Effect of Glenoid Perforation During Total Shoulder Arthroplasty on Glenoid Component Cement Fixation and Suprascapular Nerve

Overview

Journal Shoulder Elbow

Date 2021 Oct 18

PMID 34659467

Authors

Gregory I Pace

Rachel A Thomas

Connor L Zale

Gregory S Lewis

Raymond Y Kim

H Mike Kim

Affiliations

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Abstract

Background: Arthritic glenoids are susceptible to vault perforation during total shoulder arthroplasty. We investigated the effects of glenoid perforation and subsequent cement extrusion on the suprascapular nerve and on the glenoid cement infiltration.

Methods: Total shoulder arthroplasty using three-pegged glenoid components were performed on 10 cadaveric shoulders assigned to two groups (perforation vs. control). In perforation group, the glenoids were reamed eccentrically and intentionally perforated medially through the central peg hole, whereas control group received perpendicular reaming with no perforation. Bone cement was applied to each peg. Spatial relationship between the extruded cement and the suprascapular nerve, and the amount of cement infiltration into the cancellous bone were evaluated.

Results: In perforation group, five specimens were perforated anteriorly, and two posteriorly. In the two posteriorly perforated specimens, the suprascapular nerve was in direct contact with extruded cement at the spinoglenoid notch. Perforation group showed significantly less cement infiltration into the cancellous bone than control group ( = 0.008).

Conclusions: Glenoid perforation decreases the volume of cement infiltration into the cancellous bone potentially compromising glenoid component fixation. Glenoid perforation tends to occur anteriorly rather than posteriorly in arthritic glenoids; however, if perforation occurs posteriorly, the suprascapular nerve is at immediate risk from the extruded cement.: Basic science study.

References

Raiss P, Sowa B, Bruckner T, Eck S, Woerz S, Rohr K . Pressurisation leads to better cement penetration into the glenoid bone: a cadaveric study. J Bone Joint Surg Br. 2012; 94(5):671-7. DOI: 10.1302/0301-620X.94B5.28831. View

Nyffeler R, Meyer D, Sheikh R, Koller B, Gerber C . The effect of cementing technique on structural fixation of pegged glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2006; 15(1):106-11. DOI: 10.1016/j.jse.2005.05.002. View

Vaishya R, Chauhan M, Vaish A . Bone cement. J Clin Orthop Trauma. 2015; 4(4):157-63. PMC: 3880950. DOI: 10.1016/j.jcot.2013.11.005. View

Nyffeler R, Anglin C, Sheikh R, Gerber C . Influence of peg design and cement mantle thickness on pull-out strength of glenoid component pegs. J Bone Joint Surg Br. 2003; 85(5):748-52. View

Hsu J, Namdari S, Baron M, Kuntz A, Abboud J, Huffman G . Glenoid perforation with pegged components during total shoulder arthroplasty. Orthopedics. 2014; 37(6):e587-91. DOI: 10.3928/01477447-20140528-61. View

Bigliani L, Dalsey R, McCann P, April E . An anatomical study of the suprascapular nerve. Arthroscopy. 1990; 6(4):301-5. DOI: 10.1016/0749-8063(90)90060-q. View

Press C, OConnor D, Elkousy H, Gartsman G, Edwards T . Glenoid perforation does not affect the short-term outcomes of pegged all-polyethylene implants in total shoulder arthroplasty. J Shoulder Elbow Surg. 2014; 23(8):1203-7. DOI: 10.1016/j.jse.2013.11.024. View

Bohsali K, Wirth M, Rockwood Jr C . Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006; 88(10):2279-92. DOI: 10.2106/JBJS.F.00125. View

Matsen 3rd F, Clinton J, Lynch J, Bertelsen A, Richardson M . Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008; 90(4):885-96. DOI: 10.2106/JBJS.G.01263. View

10.

Flint W, Lewis G, Wee H, Bryce B, Armstrong A . Glenoid cement mantle characterization using micro-computed tomography of three cement application techniques. J Shoulder Elbow Surg. 2015; 25(4):572-80. DOI: 10.1016/j.jse.2015.08.031. View

11.

Kim H, Chacon A, Andrews S, Roush E, Cho E, Conaway W . Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study. J Orthop Res. 2015; 34(4):666-74. DOI: 10.1002/jor.23048. View

12.

Choi T, Horodyski M, Struk A, Sahajpal D, Wright T . Incidence of early radiolucent lines after glenoid component insertion for total shoulder arthroplasty: a radiographic study comparing pressurized and unpressurized cementing techniques. J Shoulder Elbow Surg. 2012; 22(3):403-8. DOI: 10.1016/j.jse.2012.05.041. View

13.

Konno S, Olmarker K, Byrod G, Nordborg C, Stromqvist B, Rydevik B . The European Spine Society AcroMed Prize 1994. Acute thermal nerve root injury. Eur Spine J. 1994; 3(6):299-302. DOI: 10.1007/BF02200140. View

14.

Deramond H, WRIGHT N, Belkoff S . Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone. 1999; 25(2 Suppl):17S-21S. DOI: 10.1016/s8756-3282(99)00127-1. View