Diagnostics and methods of solving the reduction of bone mineral density and deformities of the articular cavity of the scapula during reverse shoulder arthroplasty

Background. Reverse arthroplasty is an effective method of treating severe injuries and diseases of the shoulder joint. In cases of severe osteoporosis, defects and deformities of the glenoid, there are risks of incorrect installation and instability of the components of the endoprosthesis. In the literature data, the problem of osteoporosis in the endoprosthetics of the shoulder joint and methods of its solution are rather poorly reflected, which was the reason for this study.

The aim: to develop algorithms for diagnosing the state of the bone tissue of the articular cavity of the scapula and methods for solving its deviations during reverse shoulder arthroplasty.

Materials and methods. Forty-eight patients who underwent reversible shoulder joint replacement were examined in the Department of Adult Orthopedics of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. A standard preoperative examination of patients developed in the department was performed, as well as additional calculations of bone density in Hounsfield units and according to X-ray densitometry were performed. The parameters of bone density of the glenoid (in HU) were compared with the data of densitometry.

Results. According to the results of densitometry, the patients were divided into groups. A direct dependence of the bone density of the glenoid and the indicators of densitometry was revealed. Algorithms of treatment and preoperative preparation of patients with bone density deficiency for reverse shoulder arthroplasty have been developed.

Conclusions. In the studied groups, 100 % of patients with indicators below 139 HU were diagnosed with osteoporosis or osteopenia, and patients with more than 257 HU had normal bone mineral density. 

1. Shevnina MM, Urazgil’deev RZ, Buklemishev YuV, Dobritsyna MA, Shuyskiy AA. Drug correction of metabolic disorders in patients with false joints of the long bones of the lower extremities operated with autoplasty. The problem of osteoporosis in traumatology and orthopedics. Problema osteoporoza v travmatologii i ortopedii: Sbornik tezisov VIII kongressa s mezhdunarodnym uchastiem. 2021; 96-98. (In Russ.).

2. Krivorotko MS, Rodionova SS, Buklemishev YuV. Stress-fracture of the distal metaepiphysis of the tibia as a rare complication of intramedullary osteosynthesis with blocking. Genij Ortopedii. 2020; 26(4): 579-584. (In Russ.).

3. Evstigneeva LP. Non-drug methods of treatment of osteoporosis. Almanac of Clinical Medicine. 2014; 32: 73-79. (In Russ.).

4. Mironov SP, Rodionova SS, Torgashin AN. Draft recommendations. Pharmacotherapy for the prevention of repeated fractures in patients with osteoporosis after surgical treatment of a pathological fracture of the proximal femur. N.N. Priorov Journal of Traumatology and Orthopedics. 2017; 24(1): 47-57. (In Russ.). doi: 10.17816/vto201724147-57

5. Rodionova SS, Nuzhdin VI, Morozov AK, Klushnichenko IV, Turgumbayev TN. Osteoporosis as a risk factor for aseptic instability in hip replacement. N.N. Priorov Journal of Traumatology and Orthopedics. 2007; 14(2): 35-40. (In Russ.).

6. Melnichenko GA, Belaya ZhE, Rozhinskaya LYa, Toroptsova NV, Alekseeva LI, Biryukova EV, et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problems of Endocrinology. 2017; 63(6): 392-426. (In Russ.). doi: 10.14341/probl2017636392-426

7. Ulivieri FM, Rinaudo L. Beyond bone mineral density: A new dual X-Ray absorbtiometry index of bone strength to predict fragility fractures, the bone strain index. Front Med. 2021; 7: 590139. doi: 10.3389/fmed.2020.590139

8. Karjalainen JP, Riekkinen O, Toyras J, Jurvelin JS, Kroger H. New method for point-of-care osteoporosis screening and diagnostics. Osteoporos Int. 2015; 27(3): 971-977. doi: 10.1007/s00198-015-3387-4

9. Wagner SC, Dworak TC, Grimm PD, Balazs GC, Tintle SM. Measurement of distal ulnar Haunsfield Units accurately predicts bone mineral density of the forearm. J Bone Surg Am. 2017; 99(8): 1-38. doi: 10.2106/JBJS.15.01244

10. Hendrickson NR, Pickhardt PJ, Del Rio AM, Rosas HG, Anderson PA. Bone mineral density T-scores derived from CT attenuation numbers (Hounsfield units): clinical utility and correlation with dual-energy X-ray absorptiometry. Iowa Orthop J. 2018; 38: 25-31.

11. Batawil N, Sabiq S. Hounsfield unit for the diagnosis of bone mineral density disease: A proof of concept study. Radiography. 2016; 22(2): 93-98. doi: 10.1016/j.radi.2015.11.004

12. Boileau P. Complications and revision of reverse total shoulder arthroplasty. OTSR. 2016; 102(Suppl 1): S33-S43. doi: 10.1016/j.otsr.2015.06.031