Publications
73 results found
Davies AR, Sabharwal S, Liddle AD, et al., 2024, The risk of revision is higher following shoulder hemiarthroplasty compared with total shoulder arthroplasty for osteoarthritis: a matched cohort study of 11,556 patients from the National Joint Registry, UK., Acta Orthop, Vol: 95, Pages: 73-85
BACKGROUND AND PURPOSE: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of osteoarthritis of the glenohumeral joint. We aimed to determine whether TSA or HA resulted in a lower risk of adverse outcomes in patients of all ages with osteoarthritis and an intact rotator cuff and in a subgroup of patients aged 60 years or younger. PATIENTS AND METHODS: Shoulder arthroplasties recorded in the National Joint Registry, UK, between April 1, 2012 and June 30, 2021, were linked to Hospital Episode Statistics in England. Elective TSAs and HAs were matched on propensity scores based on 11 variables. The primary outcome was all-cause revision. Secondary outcomes were combined revision/non-revision reoperations, 30-day inpatient complications, 1-year mortality, and length of stay. 95% confidence intervals (CI) were reported. RESULTS: 11,556 shoulder arthroplasties were included: 7,641 TSAs, 3,915 HAs. At 8 years 95% (CI 94-96) of TSAs and 91% (CI 90-92) of HAs remained unrevised. The hazard ratio (HR) varied across follow-up: 4-year HR 2.7 (CI 1.9-3.5), 8-year HR 2.0 (CI 0.5-3.5). Rotator cuff insufficiency was the most common revision indication. In patients aged 60 years or younger prosthesis survival at 8 years was 92% (CI 89-94) following TSA and 84% (CI 80-87) following HA. CONCLUSION: The risk of revision was higher following HA in patients with osteoarthritis and an intact rotator cuff. Patients aged 60 years and younger had a higher risk of revision following HA.
Davies A, Lloyd T, Sabharwal S, et al., 2023, Anatomical shoulder replacements in young patients: a systematic review and meta-analysis, Shoulder & Elbow, Vol: 15, Pages: 4-14, ISSN: 1758-5732
IntroductionIncreasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to investigate the survivorship and clinical effectiveness of hemiarthroplasty and anatomical total shoulder arthroplasty (TSA) in patients younger than 65 years.MethodA systematic review was performed of MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports. The primary outcomes were implant survival and change in perioperative shoulder scores.ResultsMeta-analysis of implant survivorship was performed of six studies reporting on 416 patients. Implant survival was 86.1% (72.1,100) at 10 years for hemiarthroplasty and 82.3% (64.6,100) for TSA. 20 year survival was 80.0% for hemiarthroplasty (72.5,87.4) and 75.0% (56.9,93.1) for TSA. Ten studies were included in the meta-analysis of shoulder scores, multiple instruments were used. The standardised mean difference between pre-operative and post-operative shoulder scores was 2.15 (1.95, 2.35) for TSA at 4.2–4.9 years, and 2.72 (1.98,3.47) for hemiarthroplasty at 3.8–6 years.ConclusionOver 80% of shoulder replacements last more than 10 years, and 75% last more than 20 years. Significant improvements in shoulder scores are shown at all time points.
Davies A, Singh P, Reilly P, et al., 2022, Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis, JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, Vol: 17, ISSN: 1749-799X
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Klemt C, Toderita D, Reilly P, et al., 2022, Biceps Tenodesis cannot be used as primary treatment option in baseball pitchers with intact rotator cuff muscles, CLINICAL BIOMECHANICS, Vol: 100, ISSN: 0268-0033
MacKinnon T, Selmi H, Davies A, et al., 2022, Protocolised MRI as an adjunct to CT in the diagnosis of femoral neck fracture in high energy ipsilateral femoral shaft fractures - A break-even analysis., Injury, Vol: 53, Pages: 4099-4103
BACKGROUND: In high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures (FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting in increased treatment costs and patient complications. Preliminary evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to establish the economic break-even point for implementing such an MRI protocol in all high-energy FSFs. METHODS: We used an adapted break-even economic tool to determine whether the costs of a targeted MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged admission and re-operation). Sensitivity analyses were performed to demonstrate reliability of the economic modelling across a range of assumptions. RESULTS: Assuming a baseline of FNFs missed on CT of 12%, an MRI cost of £129 and cost of treating each missed FNF of £2457.5, the equation yielded a break-even rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 FSFs, MRI would need to diagnose 5 of the 12 missed FNF to be economically viable (number needed to treat (NNT)=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost-savings. CONCLUSION: A rapid, limited-sequence MRI protocol to exclude occult ipsilateral FNFs in all high-energy FSFs appears to be economically justified measure. Further research exploring the feasibility of such a protocol, as well as the role of intra-operative fluoroscopy in this context, is required.
