Management of intraoperative posterior decentering in shoulder arthroplasty using anteriorly eccentric humeral head components

Jason E. Hsu, Albert O. Gee, Robert M. Lucas, Jeremy Somerson, Winston J. Warme, Frederick A. Matsen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Posterior humeral decentering presents a challenge in glenohumeral arthroplasty. Soft tissue releases and osteophyte resection can lead to intraoperative decentering not evident preoperatively. Inferior outcomes result if decentering is not addressed as a part of the arthroplasty. When there is >50% posterior subluxation of the humeral head on passive elevation of the arm at surgery, we have used an anteriorly eccentric humeral head component to improve centering of the humeral articular surface on the glenoid. Methods We reviewed the 2-year outcomes for 33 shoulder arthroplasties in which anteriorly eccentric humeral heads were used to manage posterior decentering identified at surgery. Rotator interval plication was performed in 16 cases as an adjunctive stabilizing procedure. Shoulders were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST). Radiographic centering was characterized before surgery and at follow-up on standardized axillary radiographs with the arm held in a position of functional elevation. Results With the anteriorly eccentric head component, preoperative radiographic humeral decentering was reduced from 10.4% ± 7.9% to 0.9% ± 2.3% postoperatively (P < .001). SST scores improved from 4.8 ± 2.3 to 10.0 ± 2.3 (P < .001). Preoperative posterior humeral head decentering did not correlate with preoperative glenoid version. Glenoid retroversion was 19.8° ± 8.9° preoperatively and 15.5° ± 7.5° postoperatively. Conclusions Posterior decentering identified at surgery when standard trial components are in place can be addressed by replacing the anatomic humeral head with an anteriorly eccentric humeral head component.

Original languageEnglish (US)
Pages (from-to)1980-1988
Number of pages9
JournalJournal of Shoulder and Elbow Surgery
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Humeral Head
Arthroplasty
Arm
Osteophyte
Joints
Head

Keywords

  • Eccentric humeral head
  • functional decentering
  • posterior decentering
  • ream and run
  • rotator interval plication
  • total shoulder arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Management of intraoperative posterior decentering in shoulder arthroplasty using anteriorly eccentric humeral head components. / Hsu, Jason E.; Gee, Albert O.; Lucas, Robert M.; Somerson, Jeremy; Warme, Winston J.; Matsen, Frederick A.

In: Journal of Shoulder and Elbow Surgery, Vol. 25, No. 12, 01.12.2016, p. 1980-1988.

Research output: Contribution to journalArticle

Hsu, Jason E. ; Gee, Albert O. ; Lucas, Robert M. ; Somerson, Jeremy ; Warme, Winston J. ; Matsen, Frederick A. / Management of intraoperative posterior decentering in shoulder arthroplasty using anteriorly eccentric humeral head components. In: Journal of Shoulder and Elbow Surgery. 2016 ; Vol. 25, No. 12. pp. 1980-1988.
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title = "Management of intraoperative posterior decentering in shoulder arthroplasty using anteriorly eccentric humeral head components",
abstract = "Background Posterior humeral decentering presents a challenge in glenohumeral arthroplasty. Soft tissue releases and osteophyte resection can lead to intraoperative decentering not evident preoperatively. Inferior outcomes result if decentering is not addressed as a part of the arthroplasty. When there is >50{\%} posterior subluxation of the humeral head on passive elevation of the arm at surgery, we have used an anteriorly eccentric humeral head component to improve centering of the humeral articular surface on the glenoid. Methods We reviewed the 2-year outcomes for 33 shoulder arthroplasties in which anteriorly eccentric humeral heads were used to manage posterior decentering identified at surgery. Rotator interval plication was performed in 16 cases as an adjunctive stabilizing procedure. Shoulders were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST). Radiographic centering was characterized before surgery and at follow-up on standardized axillary radiographs with the arm held in a position of functional elevation. Results With the anteriorly eccentric head component, preoperative radiographic humeral decentering was reduced from 10.4{\%} ± 7.9{\%} to 0.9{\%} ± 2.3{\%} postoperatively (P < .001). SST scores improved from 4.8 ± 2.3 to 10.0 ± 2.3 (P < .001). Preoperative posterior humeral head decentering did not correlate with preoperative glenoid version. Glenoid retroversion was 19.8° ± 8.9° preoperatively and 15.5° ± 7.5° postoperatively. Conclusions Posterior decentering identified at surgery when standard trial components are in place can be addressed by replacing the anatomic humeral head with an anteriorly eccentric humeral head component.",
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AU - Gee, Albert O.

