Consequences of reaming with flat and convex reamers for bone volume and surface area of the glenoid; a basic science study.

Anne Karelse,Alexander Van Tongel,Steven Leuridan,Jos Van Der Sloten,Philippe Debeer,Lieven F De Wilde,Kathleen Denis

doi:10.1186/s13018-015-0312-7

Anne Karelse, Alexander Van Tongel + Show 5 more

Open Access

https://doi.org/10.1186/s13018-015-0312-7

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Abstract

BackgroundThe effect of reaming on bone volume and surface area of the glenoid is not precisely known. We hypothesize that (1) convex reamers create a larger surface area than flat reamers, (2) flat reamers cause less bone loss than convex reamers, and (3) the amount of bone loss increases with the amount of version correction.MethodsReaming procedures with different types of reamers are performed on similar-sized uniconcave and biconcave glenoids created from Sawbones foam blocks. The loss of bone volume, the size of the remaining surface area, and the reaming depth are measured and evaluated.ResultsReaming with convex reamers results in a significantly larger surface area than with flat reamers for both uniconcave and biconcave glenoids (p = 0.013 and p = 0.001). Convex reamers cause more bone loss than flat reamers, but the difference is only significant for uniconcave glenoids (p = 0.007).ConclusionsIn biconcave glenoids, convex reamers remove a similar amount of bone as flat reamers, but offer a larger surface area while maximizing the correction of the retroversion. In pathological uniconcave glenoids, convex reamers are preferred because of the conforming shape.

Highlights

The effect of reaming on bone volume and surface area of the glenoid is not precisely known
We find no significant difference in bone loss (p = 0.174), surface area (p = 0.521), and depth (p = 0.278) between reaming with a K-wire or a nipple-guided reamer, for both flat and convex reamers
Biomechanical studies have shown that placement of a glenoid component in more than 10° of retroversion causes eccentric loading of the prosthesis, and this can lead to instability, rocking horse phenomenon, and early loosening [7, 20,21,22,23,24]

Summary

Introduction

The effect of reaming on bone volume and surface area of the glenoid is not precisely known. We hypothesize that (1) convex reamers create a larger surface area than flat reamers, (2) flat reamers cause less bone loss than convex reamers, and (3) the amount of bone loss increases with the amount of version correction. The increased retroversion and erosion of the glenoid are associated with a higher rate of loosening of the glenoid component [2, 3]. The surgeon should aim to correct the retroversion, while minimizing glenoid bone loss and creating a maximal and congruent contact. It is not known how much bone is exactly removed by reaming or how this reaming affects the glenoid supporting area with respect to the pathology of the glenoid.

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