Selmi H, Davies A, Walker J, et al., 2022, Consent for orthopaedic trauma surgery during the COVID-19 pandemic, BMJ Open Quality, Vol: 11, ISSN: 2399-6641
INTRODUCTION: The COVID-19 pandemic has brought a series of new challenges to the management of surgical patients. The consent process relies on a foundation of open and non-coerced discussion between clinician and patient, which includes all the potential risks of surgery. This must be updated to incorporate the additional risks of surgery during the pandemic including infection with the SARS-CoV-2 and increased risks of complications with the potential requirement for intensive care support. AIM: The aim of this multi-cycle quality improvement project was to ensure all patients were fully informed of the risks of developing COVID-19 and the possible need for intensive care unit (ICU) support. METHODS: We investigated the quality of the consent process for patients undergoing surgery for trauma at our major trauma centre. Our baseline data collection included a review of all orthopaedic trauma consent forms over a 4-week period in March 2020. We subsequently undertook three further Plan-Do-Study-Act (PDSA) cycles over separate 4-week periods. First, in June 2020, after education measures and presentation of baseline data, second in July 2020 after further education and regular digital reminders were sent to staff, and third in September 2021 after the implementation of an electronic consent form. RESULTS: At baseline, only 2.6% of consent forms mentioned the risk of COVID-19 and none mentioned the risk of requiring ITU support. Through three PDSA cycles this increased to 97% of cases where consent forms displayed the additional risks of COVID-19 and the potential need for ITU admission. CONCLUSION: Our quality improvement project improved the informed consent procedure at our trust. By incorporating these additional risks into the template of an electronic consent form, we hope to achieve sustained improvement in practice.
Darwood A, Hurst SA, Villatte G, et al., 2022, Novel robotic technology for the rapid intraoperative manufacture of patient-specific instrumentation allowing for improved glenoid component accuracy in shoulder arthroplasty: a cadaveric study, JOURNAL OF SHOULDER AND ELBOW SURGERY, Vol: 31, Pages: 561-570, ISSN: 1058-2746
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- Citations: 3
Brodén C, Reilly P, Khanna M, et al., 2022, CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study., Acta Orthop, Vol: 93, Pages: 277-283
BACKGROUND AND PURPOSE: CT micromotion analysis (CTMA) has been considered as an alternative to radiostereometry (RSA) for assessing early implant migration of orthopedic implants. We investigated the feasibility of CTMA to assess early migration and the progression of radiolucent lines in shoulder arthroplasties over 24 months using sequential low-dose CT scans. PATIENTS AND METHODS: 7 patients were included and underwent 9 primary total shoulder arthroplasties. We made CT scans preoperatively, within 1 week postoperatively, and after 3, 6, 12, and 24 months. At each follow-up, postoperative glenoid migration and any development of radiolucent lines were assessed. Clinical outcomes were recorded at all time points except within 1 week postoperatively. RESULTS: For the glenoid component, the median translation and median rotation were 0.00-0.10 mm and -1.53° to 1.05° at 24 months. Radiolucent lines could be observed around all glenoid components. The radiolucent lines developed from the periphery to the center of the implant for 6 glenoid components during follow-up. The Constant Score improved from a mean of 30 (21-51) preoperatively to 69 (41-88) at 24 months. INTERPRETATION: CTMA can be used to identify early migration and the development of radiolucent lines over time in glenoid components. Clinical trials with a larger sample size and longer follow-up are needed to establish the relationship between migration, radiolucent lines, loosening, and clinical outcome.
