Filip Verhaegen - Academia.edu (original) (raw)

Papers by Filip Verhaegen

Research paper thumbnail of Quantitative statistical shape model‐based analysis of humeral head migration, Part 2: Shoulder osteoarthritis

Journal of Orthopaedic Research

Research paper thumbnail of Cuff Tear Arthropathy: Determination of Predisposing Scapular Anatomy with a Statistical Shape Model

Background Degeneration of the shoulder joint is a frequent problem. There are two main types of ... more Background Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a la...

Research paper thumbnail of The Accessory muscles of the Axilla

Acta orthopaedica Belgica, 2019

The axilla is a region of clinical and surgical importance with plenty of anatomical variations. ... more The axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.

Research paper thumbnail of The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety

Journal of Experimental Orthopaedics, 2021

Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen sh... more Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen shoulder patients on objective indices of shoulder functionality and subjective outcomes of pain, mobility, kinesiophobia, depression, and anxiety, and (2) progress knowledge about the reciprocal temporal relationship between psychological parameters at baseline and objective and subjective outcomes at 3-month follow-up. Methods We evaluated the clinical and psychological status of 72 patients with a frozen shoulder before and after hydrodilatation, using the Constant Murley score, the Visual Analogue score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, and the Shoulder Pain And Disability Index. Results We noted a significant improvement in functionality, pain and disability (p

Research paper thumbnail of Management of periprosthetic infection after reverse shoulder arthroplasty

Journal of Shoulder and Elbow Surgery, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Determination of predisposing scapular anatomy with a statistical shape model—Part II: shoulder osteoarthritis

Journal of Shoulder and Elbow Surgery, 2021

Research paper thumbnail of Determination of pre-arthropathy scapular anatomy with a statistical shape model: part I—rotator cuff tear arthropathy

Journal of Shoulder and Elbow Surgery, 2021

HYPOTHESIS AND BACKGROUND Rotator Cuff Tear Arthropathy (RCTA) is a pathology characterized by a ... more HYPOTHESIS AND BACKGROUND Rotator Cuff Tear Arthropathy (RCTA) is a pathology characterized by a massive rotator cuff tear combined with acromiohumeral and/or glenohumeral arthritis. Severity of RCTA can be staged according to Hamada. It is unknown why some patients develop RCTA. Furthermore, RCTA patients can develop distinctly different articular damage patterns on the glenoid side as categorized by Sirveaux (glenoid erosion). The goal of this study was to determine if there exists an association between scapular anatomy and RCTA, different severity stages of RCTA and their associated glenoid erosion types. METHODOLOGY A statistical shape model (SSM) of the scapula was constructed from a dataset of 110 CT scans using principal component analysis. Sixty-six patients with degenerative rotator cuff pathology formed the control group. The CT scan images of eighty-nine patients with RCTA were included and grouped according to Hamada and Sirveaux. A complete 3D scapular bone model was created and SSM reconstruction was performed. Next, automated 3D measurements were performed for glenoid version and inclination, scapular offset, critical shoulder angle (CSA), posterior acromial slope (PAS) and lateral acromion angle (LAA). All measurements were then compared between controls and RCTA patients. RESULTS The control group had a median of 7° retroversion (variance 16°), 8° superior inclination (variance 19°) and 106mm scapular offset (variance of 58mm). The median CSA, PAS and LAA was 30° (variance 14°), 65° (variance 60°) and 90° (variance 17°) respectively. In terms of inclination, version, scapular offset and PAS we found no statistically significant difference between the RCTA and the control group. For RCTA patients, median CSA and LAA was 32° (p≤ 0.01) and 86° (p≤ 0.01) respectively. For all investigated parameters, we did not find any significant difference between the different stages of RCTA. Patients with an E3 type of erosion had a different pre-arthropathy anatomy with increased retroversion (12°, p= 0.006), CSA (40°, p≤ 0.001), and reduced LAA of 79° (p≤ 0.001). DISCUSSION Our results seems to indicate that a 4° more inferiorly tilted and 2° more lateral extended acromion is associated with RCTA. RCTA patients who develop an E3 type of erosion have a distinct pre-arthropathy scapular anatomy with a more laterally extended and more inferiorly tilted acromion and a more retroverted glenoid in comparison with RCTA patients with no erosion. There does not seem to be a different pre-arthropathy scapular anatomy between patients with different stages of RCTA.

