Scapular notching is a complication after reverse shoulder arthroplasty with a high incidence up to 100%. Its clinical relevance remains uncertain; however, some studies have reported that scapular notching is associated with an inferior clinical outcome. There have been no published articles that studied positional relationship between the scapular neck and polyethylene insert in vivo. The purpose of this study was to measure the distance between the scapular neck and polyethylene insert in shoulders with Grammont type reverse shoulder arthroplasty during active external rotation at the side. Eighteen shoulders with Grammont type prosthesis (Aequalis Reverse, Tornier) were enrolled in this study. There were 13 males and 5 female, and the mean age at surgery was 74 years (range, 63–91). All shoulders used a glenosphere with 36mm diameter, and retroversion of the humeral implant was 10°in 4 shoulders, 15°in 3 shoulders, and 20°in 11 shoulders. Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at the mean of 14 months (range, 7–24) after surgery. The patients also underwent CT scans, and three-dimensional glenosphere models with screws and scapula neck models were created from CT images. CT-derived models of the glenosphere and computer-aided design humeral implant models were matched with the silhouette of the implants in the fluoroscopic images using model-image registration techniques (Figure 1). Based on the calculated kinematics of the implants, the closest distance between the scapular neck and polyethylene insert was computed using the scapular model and computer-aided design insert models (Figure 2). The distance was computed at each 5° increment of glenohumeral internal/external rotation, and the data from 20°internal rotation to 40°external rotation were used for analyses. One-way repeated-measures analysis of variance was used to examine the change of the distance during the activity, and the level of significance was set at P < 0.05.Background
Methods
Hydroxyapatite and poly-L-lactide (HA/PLLA) composites are osteoconductive and biodegradable. They have already been used clinically to treat fractured bones by inducing osteosynthesis and serving as the bone filling material. During revision of total hip arthroplasty, we have grafted bone onto the bone defect and covered it with an HA/PLLA mesh instead of using a metal mesh on the non-load bearing portion of the cup (Figure 1). However, whether the interface between the HA/PLLA and the titanium alloy cup was stable remains unclear. The purpose of this study was to determine and compare the histological osteoconductivity and osteoinductivity of HA/PLLA and titanium alloy.Introduction
Objectives
Migration of the trial femoral head is a rarely occurring complication of total hip arthroplasty (THA) performed using the anterolateral approach (ALA). This migration of the trial femoral head under the rectus femoris is extremely risky because of the anatomical situation. Analyzing the morphological character of a case of migration may help us to avoid this risk. We analyzed the three-dimensional bone morphology using computed tomography (CT) scan images to investigate the physiological characteristics of five migration cases.Introduction
Objective
The initial stress distribution in the femur after total hip arthroplasty (THA) influences the remodeling of the bone and the clinical results. We conducted thermoelastic stress analysis to evaluate the surface stress distribution in femurs after THA in vitro and elucidated the changes in the stress distribution that were due to the stem design. Using this method, we can analyze the change in the sum of the principal stresses on the basis of the changes in temperature at the bone surface and visualize the change three-dimensionally. We compared the thermoelastic stress analysis results with the clinical results of specially shaped stems that have two flanges, one anterior and one posterior.Introduction
Objectives
Massive rotator cuff tears and consequent cuff-deficient arthritis (CTA) of the shoulder can cause severe shoulder dysfunction in the elderly. Reverse total shoulder arthroplasty (RTSA) has been widely used for treatment of CTA in all over the world since its introduction in the 90's. In Japan, however, we have just started to clinically use RTSA from April 2014. In addition, we have only one choice of the implants (Aequalis Reverse, Tornier) currently, and only one size of the base-plate of the glenoid component (29 mm in diameter) is available so far. Japanese, especially elderly people, have generally smaller figure than Caucasians. We are not sure whether the base-plate would fit for the smaller Japanese. The purpose of this study was to measure the size of the glenoids in Japanese using CT images and to examine that they would fit the 29 mm base-plate. The shoulders without osteoarthritis of the glenohumeral joint were eligible for the study. The subjects consisted of 30 shoulders including 10 elderly males, 10 elderly females, and 10 younger males, and the mean ages were 73 (range, 63–81), 74 (range, 65–89), and 32 (range, 27–36) years old, respectively. Mean heights and weights were 164 cm (range, 156–179) and 59 kg (range, 49–72), 154 cm (range, 151–161) and 57 kg (range, 48–65), and 173 cm (range, 162–179) and 72 kg (range, 61–100), respectively. CT images with a 0.3 mm slice pitch were used for the analysis. The images were loaded into a DICOM viewer (OsiriX), and a slice for simulated implantation of the base-plate was created using the multi-planar reconstruction (Figure 1), which had 10° of inferior tilt to the glenoid face. The width of the glenoid in the antero-posterior direction was measured at 14 mm above the inferior edge of the glenoid.Background
Methods
The goal of joint-preserving surgery for the treatment of osteonecrosis of the femoral head (ONFH) is to delay or prevent osteoarthritic development. Bone marrow is a source of osteogenic progenitors that are key elements in the process of bone formation and fracture healing. We established an easy-to-use method using a conventional manual blood bag centrifugation technique traditionally used for extracting buffy coats, for concentration of nucleated cells and platelets from clinical bone marrow aspirates to obtain osteogenic progenitors and growth factors. However, it is unclear whether the surgical goals are really achieved and if so in which patients. The purpose of this study was to identify demographic, clinical, and radiographic factors predicting total hip arthroplasty (THA) conversion after CABMAT for the treatment of idiopathic ONFH. We retrospectively reviewed 123 patients (213 hips) who had CABMAT between 2003 and 2010. Sixty-five subjects (115 hips) were male and 58 (98 hips) were female with an average age at the time of CABMAT of 40.1 years. Of the 213 hips, 143 hips in 78 patients had corticosteroid-induced ONFH, 46 hips in 27 patients had alcohol-associated, and 24 hips in 18 patients had no etiological factors could be detected. The mean follow-up period was 60.5 months. The endpoint of evaluation was set as the time point which the patient required additional surgery (THA) depending on the spontaneous hip pain, x-ray change, and social back ground. The following factors were investigated: age, sex, body mass index (BMI), unilateral or bilateral, etiological factors, preoperative classification and staging, visual analogue scale (VAS), JOA clinical score. The 213 hips were divided into two groups: a THA conversion (THA) group and a non-THA conversion (non-THA) group. A multivariate analysis was performed using a logistic regression model.Introduction
Methods