van Der Kruk E, Silverman AK, Reilly P, et al., 2021, Compensation due to age-related decline in sit-to-stand and sit-to-walk, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290
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- Citations: 15
van der Kruk E, Silverman AK, Koizia L, et al., 2021, Age-related compensation: Neuromusculoskeletal capacity, reserve & movement objectives, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290
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- Citations: 10
Koizia L, Dani M, Brown H, et al., 2021, Does the weather contribute to admissions of neck of femur fractures?, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 12, Pages: 1-6, ISSN: 2151-4585
Background: The effects of weather on overall mortality are well documented. Anecdotally, icy conditions are perceived to result in more falls and admissions for neck of femur (NOF) fractures. The aim of this pilot study was to determine whether relationships could be extracted or at least not ruled out by analysing a small dataset, and so give impetus to a larger project. Methods: Seven trauma units across North West London were identified and NOF fracture data extracted for five years. Visual inspection of the time series, consideration of the weather on specific days and correlation analysis were used to assess associations between fracture numbers and a variety of weather parameters (temperature, rainfall, wind and ice risk). Results: Overall, 10929 individuals with hip fractures were admitted over the five-year period. The highest number of admissions in a day was 14. No clear association was found between a weather parameter and daily admissions. However, when accumulated to a weekly timescale, a negative relationship with maximum temperature was found. No seasonal cycle was detected.Conclusion: The lack of a daily relationship and presence of a weekly relationship points to a possible delayed response to weather or insufficient daily data to extract a signal. The inconclusive results also indicate a larger data sample is required in future studies. In addition, even in cold weather an urban environment may not create icy conditions, being ameliorated by the heat island effect and gritting.
Packer TW, Sabharwal S, Griffiths D, et al., 2020, The financial burden of reverse shoulder arthroplasty for proximal humerus fractures., Bone Jt Open, Vol: 1, Pages: 731-736
AIMS: The purpose of this study was to evaluate the cost of reverse shoulder arthroplasty (RSA) for patients with a proximal humerus fracture, using time-driven activity based costing (TDABC), and to compare treatment costs with reimbursement under the Healthcare Resource Groups (HRGs). METHODS: TDABC analysis based on the principles outlined by Kaplan and a clinical pathway that has previously been validated for this institution was used. Staffing cost, consumables, implants, and overheads were updated to reflect 2019/2020 costs. This was compared with the HRG reimbursements. RESULTS: The mean cost of a RSA is £7,007.46 (£6,130.67 to £8,824.67). Implants and staffing costs were the primary cost drivers, with implants (£2,824.80) making up 40% of the costs. Staffing costs made up £1,367.78 (19%) of overall costs. The total tariff, accounting for market force factors and high comorbidities, reimburses £4,629. If maximum cost and minimum reimbursement is applied the losses to the trust are £4,828.67. CONCLUSION: RSA may be an effective and appropriate surgical option in the treatment of proximal humerus fractures; however, a cost analysis at our centre has demonstrated the financial burden of this surgery. Given its increasing use in trauma, there is a need to work towards generating an HRG that adequately reimburses providers.Cite this article: Bone Jt Open 2020;1-12:731-736.
Balai E, Sabharwal S, Griffiths D, et al., 2020, A type VI acromioclavicular joint injury: subcoracoid dislocation in a patient with polytrauma., Ann R Coll Surg Engl, Vol: 102, Pages: e1-e3
The Rockwood type VI acromioclavicular joint injury describes subcoracoid dislocation of the distal end of the clavicle. This injury pattern is exceedingly rare, with only 12 cases described in the literature. Diagnosis can be challenging; it is often the result of a high-energy mechanism and patients frequently have other severe distracting injuries. We report the case of a 23-year-old man who presented to our department after falling from a fifth-floor balcony. Alongside multiple intra-abdominal and musculoskeletal injuries, the patient sustained a type VI acromioclavicular joint dislocation. This injury was not picked up on the initial clinical assessment or described in the initial radiology report, with the diagnosis only made upon subsequent repeat review of the imaging by the admitting team. Fortunately, this delay did not increase the time to the patient receiving appropriate treatment. Despite its rarity, awareness of this injury pattern and its association with polytrauma is essential to reduce the risk of the diagnosis being overlooked in the acute setting.