Research paper thumbnail of How much bone support does an anatomic glenoid component need?

Journal of Shoulder and Elbow Surgery, 2020

Background: An important reason for failure of anatomic total shoulder arthroplasty is glenoid co... more Background: An important reason for failure of anatomic total shoulder arthroplasty is glenoid component loosening. We investigated the effect of backside bone support on the risk of failure of a glenoid component. Methods: A finite element model was developed. Virtual surgery was performed for 2 types of glenoid components (cemented all polyethylene [PE] vs. metal backed [MB]), both with gradually decreasing backside bone support. Both bone failure and fixation failure were analyzed. The percentages of bone failure and fixation failure in terms of the critical cement volume (CCV) and micromotion-threshold percentage ratio (MTPR) for the PE and MB components, respectively, were defined and compared. Results: For the reference PE model, the percentages of bone failure and fixation failure (CCV) were 17% and 34%, respectively. With eccentric loading for the MB component, the percentages of bone failure and fixation failure (MTPR) were 6% and 3%, respectively. A global increase in failure was observed with decreasing bone support. The increase in fixation failure, starting from the reference values (MTPR vs. CCV), was relatively more pronounced for the MB component (136% vs. 128%). Discussion: Decreasing backside bone support for an anatomic glenoid component leads to an increased risk of fixation and bone failure. For PE components, decreasing backside support to 95% bone support had only a limited effect. In the case of an MB component, we noticed an increase in micromotion and bone failure already starting from 97% bone support. We conclude that an anatomic glenoid component should always be implanted while maximizing backside bone support.

Research paper thumbnail of Automated quantification of glenoid bone defects using 3-dimensional measurements

Journal of Shoulder and Elbow Surgery, 2020

Background: Assessment of glenoid bone defects is important to select the optimal glenoid compone... more Background: Assessment of glenoid bone defects is important to select the optimal glenoid component design during shoulder arthroplasty planning and implantation. This study presents a fully automated method to describe glenoid bone loss using three-dimensional measurements and without the need for a healthy contralateral reference scapula. Methods: The native shape of the glenoid is reconstructed by fitting a statistical shape model (SSM) of the scapula. The total vault loss percentage, local vault loss percentages, defect depth, defect area percentage and subluxation distance and region are computed based on a comparison of the reconstructed and eroded glenoid. The method is evaluated by comparing its results with a contralateral-based reconstruction approach, on a dataset of 34 scapulae and humeri pairs with unilateral glenoid bone defects. Results: The SSM-based defect measurements deviated from the contralateral-based measurements with a mean absolute difference of 5.5% on the total vault loss percentage, 4.5 to 8.0% on the local vault loss percentages, 1.9mm on the defect depth, 14.8% on the defect area percentage and 1.6mm on the subluxation distance. The SSM-based method was found to be statistically equivalent to the contralateral-based method for all parameters except for the defect area percentage. Conclusion: The presented method is able to automatically analyze glenoid bone defects using three-dimensional measurements, without the need for a healthy contralateral bone.

Research paper thumbnail of Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty?

Journal of Shoulder and Elbow Surgery, 2018

Hypothesis: The contralateral scapula can be used as a reliable template to determine scapular of... more Hypothesis: The contralateral scapula can be used as a reliable template to determine scapular offset, glenoid inclination, and version of the native scapula in view of reconstructing pathologic scapulae. Methods: Three-dimensional measurements of scapular offset, inclination, and version were performed using data from a set of 50 bilateral computed tomography scans of full scapulae to determine direct sideto-side differences. Results: The scapula pairs had a mean bilateral difference of 2 mm in offset, 2°in inclination, and 2°in version. Ninety percent of the scapula pairs showed an offset difference smaller than 3 mm. In 96% and 94% of the scapula pairs, the inclination difference and version difference, respectively, were smaller than 5°. The maximum bilateral difference for offset, inclination, and version was 6 mm, 6°, and 8°, respectively. Discussion and Conclusion: The anatomic parameters of scapular offset, glenoid inclination, and version are quite symmetrical and fall into the currently technically feasible accuracy of shoulder arthroplasty implantation. The healthy scapula can be used as a template to guide the reconstruction of the glenoid during shoulder arthroplasty planning in the case of unilateral advanced arthropathy.

