The VAULT Study – Glenoid Version Measurement

Current Research
The VAULT Study (Reliability of Glenoid Version Measurement on 3D-corrected axial CT scan)

Background

Glenoid version measurement is critical in shoulder arthroplasty especially for the anatomic design in which the glenoid implant remains the weak link and where incorrect positioning leads to a high failure rate.1–3

Essential knowledge of the glenoid vault anatomy and version is crucial for long-term survivorship. Many preoperative radiological methods have been proposed to calculate glenoid version, mostly based on CT scan using simple axial slices, 3D-corrected slices or even direct 3D viewing of the glenoid.4–7 The most commonly used method is the traditional Friedman’s angle4 but several limitations have been shown, notably the fact that it is dependant on the shape of the scapula body 6,8 and that the medial border of the scapula must be included in the CT scan field, which is not often the case.6 Moreover, glenoid version does not necessarily correspond to the orientation of the glenoid vault, a conical structure of cancellous bone that is sought for maximum purchase of pegs, keels or screws when resurfacing the glenoid. Matsumura et al. have recently proposed a new method of evaluating glenoid version according to the medial tip of the glenoid vault (the vault method), which they has shown to be more reliable than Friedman’s angle.6

Glenoid version measurement is critical in shoulder arthroplasty.

Objectives

The primary objective of this study is to determine the reliability of two commonly used radiologic methods of measuring glenoid version, according to slice height and angulation.

Design

This is a retrospective review study including two groups: normal shoulders (“Normal” group), and patients with arthritic shoulders (“Arthritic” group).

Study Procedure

Patients with thoracic and shoulder CT scans involving the entire scapula will first be screened for inclusion and exclusion criteria. Identified patients will then be de-identified and added to an anonymous database, containing age, sex, and any relevant diagnosis concerning the shoulder. Glenoid version will then be measured by the three principal investigators at two different times, using OiriX (DICOM viewer software, Pixmeo, Geneva Switzerland) to reconstruct 3D-corrected axial slices. Measures will include two validated and widely used methods of glenoid version measurement in 7 different axial cut heights and inclination. Results will be reported in the database for further analysis, concerning 2 groups: arthritic and normal shoulders.

Inclusion Criteria

  • At least 2mm thick slices to be able to carry out 3D-corrected reconstruction
  • Normal or arthritic glenoid (primary or cuff tear arthropathy)
  • Patients over 16 years old

Exclusion Criteria

  • Post-traumatic arthritis
  • Fractures involving glenoid or scapula body
  • Any other conditions that may severely alter the shape of the scapula (dysplasia, charcot joint, etc.)

Ethics and Governance

Approved by Northern Sydney Local Health District Human Research Ethics Committee to be undertaken at Royal North Shore Hospital. HREC reference LNR/16/HAWKE/37 and SSA reference LNRSSA/16/HAWKE/55.

Status

Recruitment has begun. Early stage data collection. Results not expected until late 2016 or early 2017 – watch this space.

References

  • Farron, A., Terrier, A. & Büchler, P. Risks of loosening of a prosthetic glenoid implanted in retroversion. J. Shoulder Elbow Surg. 15, 521–526 (2006).
  • Walch, G. et al. Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years. J. Shoulder Elbow Surg. 20, 385–394 (2011).
  • Yongpravat, C. et al. Glenoid implant orientation and cement failure in total shoulder arthroplasty: a finite element analysis. J. Shoulder Elbow Surg. 22, 940–947 (2013).
  • Friedman, R. J., Hawthorne, K. B. & Genez, B. M. The use of computerized tomography in the measurement of glenoid version. J. Bone Jt. Surg. 74, 1032–1037 (1992).
  • Kwon, Y. W., Powell, K. A., Yum, J. K., Brems, J. J. & Iannotti, J. P. Use of three-dimensional computed tomography for the analysis of the glenoid anatomy. J. Shoulder Elbow Surg. 14, 85–90 (2005).
  • Matsumura, N. et al. Computed tomography measurement of glenoid vault version as an alternative measuring method for glenoid version. J Orthop Surg Res 9, 17 (2014).
  • Poon, P. C. & Ting, F. S. H. A 2-dimensional glenoid vault method for measuring glenoid version on computed tomography. J. Shoulder Elbow Surg. 21, 329–335 (2012).
  • Bryce, C. D. <article-title aid=‘1458783’>Two-Dimensional Glenoid Version Measurements Vary with Coronal and Sagittal Scapular Rotation</article-title> J. Bone Jt. Surg. Am. 92, 692 (2010).
  • Bokor, D. J., O’Sullivan, M. D. & Hazan, G. J. Variability of measurement of glenoid version on computed tomography scan. J. Shoulder Elb. Surg. Am. Shoulder Elb. Surg. Al 8, 595–598 (1999).

sydney-shoulder-research-institute-projects

Lead Investigator:

Dr Benjamin Cass

Commenced:

March 2016

Category:

Current Projects

The VAULT Study (Reliability of Glenoid Version Measurement on 3D-corrected axial CT scan)
In Research - Current

Humeral Head to Greater Tuberosity Angle Study

The VAULT Study - Glenoid Version Measurement
In Research - Current

The VAULT Study – Glenoid Version Measurement

The FUSE Study (Fitness band Used in Shoulder Evaluation)
In Research - Current

The FUSE Study – Fitness band Used in Shoulder Evaluation

TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty
In Research - Current

The TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty)

In Research - Current

Shoulder Arthrodesis Long Term follow-up

In Research - Current

The TXA 2 Study (Systemic Tranexamic Acid in Shoulder Arthroscopy and Rotator Cuff Repair)