Urbanczyk CA, Prinold JAI, Reilly P, et al., 2020, Avoiding high-risk rotator cuff loading: Muscle force during three pull-up techniques., Scandinavian Journal of Medicine and Science in Sports, Vol: 30, Pages: 2205-2214, ISSN: 0905-7188
Heavily loaded overhead training tasks, such as pull-ups are an effective strength training and rehabilitation exercise requiring high muscle forces maintained over a large range of motion. This study used experiments and computational modeling to examine loading patterns during three different pull-up variants and highlighted risks to vulnerable musculoskeletal structures. Optical motion tracking and a force platform captured kinematics and kinetics of 11 male subjects with no history of shoulder pathology, during performance of three pull-up variants-pronated front grip, pronated wide grip, and supinated reverse grip. UK National Shoulder model (UKNSM) simulated biomechanics of the shoulder girdle. Muscle forces and activation patterns were analyzed by repeated measures ANOVA with post-hoc comparisons. Motor group recruitment was similar across all pull-up techniques, with upper limb depression occurring secondary to torso elevation. Stress-time profiles show significant differences in individual muscle patterns among the three pull-up variants, with the most marked differences between wide grip and reverse grip. Comparing across techniques, latissimus dorsi was relatively more active in wide pull-ups (P < .01); front pull-ups favored activation of biceps brachii and brachialis (P < .02); reverse pull-ups displayed higher proportional rotator cuff activation (P < .01). Pull-ups promote stability of the shoulder girdle and activation of scapula stabilizers and performing pull-ups over their full range of motion is important as different techniques and phases emphasize different muscles. Shoulder rehabilitation and strength & conditioning programs should encourage incorporation of all three pull-up variants with systematic progression to provide greater global strengthening of the torso and upper limb musculature.
Villatte G, van der Kruk E, Asim B, et al., 2020, A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading, Journal of Shoulder and Elbow Surgery, Vol: 29, Pages: 1967-1973, ISSN: 1058-2746
Background: The Critical Shoulder Angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA. Methods: An inverse dynamics three-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane, and slow and fast forward flexion measured by a 3D motion capture system were used to quantify joint reaction shear and compressive forces.Results: Increasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; p<0.05). Reducing CSA results in increased latero-medial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion; p<0.01).Discussion/Conclusion: Changes in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that would contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces which contribute to joint wear.
Franklin S, Sabharwal S, Hettiaratchy S, et al., 2020, When infection isn't infection., Ann R Coll Surg Engl, Vol: 102, Pages: e183-e184
Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Surgical site infections represent the most common cause of morbidity postoperatively. This case highlights the importance of considering a number of differential diagnoses. A diagnosis of pyoderma gangrenosum prompted systemic corticosteroid therapy giving rapid clinical improvement.
Davies A, Heaton T, Sabharwal S, et al., 2020, Consent for surgery during the COVID-19 pandemic, Transient Journal of Trauma, Orthopaedics and the Coronavirus
van der Kruk E, Silverman A, Koizia L, et al., 2020, CaReMoOC: Capacity, Reserve, Movement Objectives, and Compensation. A New Framework to Describe Mechanisms of Movement Limitations, Demonstrated for Ageing, Preprints
Smith SHL, Reilly P, Bull AMJ, 2020, A musculoskeletal modelling approach to explain sit-to-stand difficulties in older people due to changes in muscle recruitment and movement strategies, Journal of Biomechanics, Vol: 98, ISSN: 0021-9290
By 2050 the proportion of over 65s is predicted to be 20% of the population. The consequences of an age-related reduction in muscle mass have not been fully investigated and, therefore, the aim of the present study was to quantify the muscle and joint contact forces using musculoskeletal modelling, during a sit-to-stand activity, to better explain difficulties in performing everyday activities for older people. A sit-to-stand activity with and without the use of arm rests was observed in ninety-five male participants, placed into groups of young (aged 18-35 years), middle-aged (aged 40-60 years) or older adults (aged 65 years and over). Older participants demonstrated significantly lower knee extensor and joint forces than the young when not using arm rests, compensating through elevated hip extensor and ankle plantarflexor muscle activity. The older group were also found to have higher shoulder joint contact forces whilst using arm rests. This tendency to reorganise muscle recruitment to include neighbouring groups or other parts of the body could make everyday activities more susceptible to age-related functional decline. Reductions in leg strength, via age- or atrophy- related means, creates increased reliance on the upper body and may result in further lower limb atrophy through disuse. The eventual decline of upper body function reduces strength reserves, leading to increased vulnerability, dependence on others and risk of institutionalisation.
Smith SHL, Reilly P, Bull AMJ, 2019, Serratus anterior weakness is a key determinant of arm-assisted standing difficulties, Medical Engineering and Physics, Vol: 74, Pages: 41-48, ISSN: 1350-4533
The ageing population has led to recent increases in musculoskeletal conditions, with muscle weakness a major contributor to functional decline. Understanding the early phases of muscle weakness will help devise treatments to extend musculoskeletal health. Little is understood of the effects of muscle weakness on everyday activities such as sit-to-stand, a determinant of mobility that, in the early stages of weakness, requires upper limb compensation. This experimental and computational modelling study investigated the effects of muscle weakness on upper-extremity muscle forces of 27 healthy adults when using arm rests. Weakness of 29 upper limb muscles was simulated by individually removing each from a musculoskeletal model. Serratus anterior weakness was highlighted as detrimental, with the model unable to fully solve the loadsharing redundancy in its absence, and forces at the elbow and glenohumeral joint and in other muscles were found to be profoundly increased. Its large number of fast-twitch muscle fibres, predisposed to atrophy with age, highlight the centrality of the serratus anterior as a key determinant of mobility in this critical task and a potential source of early immobility through its preferential loss of strength and thus point to the requirement for early clinical interventions to mitigate loss.