Research paper thumbnail of Treatment of severe glenoid deficiencies in reverse shoulder arthroplasty: the Glenius Glenoid Reconstruction System experience

Journal of Shoulder and Elbow Surgery, 2019

BACKGROUND The treatment of glenoid bone deficiencies in primary or revision total shoulder arthr... more BACKGROUND The treatment of glenoid bone deficiencies in primary or revision total shoulder arthroplasty is challenging. This retrospective study evaluated the short-term clinical and radiologic results of a new custom-made patient-specific glenoid implant. METHODS We treated 10 patients with severe glenoid deficiencies with the Glenius Glenoid Reconstruction System (Materialise NV, Leuven, Belgium). Outcome data included a patient-derived Constant-Murley score, a visual analog score (VAS), a satisfaction score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and the Simple Shoulder Test. We compared the postoperative position of the implant with the preoperative planned position on computed tomography scans. RESULTS At an average follow-up period of 30.5 months, the mean patient-derived Constant-Murley score was 41.3 ± 17.5 points (range, 18-76 points) with a visual analog scale of 3.3 ± 2.5 points (range, 0-7 points). The mean 11-item version of the Disabilities of the Arm, Shoulder and Hand score was 35.8 ± 18.4 (range, 2-71), and the mean Simple Shoulder Test was 47.5% ± 25.3% (range, 8%-92%). Eight patients reported the result as better (n = 3) or much better (n = 5). One patient had an elongation of the brachial plexus, and 1 patient had a period of instability. The average preoperative glenoid defect size was 9 ± 4 cm3 (range, 1-14 cm3). The mean deviation between the preoperative planned and the postoperative version and inclination was 6° ± 4° (range 1°-16°) and 4° ± 4° (range 0°-11°), respectively. CONCLUSION Early results of the Glenius Glenoid Reconstruction System are encouraging. Adequate pain relief, a reasonable functionality, and good patient satisfaction can be obtained in these difficult cases. Further follow-up will determine the bony ingrowth and subsequent longevity of this patient-specific glenoid component.

Research paper thumbnail of Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial

Journal of Shoulder and Elbow Surgery, 2016

BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation i... more BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation in terms of pain relief and return of function. However, during the needling process, a cuff defect is created. Little is known about the evolution of this defect. METHODS We conducted a prospective, randomized controlled clinical trial to investigate the evolution of the aforementioned defect and the role of platelet-rich plasma (PRP) augmentation in this healing process. Patients were randomized to either group 1 (PRP, n = 20) or group 2 (no PRP [control group], n = 20). Patients in group 1 received a perioperative PRP infiltration at the rotator cuff defect, whereas the control group did not. Patients were assessed clinically preoperatively and postoperatively at 6 weeks, 3 and 6 months, and 1 year. The Constant score, Simple Shoulder Test, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) were used as outcome measures. The evolution of the cuff defect was evaluated on sonography at 3 and 6 months and with magnetic resonance imaging after 1 year. RESULTS All patients improved significantly after surgery (P < .05). There was no difference in clinical outcome or rotator cuff healing between groups. We observed a high rate of persistent rotator cuff defects after 1 year in both groups. The presence of residual cuff defects did not influence the clinical outcome. CONCLUSION Arthroscopic needling is an operation with a predictive, good clinical outcome. We found a high rate of persistent rotator cuff defects after 1 year. This study could not identify any beneficial effect of the addition of PRP on rotator cuff healing. LEVEL OF EVIDENCE Level II; Randomized Controlled Trial; Treatment Study.

Research paper thumbnail of Arthroscopic Removal of Rotator Cuff Calcifications

JBJS Essential Surgical Techniques, 2016

Research paper thumbnail of Are clinical photographs appropriate to determine the maximal range of motion of the knee?

Acta orthopaedica Belgica, 2010

Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the ... more Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p < 0.0001) and extension (p = 0.005) compared to goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p < 0.001). For both methods, the intra-observer reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the ...

