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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2013
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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. |
format | Online Article Text |
id | pubmed-3807943 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
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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