AU - Lucas, Robert M.

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AU - Warme, Winston J.

AU - Matsen, Frederick A.

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N2 - Background Posterior humeral decentering presents a challenge in glenohumeral arthroplasty. Soft tissue releases and osteophyte resection can lead to intraoperative decentering not evident preoperatively. Inferior outcomes result if decentering is not addressed as a part of the arthroplasty. When there is >50% posterior subluxation of the humeral head on passive elevation of the arm at surgery, we have used an anteriorly eccentric humeral head component to improve centering of the humeral articular surface on the glenoid. Methods We reviewed the 2-year outcomes for 33 shoulder arthroplasties in which anteriorly eccentric humeral heads were used to manage posterior decentering identified at surgery. Rotator interval plication was performed in 16 cases as an adjunctive stabilizing procedure. Shoulders were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST). Radiographic centering was characterized before surgery and at follow-up on standardized axillary radiographs with the arm held in a position of functional elevation. Results With the anteriorly eccentric head component, preoperative radiographic humeral decentering was reduced from 10.4% ± 7.9% to 0.9% ± 2.3% postoperatively (P < .001). SST scores improved from 4.8 ± 2.3 to 10.0 ± 2.3 (P < .001). Preoperative posterior humeral head decentering did not correlate with preoperative glenoid version. Glenoid retroversion was 19.8° ± 8.9° preoperatively and 15.5° ± 7.5° postoperatively. Conclusions Posterior decentering identified at surgery when standard trial components are in place can be addressed by replacing the anatomic humeral head with an anteriorly eccentric humeral head component.

AB - Background Posterior humeral decentering presents a challenge in glenohumeral arthroplasty. Soft tissue releases and osteophyte resection can lead to intraoperative decentering not evident preoperatively. Inferior outcomes result if decentering is not addressed as a part of the arthroplasty. When there is >50% posterior subluxation of the humeral head on passive elevation of the arm at surgery, we have used an anteriorly eccentric humeral head component to improve centering of the humeral articular surface on the glenoid. Methods We reviewed the 2-year outcomes for 33 shoulder arthroplasties in which anteriorly eccentric humeral heads were used to manage posterior decentering identified at surgery. Rotator interval plication was performed in 16 cases as an adjunctive stabilizing procedure. Shoulders were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST). Radiographic centering was characterized before surgery and at follow-up on standardized axillary radiographs with the arm held in a position of functional elevation. Results With the anteriorly eccentric head component, preoperative radiographic humeral decentering was reduced from 10.4% ± 7.9% to 0.9% ± 2.3% postoperatively (P < .001). SST scores improved from 4.8 ± 2.3 to 10.0 ± 2.3 (P < .001). Preoperative posterior humeral head decentering did not correlate with preoperative glenoid version. Glenoid retroversion was 19.8° ± 8.9° preoperatively and 15.5° ± 7.5° postoperatively. Conclusions Posterior decentering identified at surgery when standard trial components are in place can be addressed by replacing the anatomic humeral head with an anteriorly eccentric humeral head component.

KW - Eccentric humeral head

KW - functional decentering

KW - posterior decentering

KW - ream and run

KW - rotator interval plication

KW - total shoulder arthroplasty

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