Research paper thumbnail of Quantitative SSM‐based analysis of humeral head migration in rotator cuff tear arthropathy patients

Journal of Orthopaedic Research, 2021

Rotator cuff tear arthropathy (RCTA) is characterised by massive rotator cuff tearing combined wi... more Rotator cuff tear arthropathy (RCTA) is characterised by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study was to investigate the quantitative characteristics of this migration and its association with glenoid erosions and pre-arthropathy scapular anatomy. We quantified humeral head migration and pre-arthropathy scapular anatomy of 64 RCTA patients with statistical shape modelling-based techniques. Glenoid erosion was classified according to Sirveaux et al. A cut-off value for confirming HHM was 5mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with mean subluxation distance (SLD) of 3mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9mm, SLD in the anteroposterior plane of -1mm (SD ± 4mm), SLD in the superoinferior plane of 7mm (SD ± 3mm) and subluxation angle of -5° (SD ± 40°). Analysis with the Fisher's exact test showed a clear association between HHM and glenoid erosions (p= 0.002). Multivariate regression analysis of group 2 showed that pre-arthropathy lateral acromial angle (LAA) combined with critical shoulder angle (CSA) (p= 0.004) explained 21% of the observed variability in SLD. Pre-arthropathy glenoid version explained 23% of the variability in SLA (p= 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the pre-arthropathy scapular anatomy and the magnitude and direction of HHM. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy

Journal of wrist surgery, 2014

Introduction Malunions of the distal radius often induce carpal malalignment. Two different types... more Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied. Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated. Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to ...

Research paper thumbnail of Chronic anterior shoulder dislocation: aspects of current management and potential complications

Acta orthopaedica Belgica, 2012

Chronic unreduced anterior dislocations of the shoulder are rare. Arterial and neurological compl... more Chronic unreduced anterior dislocations of the shoulder are rare. Arterial and neurological complications in chronic glenohumeral dislocations are even less frequent. We report three cases of old anterior shoulder dislocations. Open reduction is indicated for most chronic shoulder dislocations. Arterial lesions require urgent intervention with reconstruction. Conservative treatment is advised for most neurological complications.

Research paper thumbnail of Corrective osteotomy of the distal radius: dorsal or volar approach, closing or opening wedge

Acta orthopaedica Belgica, 2010

The radiological outcomes of 31 corrective osteotomies for malunion of the distal radius were ass... more The radiological outcomes of 31 corrective osteotomies for malunion of the distal radius were assessed. The procedure re-established normal anatomy in the majority of cases. There was no significant difference in outcome between the dorsal and the palmar approach, but more secondary procedures for hardware removal were necessary with the dorsal approach.

Research paper thumbnail of Evaluation of Corrective Osteotomy of the Malunited Distal Radius on Midcarpal and Radiocarpal Malalignment

The Journal of Hand Surgery, 2010

To quantify 2 patterns of carpal malalignment, midcarpal malalignment (type 1) and radiocarpal ma... more To quantify 2 patterns of carpal malalignment, midcarpal malalignment (type 1) and radiocarpal malalignment (type 2), and to evaluate the effect of distal radius osteotomy on these malalignment patterns. In a retrospective review, we studied 31 wrists treated with corrective osteotomy for distal radius malunion after Colles&amp;amp;amp;amp;amp;amp;#39; fracture, in 31 patients (mean age, 44 y). The patients were divided on the basis of effective radiolunate flexion (ERLF) into 2 patterns of carpal malalignment as measured on preoperative radiographs. There were 20 patients with midcarpal malalignment (ERLF &amp;amp;amp;amp;amp;amp;lt; or = 25 degrees ) and 11 with radiocarpal malalignment (ERLF &amp;amp;amp;amp;amp;amp;gt; 25 degrees ). Measurements of alignment were repeated after distal radius osteotomy and compared with preoperative values. Both groups had correction of radial tilt and ulnar variance with distal radius osteotomy. In the midcarpal malalignment group, carpal alignment improved to normal parameters. In the radiocarpal malalignment group, we observed a notable effect on the ERLF. Neither age of the subject nor delay between fracture and osteotomy correlated with improvement in carpal alignment. Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and both radiocarpal and midcarpal malalignment. Therapeutic IV.

Research paper thumbnail of Are clinical photographs appropriate to determine the maximal range of motion of the knee?

Acta orthopaedica Belgica, 2010

Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the ... more Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p < 0.0001) and extension (p = 0.005) compared to goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p < 0.001). For both methods, the intra-observer reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the ...