Hurst SA, Gregory TM, Reilly P, 2019, Os acromiale: a review of its incidence, pathophysiology, and clinical management, EFORT Open Reviews, Vol: 4, Pages: 525-532, ISSN: 2058-5241
Majed A, Thangarajah T, Southgate DFL, et al., 2019, The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology, Shoulder & Elbow, Vol: 11, Pages: 247-255, ISSN: 1758-5732
BackgroundThe aim of this study was to examine the effect of arm position on proximal humerus fracture configuration and to determine whether cortical thinning would predispose to fracture propagation and more complex patterns of injury.MethodsA drop test rig was designed to simulate falls onto an outstretched arm (‘parachute reflex’). Thirty-one cadaveric specimens underwent computer tomography scanning and cortical thicknesses mapping. Humeri were fractured according to one of the two injury mechanisms and filmed using a high-speed camera. Anatomical descriptions of the injuries were made. Areas of thinning were measured and correlated with zones of fracture propagation.ResultsDirect impact simulation resulted in undisplaced humeral head split fractures in 53% of cases, with the remainder involving disruption to the articular margin and valgus impaction. Alternatively, the ‘parachute reflex’ predominantly produced shield-type injuries (38%) and displaced greater tuberosity fractures (19%). A strong correlation was demonstrated between cortical thinning and the occurrence of fracture (odds ratio = 7.766, 95% confidence interval from 4.760 to 12.669, p<0.0001).ConclusionThis study has shown that arm position during a fall influences fracture configuration of the proximal humerus. Correlating fracture pattern and mechanism of injury will allow more appropriate fracture reduction techniques to be devised.
Koizia LJ, Wilson F, Reilly P, et al., 2019, Delirium after emergency hip surgery – common and serious, but rarely consented for, World Journal of Orthopedics, Vol: 10, Pages: 228-234, ISSN: 2218-5836
A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay. Yet it is often unrecognised, poorly managed, and rarely discussed by doctors. Delirium is important not only to the affected individuals and their families, but also socioeconomically to the broader community. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons when gaining consent. Failing to do so may expose surgeons to claims of negligence. Here we present a concise review of the literature and discuss the epidemiology, causative factors, potential consequences and preventative strategies in the perioperative period.
Sugand K, Malik HH, Newman S, et al., 2019, Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 146-155, ISSN: 1479-666X
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Sabharwal S, Archer S, Cadoux-Hudson D, et al., 2019, Exploring elderly patients' experiences of recovery following complex proximal humerus fracture: A qualitative study., J Health Psychol, Pages: 1359105319850883-1359105319850883
This study explores the experiences and perceptions of recovery in elderly patients who had sustained a proximal humerus fracture. In-depth semi-structured interviews were conducted with 15 patients over the age of 65. Thematic analysis identified aspects of care that impacted upon patient experience and quality of life. Seven main patient-reported themes were identified, including pain, sleep, shoulder function, emotional state, social support, relationship with their professional and experience of healthcare institution. These themes offer insight into the experiences of adults receiving care for proximal humerus fracture and highlight that existing quantitative measures of quality of life do not measure domains that are important to patients.
Thompson SM, Prinold JAI, Hill AM, et al., 2019, The influence of full-thickness supraspinatus tears on abduction moments: the importance of the central tendon, Shoulder and Elbow, Vol: 11, Pages: 19-25, ISSN: 1758-5740
Background: Detachment of the central tendon of the supraspinatus from its insertion is considered to be crucial to functional deficit. The aim of the present study was to assess the function of the supraspinatus in terms of abduction moments by introducing different tear configurations to assess the functional effect of the central tendon insertion. Methods: Ten fresh frozen shoulders from five cadavers were prepared for testing. A testing protocol was established to measure the abduction moment of the supraspinatus under physiological loading tailored to the anthropometrics of each specimen. Four conditions were tested: intact supraspinatus; complete detachment of portion of the supraspinatus tendon anterior to the main central tendon; detachment of the main central tendon; and detachment of the region of the supraspinatus posterior to the main central tendon. Results: There was a significant and large reduction in abduction moment when the central tendon was sectioned (p < 0.05). A smaller reduction in abduction moment was found when the regions anterior and posterior to the main central tendon were sectioned (p < 0.05). Conclusions: The central tendon is vital in the role of functional arm abduction through force transmission through the intact rotator cuff. Reinsertion of the central tendon in the correct anatomical location is desirable to optimize functional outcome of surgery.
