Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2017; 8(10): 790-797
Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.790
Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty
Lars V von Engelhardt, Michael Manzke, Andreas Breil-Wirth, Timm J Filler, Joerg Jerosch
Lars V von Engelhardt, Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany
Lars V von Engelhardt, Michael Manzke, Andreas Breil-Wirth, Joerg Jerosch, Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
Timm J Filler, Department of Anatomy, Heinrich-Heine University of Duesseldorf, Duesseldorf 40225, Germany
Author contributions: von Engelhardt LV, Filler TJ and Jerosch J contributed to study conception and design; von Engelhardt LV, Manzke M and Breil-Wirth A contributed to the data acquisition and analysis, von Engelhardt LV and Manzke M contributed to the data interpretation and writing of the article which was approved by all authors.
Institutional review board statement: The study was reviewed and approved by the local ethical committee of the University of Duesseldorf (Study No. 4426).
Informed consent statement: All persons involved in this study gave their informed consent prior to study inclusion.
Conflict-of-interest statement: All authors have no interests, commercial or otherwise, which represent a conflict of interest in relation to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lars V von Engelhardt, MD, PhD, Docent at the University of Witten/Herdecke, Senior Consultant of the Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Am Hasenberg 46, Neuss 41462, Germany. l.vonengelhardt@ak-neuss.de
Telephone: +49-2131-52952074 Fax: +49-2131-52952003
Received: May 12, 2017
Peer-review started: May 12, 2017
First decision: July 10, 2017
Revised: July 20, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: October 18, 2017
Abstract
AIM

To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.

METHODS

Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.

RESULTS

Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.

CONCLUSION

TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

Keywords: Anatomical shoulder arthroplasty, Stemless, Omarthrosis, Total shoulder replacement, Joint geometry

Core tip: By using bony landmarks that are not altered by osteoarthritic changes, the premorbid center of rotation (CoR) was assessed in comparison to the postoperative one after TESS arthroplasty. Furthermore, joint geometry changes were assessed in relation to the glenoid, the acromion and the proximal humerus. Our data demonstrate a precise restoration of the joint and a very good clinical outcome. This study also describes outliers with a clinically relevant medialized CoR. Being caused by a slightly inaccurate humeral neck cut, this study might sensitize us that this osteotomy is a crucial step to ensure a good clinical outcome.