Research paper thumbnail of Quantitative statistical shape model‐based analysis of humeral head migration, Part 2: Shoulder osteoarthritis

Journal of Orthopaedic Research

Research paper thumbnail of Cuff Tear Arthropathy: Determination of Predisposing Scapular Anatomy with a Statistical Shape Model

Background Degeneration of the shoulder joint is a frequent problem. There are two main types of ... more Background Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a la...

Research paper thumbnail of The Accessory muscles of the Axilla

Acta orthopaedica Belgica, 2019

The axilla is a region of clinical and surgical importance with plenty of anatomical variations. ... more The axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.

Research paper thumbnail of The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety

Journal of Experimental Orthopaedics, 2021

Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen sh... more Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen shoulder patients on objective indices of shoulder functionality and subjective outcomes of pain, mobility, kinesiophobia, depression, and anxiety, and (2) progress knowledge about the reciprocal temporal relationship between psychological parameters at baseline and objective and subjective outcomes at 3-month follow-up. Methods We evaluated the clinical and psychological status of 72 patients with a frozen shoulder before and after hydrodilatation, using the Constant Murley score, the Visual Analogue score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, and the Shoulder Pain And Disability Index. Results We noted a significant improvement in functionality, pain and disability (p

Research paper thumbnail of Management of periprosthetic infection after reverse shoulder arthroplasty

Journal of Shoulder and Elbow Surgery, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Determination of predisposing scapular anatomy with a statistical shape model—Part II: shoulder osteoarthritis

Journal of Shoulder and Elbow Surgery, 2021

Research paper thumbnail of Determination of pre-arthropathy scapular anatomy with a statistical shape model: part I—rotator cuff tear arthropathy

Journal of Shoulder and Elbow Surgery, 2021

HYPOTHESIS AND BACKGROUND Rotator Cuff Tear Arthropathy (RCTA) is a pathology characterized by a ... more HYPOTHESIS AND BACKGROUND Rotator Cuff Tear Arthropathy (RCTA) is a pathology characterized by a massive rotator cuff tear combined with acromiohumeral and/or glenohumeral arthritis. Severity of RCTA can be staged according to Hamada. It is unknown why some patients develop RCTA. Furthermore, RCTA patients can develop distinctly different articular damage patterns on the glenoid side as categorized by Sirveaux (glenoid erosion). The goal of this study was to determine if there exists an association between scapular anatomy and RCTA, different severity stages of RCTA and their associated glenoid erosion types. METHODOLOGY A statistical shape model (SSM) of the scapula was constructed from a dataset of 110 CT scans using principal component analysis. Sixty-six patients with degenerative rotator cuff pathology formed the control group. The CT scan images of eighty-nine patients with RCTA were included and grouped according to Hamada and Sirveaux. A complete 3D scapular bone model was created and SSM reconstruction was performed. Next, automated 3D measurements were performed for glenoid version and inclination, scapular offset, critical shoulder angle (CSA), posterior acromial slope (PAS) and lateral acromion angle (LAA). All measurements were then compared between controls and RCTA patients. RESULTS The control group had a median of 7° retroversion (variance 16°), 8° superior inclination (variance 19°) and 106mm scapular offset (variance of 58mm). The median CSA, PAS and LAA was 30° (variance 14°), 65° (variance 60°) and 90° (variance 17°) respectively. In terms of inclination, version, scapular offset and PAS we found no statistically significant difference between the RCTA and the control group. For RCTA patients, median CSA and LAA was 32° (p≤ 0.01) and 86° (p≤ 0.01) respectively. For all investigated parameters, we did not find any significant difference between the different stages of RCTA. Patients with an E3 type of erosion had a different pre-arthropathy anatomy with increased retroversion (12°, p= 0.006), CSA (40°, p≤ 0.001), and reduced LAA of 79° (p≤ 0.001). DISCUSSION Our results seems to indicate that a 4° more inferiorly tilted and 2° more lateral extended acromion is associated with RCTA. RCTA patients who develop an E3 type of erosion have a distinct pre-arthropathy scapular anatomy with a more laterally extended and more inferiorly tilted acromion and a more retroverted glenoid in comparison with RCTA patients with no erosion. There does not seem to be a different pre-arthropathy scapular anatomy between patients with different stages of RCTA.

