Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

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License: CC BY 4.0
Serval ID
serval:BIB_F7FA2E1EF131
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?
Journal
BMC musculoskeletal disorders
Author(s)
Mariaux S., Obrist R., Farron A., Becce F., Terrier A.
ISSN
1471-2474 (Electronic)
ISSN-L
1471-2474
Publication state
Published
Issued date
08/01/2021
Peer-reviewed
Oui
Volume
22
Number
1
Pages
49
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Aseptic loosening of glenoid implants is the primary revision cause in anatomic total shoulder arthroplasty (aTSA). While supported by biomechanical studies, the impact of glenoid bone quality, more specifically bone mineral density (BMD), on aseptic glenoid loosening remains unclear. We hypothesized that lower preoperative glenoid BMD was associated with aseptic glenoid implant loosening in aTSA.
We retrospectively included 93 patients (69 females and 24 males; mean age, 69.2 years) who underwent preoperative non-arthrographic shoulder computed tomography (CT) scans and aTSA between 2002 and 2014. Preoperative glenoid BMD (CT numbers in Hounsfield unit) was measured in 3D using a reliable semi-automated quantitative method, in the following six contiguous volumes of interest (VOI): cortical, subchondral cortical plate (SC), subchondral trabecular, and three successive adjacent layers of trabecular bone. Univariate Cox regression was used to estimate the impact of preoperative glenoid BMD on aseptic glenoid implant loosening. We further compared 26 aseptic glenoid loosening patients with 56 matched control patients.
Glenoid implant survival rates were 89% (95% confidence interval CI, 81-96%) and 57% (41-74%) at 5 and 10 years, respectively. Hazard ratios for the different glenoid VOIs ranged between 0.998 and 1.004 (95% CI [0.996, 1.007], p≥0.121). Only the SC VOI showed significantly lower CTn in the loosening group (622±104 HU) compared with the control group (658±88 HU) (p=0.048), though with a medium effect size (d=0.42). There were no significant differences in preoperative glenoid BMD in any other VOI between patients from the loosening and control groups.
Although the preoperative glenoid BMD was statistically significantly lower in the SC region of patients with aseptic glenoid implant loosening compared with controls, this single-VOI difference was only moderate. We are thus unable to prove that lower preoperative glenoid BMD is clearly associated with aseptic glenoid implant loosening in aTSA. However, due to its proven biomechanical role in glenoid implant survival, we recommend extending this study to larger CT datasets to further assess and better understand the impact of preoperative glenoid BMD on glenoid implant loosening/survival and aTSA outcome.
Keywords
Anatomic total shoulder arthroplasty, Aseptic loosening, Bone mineral density, Computed tomography, Glenoid implant
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2021 11:22
Last modification date
30/04/2021 6:16
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