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Are there differences between stemless and conventional stemmed shoulder prostheses in the treatment of glenohumeral osteoarthritis?

Maier MW, Lauer S, Klotz MC, Bülhoff M, Spranz D, Zeifang F - BMC Musculoskelet Disord (2015)

Bottom Line: The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.There was no significant difference in postoperative proprioception between the TESS group (7.2° [SD ± 2.8]) and the Aequalis group(8.7° [SD ± 2.7]; p = 0.196), either.Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.

View Article: PubMed Central - PubMed

Affiliation: Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany. m.w.maier@web.de.

ABSTRACT

Background: Conventional stemmed anatomical shoulder prostheses are widely used in the treatment of glenohumeral osteoarthritis. The stemless shoulder prosthesis, in contrast, is a new concept, and fewer outcome studies are available. Therefore, the purpose of the study was to investigate the early functional outcome and postoperative proprioception of a stemless prosthesis in comparison with a standard stemmed anatomic shoulder prosthesis.

Methods: Twelve patients (mean age 68.3 years [SD ± 5.4]; 5 female, 7 male) with primary glenohumeral osteoarthritis of the shoulder were enrolled, who underwent total shoulder arthroplasty (TSA) with a stemless total shoulder prosthesis, Total Evolution Shoulder System (TESS; Biomed, France). The control group consisted of twelve (age and gender matched) patients (mean age 67.8 years; [SD ± 7.1]; 9 female, 3 male), getting a TSA with a standard anatomic stemmed prosthesis, Aequalis Shoulder (Tournier, Lyon, France). Patients were examined the day before and six months after surgery. The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.

Results: Comparing the postoperative CS, there was no significant difference between the groups treated with the TESS prosthesis (48.0 ± 13.8 points) and the Aequalis prosthesis (49.3 ± 8.6 points; p = 0.792). There was no significant difference in postoperative proprioception between the TESS group (7.2° [SD ± 2.8]) and the Aequalis group(8.7° [SD ± 2.7]; p = 0.196), either. Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.

Discussion: In patients with glenohumeral osteoarthritis, treated with TSA, the functional and the proprioceptive outcome is comparable between a stemless and a standard stemmed anatomic shoulder prosthesis at early followup.

Conclusion: Further follow-up is necessary regarding the long-term performance of this prosthesis.

Trial registration: Current Controlled Trials DRKS 00007528 . Registered 17 November 2014.

No MeSH data available.


Related in: MedlinePlus

Left: Patient with markers for the three-dimensional motion video analysis (the patient gave specific written consent for the publiaction of their image). Right: Localization of the GHJC (glenohumeral joint center of rotation) and proprioception measurement in the ab-/adduction plane using the HUX model
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Fig1: Left: Patient with markers for the three-dimensional motion video analysis (the patient gave specific written consent for the publiaction of their image). Right: Localization of the GHJC (glenohumeral joint center of rotation) and proprioception measurement in the ab-/adduction plane using the HUX model

Mentions: A twelve-camera motion analysis system (Vicon 612; Vicon, Lake Forest, USA) operating at 120 Hz and the Heidelberg Upper Extremity (HUX)-model was used as described previously [19]. The spatial resolution of the system was approximately 1 mm. The HUX model consisted of seven segments: thorax, clavicles, upper arms, and forearms. The sternoclavicular and the glenohumeral joints were treated as a ball-and-socket joint, whereas the elbow was treated as a hinge joint. Translational degrees of freedom were not considered in any of these joints. For the measurement, the patients were prepared with four markers placed on the trunk as recommended by the International Society of Biomechanics [20]. Four markers were placed on each forearm: one at the radial and one at the ulnar styloid process of the wrist and two, connected with a wand, on the ulna close to the elbow joint (Fig. 1). For the AAR test, the patients sat on a chair with the arm hanging in 0° abduction and rotation. They were blindfolded to eliminate visual clues and wore sleeveless shirts. We ensured that the arm did not touch the trunk and, consequently, skin contact was minimized. The arm was moved to the desired position by the examiner with visual control of a manual, handheld goniometer. In detail, the positions were 30° and 60° abduction, 30° and 60° flexion, and 30° external (and afterwards 30° internal rotation) in 30° abduction (total of six joint positions). In the target position the subjects were told to maintain the position for ten seconds (in the meantime a mean value of the joint position was measured), and then the initial position with the arm hanging was resumed. Afterwards, the subject was asked to move the arm back into the target position. We measured the difference between the actual and the target joint position, and thus a smaller number indicates better proprioception. Standardized instructions were given to all subjects, and a test trial was conducted to acquaint them with each test condition. All tests were randomized for side and movement. Two test trials were performed at each angle, and the mean value was used for further analysis. The total proprioception performance (total) was defined as the mean value of all single measurements (six joint positions) to have one quality for comparing proprioceptive ability.Fig. 1


Are there differences between stemless and conventional stemmed shoulder prostheses in the treatment of glenohumeral osteoarthritis?