Research paper thumbnail of How much bone support does an anatomic glenoid component need?

Journal of Shoulder and Elbow Surgery, 2020

Background: An important reason for failure of anatomic total shoulder arthroplasty is glenoid co... more Background: An important reason for failure of anatomic total shoulder arthroplasty is glenoid component loosening. We investigated the effect of backside bone support on the risk of failure of a glenoid component. Methods: A finite element model was developed. Virtual surgery was performed for 2 types of glenoid components (cemented all polyethylene [PE] vs. metal backed [MB]), both with gradually decreasing backside bone support. Both bone failure and fixation failure were analyzed. The percentages of bone failure and fixation failure in terms of the critical cement volume (CCV) and micromotion-threshold percentage ratio (MTPR) for the PE and MB components, respectively, were defined and compared. Results: For the reference PE model, the percentages of bone failure and fixation failure (CCV) were 17% and 34%, respectively. With eccentric loading for the MB component, the percentages of bone failure and fixation failure (MTPR) were 6% and 3%, respectively. A global increase in failure was observed with decreasing bone support. The increase in fixation failure, starting from the reference values (MTPR vs. CCV), was relatively more pronounced for the MB component (136% vs. 128%). Discussion: Decreasing backside bone support for an anatomic glenoid component leads to an increased risk of fixation and bone failure. For PE components, decreasing backside support to 95% bone support had only a limited effect. In the case of an MB component, we noticed an increase in micromotion and bone failure already starting from 97% bone support. We conclude that an anatomic glenoid component should always be implanted while maximizing backside bone support.

Research paper thumbnail of Automated quantification of glenoid bone defects using 3-dimensional measurements

Journal of Shoulder and Elbow Surgery, 2020

Background: Assessment of glenoid bone defects is important to select the optimal glenoid compone... more Background: Assessment of glenoid bone defects is important to select the optimal glenoid component design during shoulder arthroplasty planning and implantation. This study presents a fully automated method to describe glenoid bone loss using three-dimensional measurements and without the need for a healthy contralateral reference scapula. Methods: The native shape of the glenoid is reconstructed by fitting a statistical shape model (SSM) of the scapula. The total vault loss percentage, local vault loss percentages, defect depth, defect area percentage and subluxation distance and region are computed based on a comparison of the reconstructed and eroded glenoid. The method is evaluated by comparing its results with a contralateral-based reconstruction approach, on a dataset of 34 scapulae and humeri pairs with unilateral glenoid bone defects. Results: The SSM-based defect measurements deviated from the contralateral-based measurements with a mean absolute difference of 5.5% on the total vault loss percentage, 4.5 to 8.0% on the local vault loss percentages, 1.9mm on the defect depth, 14.8% on the defect area percentage and 1.6mm on the subluxation distance. The SSM-based method was found to be statistically equivalent to the contralateral-based method for all parameters except for the defect area percentage. Conclusion: The presented method is able to automatically analyze glenoid bone defects using three-dimensional measurements, without the need for a healthy contralateral bone.

Research paper thumbnail of Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty?

Journal of Shoulder and Elbow Surgery, 2018

Hypothesis: The contralateral scapula can be used as a reliable template to determine scapular of... more Hypothesis: The contralateral scapula can be used as a reliable template to determine scapular offset, glenoid inclination, and version of the native scapula in view of reconstructing pathologic scapulae. Methods: Three-dimensional measurements of scapular offset, inclination, and version were performed using data from a set of 50 bilateral computed tomography scans of full scapulae to determine direct sideto-side differences. Results: The scapula pairs had a mean bilateral difference of 2 mm in offset, 2°in inclination, and 2°in version. Ninety percent of the scapula pairs showed an offset difference smaller than 3 mm. In 96% and 94% of the scapula pairs, the inclination difference and version difference, respectively, were smaller than 5°. The maximum bilateral difference for offset, inclination, and version was 6 mm, 6°, and 8°, respectively. Discussion and Conclusion: The anatomic parameters of scapular offset, glenoid inclination, and version are quite symmetrical and fall into the currently technically feasible accuracy of shoulder arthroplasty implantation. The healthy scapula can be used as a template to guide the reconstruction of the glenoid during shoulder arthroplasty planning in the case of unilateral advanced arthropathy.