Klemt C, Nolte D, Ding Z, et al., 2019, Anthropometric scaling of anatomical datasets for subject-specific musculoskeletal modelling of the shoulder, Annals of Biomedical Engineering, Vol: 47, Pages: 924-936, ISSN: 0090-6964
Linear scaling of generic shoulder models leads to substantial errors in model predictions. Customisation of shoulder modelling through magnetic resonance imaging (MRI) improves modelling outcomes, but model development is time and technology intensive. This study aims to validate 10 MRI-based shoulder models, identify the best combinations of anthropometric parameters for model scaling, and quantify the improvement in model predictions of glenohumeral loading through anthropometric scaling from this anatomical atlas. The shoulder anatomy was modelled using a validated musculoskeletal model (UKNSM). Ten subject-specific models were developed through manual digitisation of model parameters from high-resolution MRI. Kinematic data of 16 functional daily activities were collected using a 10-camera optical motion capture system. Subject-specific model predictions were validated with measured muscle activations. The MRI-based shoulder models show good agreement with measured muscle activations. A tenfold cross-validation using the validated personalised shoulder models demonstrates that linear scaling of anthropometric datasets with the most similar ratio of body height to shoulder width and from the same gender (p < 0.04) yields best modelling outcomes in glenohumeral loading. The improvement in model reliability is significant (p < 0.02) when compared to the linearly scaled-generic UKNSM. This study may facilitate the clinical application of musculoskeletal shoulder modelling to aid surgical decision-making.
Majed A, Thangarajah T, Southgate D, et al., 2019, Cortical thickness analysis of the proximal humerus., Shoulder Elbow, Vol: 11, Pages: 87-93, ISSN: 1758-5732
BACKGROUND: Structural changes within the proximal humerus influence the mechanical properties of the entire bone and predispose to low-energy fractures with complex patterns. The aim of the present study was to measure the cortical thickness in different regions of the proximal humerus. METHODS: Thirty-seven proximal humeri were analyzed using novel engineering software to determine cortical thickness in 10 distinct anatomical zones. RESULTS: The cortical thickness values ranged from 0.33 mm to 3.5 mm. Fifteen specimens demonstrated a consistent pattern of progressive cortical thinning that increased between the bicipital groove (thickest), the lesser tuberosity and the greater tuberosity (thinnest). Fifteen humeri were characterized by a progressive increase in cortical thickness between the greater tuberosity (thinnest), the bicipital groove and lesser tuberosity (thickest). The diaphysis exhibited the thickest cortical zone in 27 specimens, whereas the articular surface possessed the thinnest cortex in 18 cases. CONCLUSIONS: In conclusion, this is the first study to comprehensively assess cortical thickness of the humeral head. Our findings suggest that proximal humeral fractures occur along lines of cortical thinning and are displaced by the hard glenoid bone. The identification of specific areas of thick cortices may improve pre-operative planning and optimize fracture fixation.
Klemt C, Toderita D, Nolte D, et al., 2019, The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading, Bone and Joint Journal, Vol: 101-B, Pages: 68-74, ISSN: 2049-4394
AIMS: Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. PATIENTS AND METHODS: Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate in vivo forces during these ADLs. The critical size of a defect was defined as the smallest osseous defect that leads to dislocation. RESULTS: The FE models showed a high risk of dislocation during ADLs after a Bankart repair for anterior defects corresponding to 16% of the length of the glenoid. CONCLUSION: This computational study suggests that bone grafting should be undertaken for an anterior osseous defect in the glenoid of more than 16% of its length rather than a solely soft-tissue procedure, in order to optimize stability by restoring the concavity of the glenoid.
Villatte G, Spurr S, Broden C, et al., 2018, The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions, INTERNATIONAL ORTHOPAEDICS, Vol: 42, Pages: 2491-2495, ISSN: 0341-2695
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