Background and purpose

Alignment of the glenoid component with the scapula during total shoulder arthroplasty (TSA) is challenging due to glenoid erosion and lack of both bone stock and guiding landmarks. We determined the extent to which the implant position is governed by the preoperative erosion of the glenoid. Also, we investigated whether excessive erosion of the glenoid is associated with perforation of the glenoid vault.

Methods

We used preoperative and postoperative CT scans of 29 TSAs to assess version, inclination, rotation, and offset of the glenoid relative to the scapula plane. The position of the implant keel within the glenoid vault was classified into three types: centrally positioned, component touching vault cortex, and perforation of the cortex.

Results

Preoperative glenoid erosion was statistically significantly linked to the postoperative placement of the implant regarding all position parameters. Retroversion of the eroded glenoid was on average 10° (SD10) and retroversion of the implant after surgery was 7° (SD11). The implant keel was centered within the vault in 7 of 29 patients and the glenoid vault was perforated in 5 patients. Anterior cortex perforation was most frequent and was associated with severe preoperative posterior erosion, causing implant retroversion.

Interpretation

The position of the glenoid component reflected the preoperative erosion and “correction” was not a characteristic of the reconstructive surgery. Severe erosion appears to be linked to vault perforation. If malalignment and perforation are associated with loosening, our results suggest reorientation of the implant relative to the eroded surface.

Background

Current techniques for measuring in vivo polyethylene wear suffer from a range of problems, resulting in an unacceptable lack of repeatability and/or insufficient accuracy when they are used to measure the low wear rates associated with new, highly crosslinked polyethylene. We describe an improved CT method for measurement of 3D femoral head penetration in PE acetabular cups that has sufficient accuracy and repeatability to allow assessment of the wear potential of modern implants.

Method

The accuracy and repeatability of the CT-scan method was determined by blindly repeating measurements on a precisely calibrated 28-mm prosthetic head and by comparing them with direct metrological measurements on 10 acetabular specimens with in vitro wear from machining, and on 8 explanted acetabular specimens with in vivo wear.

Results

The intra- and interobserver errors in femoral head diameter were 0.036 mm (SD 0.044) and 0.050 mm (SD 0.022), respectively. CT estimated femoral head penetration in both all-poly and metal-backed acetabular components with accuracy ranging from 0.009 to 0.245 mm (mean 0.080; SD 0.067).

Interpretation

We found that the CT method is rapid, is accurate, and has repeatability and ease of availability. Using a slice thickness of 0.0625 mm, this method can detect wear—and also the threshold for the wear rate that causes osteolysis—much earlier than previous methods.

Binding of oleate to S-nitrosylated human serum albumin (SNO-HSA) enhances its cytoprotective effect on liver cells in a rat ischemia/reperfusion model. It enhances the antiapoptotic effect of SNO-HSA on HepG2 cells exposed to anti-Fas antibody. To identify some of the reasons for the increased cytoprotective effects, additional experiments were performed with glutathione and HepG2 cells. As indicated by 5,5′-dithiobis-2-nitrobenzoic acid binding, the addition of oleate increased the accessibility of the single thiol group of albumin. Binding of increasing amounts of oleate resulted in increasing and more rapid S-transnitrosation of glutathione. Likewise, binding of oleate, or of a mixture of endogenous fatty acids, improved S-denitrosation of SNO-HSA by HepG2 cells. Oleate also enhanced S-transnitrosation by HepG2 cells, as detected by intracellular fluorescence of diaminofluorescein-FM. All of the S-transnitrosation caused by oleate binding was blocked by filipin III. Oleate also increased, in a dose-dependent manner, the binding of SNO-HSA labeled with fluorescein isothiocyanate to the surface of the hepatocytes. A model in two parts was worked out for S-transnitrosation, which does not involve low molecular weight thiols. Fatty acid binding facilitates S-denitrosation of SNO-HSA, increases its binding to HepG2 cells and greatly increases S-transnitrosation by hepatocytes in a way that is sensitive to filipin III. A small nitric oxide transfer takes place in a slow system, which is unaffected by fatty acid binding to SNO-HSA and not influenced by filipin III. Thus, fatty acids could be a novel type of mediator for S-transnitrosation.

A robust quantification method is essential for inter-subject glenoid comparison and planning of total shoulder arthroplasty. This study compared various scapular and glenoid axes with each other in order to optimally define the most appropriate method of quantifying glenoid version and inclination.

Six glenoid and eight scapular axes were defined and quantified from identifiable landmarks of twenty-one scapular image scans. Pathology independency and insensitivity of each axis to inter-subject morphological variation within its region was tested. Glenoid version and inclination were calculated using the best axes from the two regions.

The best glenoid axis was the normal to a least-square plane fit on the glenoid rim, directed approximately medio-laterally. The best scapular axis was the normal to a plane formed by the spine root and lateral border ridge. Glenoid inclination was 15.7° ± 5.1° superiorly and version was 4.9° ± 6.1°, retroversion.

The choice of axes in the present technique makes it insensitive to pathology and scapular morphological variabilities. Its application would effectively improve inter-subject glenoid version comparison, surgical planning and design of prostheses for shoulder arthroplasty.