Research paper thumbnail of Treatment of severe glenoid deficiencies in reverse shoulder arthroplasty: the Glenius Glenoid Reconstruction System experience

Journal of Shoulder and Elbow Surgery, 2019

BACKGROUND The treatment of glenoid bone deficiencies in primary or revision total shoulder arthr... more BACKGROUND The treatment of glenoid bone deficiencies in primary or revision total shoulder arthroplasty is challenging. This retrospective study evaluated the short-term clinical and radiologic results of a new custom-made patient-specific glenoid implant. METHODS We treated 10 patients with severe glenoid deficiencies with the Glenius Glenoid Reconstruction System (Materialise NV, Leuven, Belgium). Outcome data included a patient-derived Constant-Murley score, a visual analog score (VAS), a satisfaction score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and the Simple Shoulder Test. We compared the postoperative position of the implant with the preoperative planned position on computed tomography scans. RESULTS At an average follow-up period of 30.5 months, the mean patient-derived Constant-Murley score was 41.3 ± 17.5 points (range, 18-76 points) with a visual analog scale of 3.3 ± 2.5 points (range, 0-7 points). The mean 11-item version of the Disabilities of the Arm, Shoulder and Hand score was 35.8 ± 18.4 (range, 2-71), and the mean Simple Shoulder Test was 47.5% ± 25.3% (range, 8%-92%). Eight patients reported the result as better (n = 3) or much better (n = 5). One patient had an elongation of the brachial plexus, and 1 patient had a period of instability. The average preoperative glenoid defect size was 9 ± 4 cm3 (range, 1-14 cm3). The mean deviation between the preoperative planned and the postoperative version and inclination was 6° ± 4° (range 1°-16°) and 4° ± 4° (range 0°-11°), respectively. CONCLUSION Early results of the Glenius Glenoid Reconstruction System are encouraging. Adequate pain relief, a reasonable functionality, and good patient satisfaction can be obtained in these difficult cases. Further follow-up will determine the bony ingrowth and subsequent longevity of this patient-specific glenoid component.

Research paper thumbnail of Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial

Journal of Shoulder and Elbow Surgery, 2016

BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation i... more BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation in terms of pain relief and return of function. However, during the needling process, a cuff defect is created. Little is known about the evolution of this defect. METHODS We conducted a prospective, randomized controlled clinical trial to investigate the evolution of the aforementioned defect and the role of platelet-rich plasma (PRP) augmentation in this healing process. Patients were randomized to either group 1 (PRP, n = 20) or group 2 (no PRP [control group], n = 20). Patients in group 1 received a perioperative PRP infiltration at the rotator cuff defect, whereas the control group did not. Patients were assessed clinically preoperatively and postoperatively at 6 weeks, 3 and 6 months, and 1 year. The Constant score, Simple Shoulder Test, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) were used as outcome measures. The evolution of the cuff defect was evaluated on sonography at 3 and 6 months and with magnetic resonance imaging after 1 year. RESULTS All patients improved significantly after surgery (P < .05). There was no difference in clinical outcome or rotator cuff healing between groups. We observed a high rate of persistent rotator cuff defects after 1 year in both groups. The presence of residual cuff defects did not influence the clinical outcome. CONCLUSION Arthroscopic needling is an operation with a predictive, good clinical outcome. We found a high rate of persistent rotator cuff defects after 1 year. This study could not identify any beneficial effect of the addition of PRP on rotator cuff healing. LEVEL OF EVIDENCE Level II; Randomized Controlled Trial; Treatment Study.

Research paper thumbnail of Arthroscopic Removal of Rotator Cuff Calcifications

JBJS Essential Surgical Techniques, 2016

Research paper thumbnail of Are clinical photographs appropriate to determine the maximal range of motion of the knee?

Acta orthopaedica Belgica, 2010

Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the ... more Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p < 0.0001) and extension (p = 0.005) compared to goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p < 0.001). For both methods, the intra-observer reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the ...

