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Thermal damage during humeral reaming in total shoulder resurfacing

INTRODUCTION: Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed...

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Autores principales: McCann, Philip A., Sarangi, Partha P., Baker, Richard P., Blom, Ashley W., Amirfeyz, Rouin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807943/
https://www.ncbi.nlm.nih.gov/pubmed/24167401
http://dx.doi.org/10.4103/0973-6042.118910
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author McCann, Philip A.
Sarangi, Partha P.
Baker, Richard P.
Blom, Ashley W.
Amirfeyz, Rouin
author_facet McCann, Philip A.
Sarangi, Partha P.
Baker, Richard P.
Blom, Ashley W.
Amirfeyz, Rouin
author_sort McCann, Philip A.
collection PubMed
description INTRODUCTION: Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed to determine if humeral reaming instruments produce a thermal insult to subchondral bone during TSR. PATIENTS AND METHODS: This was tested in vivo on 13 patients (8 with rheumatoid arthritis and 5 with osteoarthritis) with a single reaming system and in vitro with three different humeral reaming systems on saw bone models. Real-time infrared thermal video imaging was used to assess the temperatures generated. RESULTS: Synthes (Epoca) instruments generated average temperatures of 40.7°C (SD 0.9°C) in the rheumatoid group and 56.5°C (SD 0.87°C) in the osteoarthritis group (P = 0.001). Irrigation with room temperature saline cooled the humeral head to 30°C (SD 1.2°C). Saw bone analysis generated temperatures of 58.2°C (SD 0.79°C) in the Synthes (Epoca) 59.9°C (SD 0.81°C) in Biomet (Copeland) and 58.4°C (SD 0.88°C) in the Depuy Conservative Anatomic Prosthesis (CAP) reamers (P = 0.12). CONCLUSION: Humeral reaming with power driven instruments generates considerable temperatures both in vivo and in vitro. This paper demonstrates that a significant thermal effect beyond the 47°C threshold needed to induce osteonecrosis is observed with humeral reamers, with little variation seen between manufacturers. Irrigation with room temperature saline cools the reamed bone to physiological levels and should be performed regularly during this step in TSR.
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spelling pubmed-38079432013-10-28 Thermal damage during humeral reaming in total shoulder resurfacing McCann, Philip A. Sarangi, Partha P. Baker, Richard P. Blom, Ashley W. Amirfeyz, Rouin Int J Shoulder Surg Original Article INTRODUCTION: Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed to determine if humeral reaming instruments produce a thermal insult to subchondral bone during TSR. PATIENTS AND METHODS: This was tested in vivo on 13 patients (8 with rheumatoid arthritis and 5 with osteoarthritis) with a single reaming system and in vitro with three different humeral reaming systems on saw bone models. Real-time infrared thermal video imaging was used to assess the temperatures generated. RESULTS: Synthes (Epoca) instruments generated average temperatures of 40.7°C (SD 0.9°C) in the rheumatoid group and 56.5°C (SD 0.87°C) in the osteoarthritis group (P = 0.001). Irrigation with room temperature saline cooled the humeral head to 30°C (SD 1.2°C). Saw bone analysis generated temperatures of 58.2°C (SD 0.79°C) in the Synthes (Epoca) 59.9°C (SD 0.81°C) in Biomet (Copeland) and 58.4°C (SD 0.88°C) in the Depuy Conservative Anatomic Prosthesis (CAP) reamers (P = 0.12). CONCLUSION: Humeral reaming with power driven instruments generates considerable temperatures both in vivo and in vitro. This paper demonstrates that a significant thermal effect beyond the 47°C threshold needed to induce osteonecrosis is observed with humeral reamers, with little variation seen between manufacturers. Irrigation with room temperature saline cools the reamed bone to physiological levels and should be performed regularly during this step in TSR. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3807943/ /pubmed/24167401 http://dx.doi.org/10.4103/0973-6042.118910 Text en Copyright: © International Journal of Shoulder Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
McCann, Philip A.
Sarangi, Partha P.
Baker, Richard P.
Blom, Ashley W.
Amirfeyz, Rouin
Thermal damage during humeral reaming in total shoulder resurfacing
title Thermal damage during humeral reaming in total shoulder resurfacing
title_full Thermal damage during humeral reaming in total shoulder resurfacing
title_fullStr Thermal damage during humeral reaming in total shoulder resurfacing
title_full_unstemmed Thermal damage during humeral reaming in total shoulder resurfacing
title_short Thermal damage during humeral reaming in total shoulder resurfacing
title_sort thermal damage during humeral reaming in total shoulder resurfacing
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807943/
https://www.ncbi.nlm.nih.gov/pubmed/24167401
http://dx.doi.org/10.4103/0973-6042.118910
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