Maier MW, Lauer S, Klotz MC, Bülhoff M, Spranz D, Zeifang F - BMC Musculoskelet Disord (2015)

Left: Patient with markers for the three-dimensional motion video analysis (the patient gave specific written consent for the publiaction of their image). Right: Localization of the GHJC (glenohumeral joint center of rotation) and proprioception measurement in the ab-/adduction plane using the HUX model
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4591701&req=5

Fig1: Left: Patient with markers for the three-dimensional motion video analysis (the patient gave specific written consent for the publiaction of their image). Right: Localization of the GHJC (glenohumeral joint center of rotation) and proprioception measurement in the ab-/adduction plane using the HUX model
Mentions: A twelve-camera motion analysis system (Vicon 612; Vicon, Lake Forest, USA) operating at 120 Hz and the Heidelberg Upper Extremity (HUX)-model was used as described previously [19]. The spatial resolution of the system was approximately 1 mm. The HUX model consisted of seven segments: thorax, clavicles, upper arms, and forearms. The sternoclavicular and the glenohumeral joints were treated as a ball-and-socket joint, whereas the elbow was treated as a hinge joint. Translational degrees of freedom were not considered in any of these joints. For the measurement, the patients were prepared with four markers placed on the trunk as recommended by the International Society of Biomechanics [20]. Four markers were placed on each forearm: one at the radial and one at the ulnar styloid process of the wrist and two, connected with a wand, on the ulna close to the elbow joint (Fig. 1). For the AAR test, the patients sat on a chair with the arm hanging in 0° abduction and rotation. They were blindfolded to eliminate visual clues and wore sleeveless shirts. We ensured that the arm did not touch the trunk and, consequently, skin contact was minimized. The arm was moved to the desired position by the examiner with visual control of a manual, handheld goniometer. In detail, the positions were 30° and 60° abduction, 30° and 60° flexion, and 30° external (and afterwards 30° internal rotation) in 30° abduction (total of six joint positions). In the target position the subjects were told to maintain the position for ten seconds (in the meantime a mean value of the joint position was measured), and then the initial position with the arm hanging was resumed. Afterwards, the subject was asked to move the arm back into the target position. We measured the difference between the actual and the target joint position, and thus a smaller number indicates better proprioception. Standardized instructions were given to all subjects, and a test trial was conducted to acquaint them with each test condition. All tests were randomized for side and movement. Two test trials were performed at each angle, and the mean value was used for further analysis. The total proprioception performance (total) was defined as the mean value of all single measurements (six joint positions) to have one quality for comparing proprioceptive ability.Fig. 1

Bottom Line: The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.There was no significant difference in postoperative proprioception between the TESS group (7.2° [SD ± 2.8]) and the Aequalis group(8.7° [SD ± 2.7]; p = 0.196), either.Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.

View Article: PubMed Central - PubMed

Affiliation: Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany. m.w.maier@web.de.

ABSTRACT

Background: Conventional stemmed anatomical shoulder prostheses are widely used in the treatment of glenohumeral osteoarthritis. The stemless shoulder prosthesis, in contrast, is a new concept, and fewer outcome studies are available. Therefore, the purpose of the study was to investigate the early functional outcome and postoperative proprioception of a stemless prosthesis in comparison with a standard stemmed anatomic shoulder prosthesis.

Methods: Twelve patients (mean age 68.3 years [SD ± 5.4]; 5 female, 7 male) with primary glenohumeral osteoarthritis of the shoulder were enrolled, who underwent total shoulder arthroplasty (TSA) with a stemless total shoulder prosthesis, Total Evolution Shoulder System (TESS; Biomed, France). The control group consisted of twelve (age and gender matched) patients (mean age 67.8 years; [SD ± 7.1]; 9 female, 3 male), getting a TSA with a standard anatomic stemmed prosthesis, Aequalis Shoulder (Tournier, Lyon, France). Patients were examined the day before and six months after surgery. The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.

Results: Comparing the postoperative CS, there was no significant difference between the groups treated with the TESS prosthesis (48.0 ± 13.8 points) and the Aequalis prosthesis (49.3 ± 8.6 points; p = 0.792). There was no significant difference in postoperative proprioception between the TESS group (7.2° [SD ± 2.8]) and the Aequalis group(8.7° [SD ± 2.7]; p = 0.196), either. Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.

Discussion: In patients with glenohumeral osteoarthritis, treated with TSA, the functional and the proprioceptive outcome is comparable between a stemless and a standard stemmed anatomic shoulder prosthesis at early followup.

Conclusion: Further follow-up is necessary regarding the long-term performance of this prosthesis.

Trial registration: Current Controlled Trials DRKS 00007528 . Registered 17 November 2014.

No MeSH data available.


Related in: MedlinePlus