Research paper thumbnail of Quantitative SSM‐based analysis of humeral head migration in rotator cuff tear arthropathy patients

Journal of Orthopaedic Research, 2021

Rotator cuff tear arthropathy (RCTA) is characterised by massive rotator cuff tearing combined wi... more Rotator cuff tear arthropathy (RCTA) is characterised by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study was to investigate the quantitative characteristics of this migration and its association with glenoid erosions and pre-arthropathy scapular anatomy. We quantified humeral head migration and pre-arthropathy scapular anatomy of 64 RCTA patients with statistical shape modelling-based techniques. Glenoid erosion was classified according to Sirveaux et al. A cut-off value for confirming HHM was 5mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with mean subluxation distance (SLD) of 3mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9mm, SLD in the anteroposterior plane of -1mm (SD ± 4mm), SLD in the superoinferior plane of 7mm (SD ± 3mm) and subluxation angle of -5° (SD ± 40°). Analysis with the Fisher's exact test showed a clear association between HHM and glenoid erosions (p= 0.002). Multivariate regression analysis of group 2 showed that pre-arthropathy lateral acromial angle (LAA) combined with critical shoulder angle (CSA) (p= 0.004) explained 21% of the observed variability in SLD. Pre-arthropathy glenoid version explained 23% of the variability in SLA (p= 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the pre-arthropathy scapular anatomy and the magnitude and direction of HHM. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy

Journal of wrist surgery, 2014

Introduction Malunions of the distal radius often induce carpal malalignment. Two different types... more Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied. Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated. Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to ...

Research paper thumbnail of Chronic anterior shoulder dislocation: aspects of current management and potential complications

Acta orthopaedica Belgica, 2012

Chronic unreduced anterior dislocations of the shoulder are rare. Arterial and neurological compl... more Chronic unreduced anterior dislocations of the shoulder are rare. Arterial and neurological complications in chronic glenohumeral dislocations are even less frequent. We report three cases of old anterior shoulder dislocations. Open reduction is indicated for most chronic shoulder dislocations. Arterial lesions require urgent intervention with reconstruction. Conservative treatment is advised for most neurological complications.

Research paper thumbnail of Corrective osteotomy of the distal radius: dorsal or volar approach, closing or opening wedge

Acta orthopaedica Belgica, 2010

The radiological outcomes of 31 corrective osteotomies for malunion of the distal radius were ass... more The radiological outcomes of 31 corrective osteotomies for malunion of the distal radius were assessed. The procedure re-established normal anatomy in the majority of cases. There was no significant difference in outcome between the dorsal and the palmar approach, but more secondary procedures for hardware removal were necessary with the dorsal approach.

Research paper thumbnail of Evaluation of Corrective Osteotomy of the Malunited Distal Radius on Midcarpal and Radiocarpal Malalignment

The Journal of Hand Surgery, 2010

To quantify 2 patterns of carpal malalignment, midcarpal malalignment (type 1) and radiocarpal ma... more To quantify 2 patterns of carpal malalignment, midcarpal malalignment (type 1) and radiocarpal malalignment (type 2), and to evaluate the effect of distal radius osteotomy on these malalignment patterns. In a retrospective review, we studied 31 wrists treated with corrective osteotomy for distal radius malunion after Colles&amp;amp;amp;amp;amp;amp;#39; fracture, in 31 patients (mean age, 44 y). The patients were divided on the basis of effective radiolunate flexion (ERLF) into 2 patterns of carpal malalignment as measured on preoperative radiographs. There were 20 patients with midcarpal malalignment (ERLF &amp;amp;amp;amp;amp;amp;lt; or = 25 degrees ) and 11 with radiocarpal malalignment (ERLF &amp;amp;amp;amp;amp;amp;gt; 25 degrees ). Measurements of alignment were repeated after distal radius osteotomy and compared with preoperative values. Both groups had correction of radial tilt and ulnar variance with distal radius osteotomy. In the midcarpal malalignment group, carpal alignment improved to normal parameters. In the radiocarpal malalignment group, we observed a notable effect on the ERLF. Neither age of the subject nor delay between fracture and osteotomy correlated with improvement in carpal alignment. Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and both radiocarpal and midcarpal malalignment. Therapeutic IV.

Research paper thumbnail of Are clinical photographs appropriate to determine the maximal range of motion of the knee?

Acta orthopaedica Belgica, 2010

Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the ... more Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p < 0.0001) and extension (p = 0.005) compared to goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p < 0.001). For both methods, the intra-observer reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the ...