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Related Concept Videos

General Case of Eccentric Axial Loading01:12

General Case of Eccentric Axial Loading

Unsymmetrical bending occurs when the bending moment applied to a structural member does not align with its principal axis. This misalignment leads to complex stress distributions and deflection patterns that differ from symmetrical bending, which are essential for designing structures to withstand different loading conditions.
Consider a member subjected to equal and opposite forces that are applied along a line that does not coincide with the member's neutral axis. In unsymmetrical bending,...

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Eccentric reaming in total shoulder arthroplasty: a cadaveric study.

Robert Gillespie1, Robert Lyons, Mark Lazarus

  • 1Department of Orthopedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44118, USA.

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Eccentric anterior reaming for posterior glenoid bone loss in total shoulder arthroplasty can significantly narrow the glenoid width. Correction of defects greater than 10 degrees may not be possible, impacting prosthesis placement.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Anatomy

Background:

  • Posterior glenoid bone loss is common in glenohumeral osteoarthritis.
  • Eccentric anterior reaming is a popular technique to address bone loss during total shoulder arthroplasty.
  • The quantifiable limits of correction with this technique are not well-established.

Purpose of the Study:

  • To quantify the degree of eccentric posterior glenoid wear correctable by anterior glenoid reaming.
  • To evaluate the impact of anterior reaming on glenoid dimensions and prosthesis fit.

Main Methods:

  • Eight cadaveric scapulae were used.
  • Simulated posterior glenoid wear in 5-degree increments.
  • Specimens underwent eccentric anterior reaming to correct simulated defects.
  • Measurements included anteroposterior width, superior-inferior height, and best-fit glenoid prosthesis size.

Main Results:

  • Correcting a 10-degree posterior defect decreased anteroposterior glenoid diameter significantly (26.7 mm to 23.8 mm, P=.006).
  • A 15-degree defect was successfully correctable in only 50% of specimens due to inadequate bone support or component fit issues.
  • A 20-degree defect was correctable in only 25% of specimens, often requiring component downsizing.

Conclusions:

  • Anterior glenoid reaming for posterior wear exceeding 10 degrees leads to significant anteroposterior narrowing.
  • Surgeons must consider these limitations in preoperative planning for total shoulder arthroplasty.
  • A 15-degree posterior defect presents a 50% risk of failed correction with this method.