetic components tested are from the Mirai® Modular Shoulder System by Permedica S.p.A.. The prosthetic bearing components were tested in their anatomic configuration: the humeral head rubbing against the glenoid inlay, assembled over the glenoid base-plate. The glenoid insert is made of Ti6Al4V alloy coated with TiNbN. The glenoid insert, as the glenoid base-plate have the same shape which reproduce the native shape of the glenoid. Moreover, the glenoid insert has a concave articular surface described by two different radii on orthogonal planes. The vitamin E-blended UHMWPE humeral head is not spherical but elliptic-shaped with an articular surface described by two different profiles in sagittal and coronal plane. The component sizes combination tested have the greatest radial mismatches allowed between humeral head and glenoid insert. The test was performed up to 2.5 million of cycles applying a constant axial load of 756 N.Background
Material and methods
Reverse shoulder prosthesis has been developed to treat the clinical and pathological condition noted as cuff tear arthropathy (CTA). The current models of reverse shoulder arthroplasty (RSA) expose the procedure to the risk of scapular notching, possibly leading to loosening of the glenoid. The purpose of this study was to report updated results at a minimum follow-up of four years of 25 patients underwent reverse shoulder arthroplasty between 2006 and 2010 with an eccentric 36-mm glenoid component (SMR Lima).Introduction
Aim
Reverse shoulder arthroplasty (RSA) is a reasonable treatment modality in patients with Cuff Tear Arthropaty and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. The aim of this study is to evaluate the clinical and radiographic results of a 44 polyethylene glenosphere. Since 2008 we treated 88 patients with cuff tear arthropaty and irreparable massive cuff tear, using an RSA. We selected 80 patients with minimum FU of 24 months in which we used an implant with polyethylene glenosphere and metal humeral insert. Size of the glenosphere used was 44. All patients were assessed with the Constant score and with VAS. The shoulder ROM was measured preoperatively and postoperatively.Introduction:
Methods:
Different surgical approaches have been proposed for the treatment of chondral lesions. However surgical management of osteochondral defects of the knee joint involving subchondral bone are still under debate. The aim of this prospective non-randomized uncontrolled clinical investigation is to confirm the effectiveness of a commercially available biomimetic osteochondral scaffold in regenerating cartilage and subchondral bone of severe osteochondral lesions of the knee joint with one step surgery.Background:
Purpose:
Published experimental data on BMP-7(OP-1), carried by collagen type 1 (Osigraft), related to reconstructive surgery attest that: it accelerates and improves the incorporation of strut allograft; the combination of OP-1 with auto or allograft results in an improvement of critical size defect healing from radiological, histological and mechanical perspective. In human revision hip surgery, OP-1 has been used with morcellized allograft, proximal femoral allograft and bulk femoral head allograft for acetabular or femoral reconstruction: a faster and more evident new bone formation as well as a faster incorporation of grafts has been shown compared to what expected without OP-1 usage. Even if OP-1 usage in hip surgery is not approved by regulatory agencies, because of lack of randomised clinical studies, we decided to use it in patients with serious acetabular defects (II/III GIR). In our experience, we treated eight patients with OP1, in conjunction with allografts. Clinical, radiographic and densitometric analysis has been done at 3, 6 and 12 months. Preliminary densitometric results show that the quantity and features of new formed bone are superimposable to natural bone.
