Clin Orthop Surg.  2016 Sep;8(3):280-287. 10.4055/cios.2016.8.3.280.

Morphologic Variability of the Shoulder between the Populations of North American and East Asian

• Cabezas AF
• Krebes K
• Hussey MM
• Santoni BG
• Kim HS
• Frankle MA
• Oh JH

• KMID: 2374274
• DOI: http://doi.org/10.4055/cios.2016.8.3.280

Abstract

BACKGROUND
The aim of this study was to determine if there were significant differences in glenohumeral joint morphology between North American and East Asian populations that may influence sizing and selection of shoulder arthroplasty systems.
METHODS
Computed tomography reconstructions of 92 North American and 58 East Asian patients were used to perform 3-dimensional measurements. The proximal humeral position was normalized in all patients by aligning it with the scapular plane utilizing anatomic landmarks. Measurements were performed on the humerus and scapula and included coronal and axial humeral head radius, humeral neck shaft and articular arc angles, glenoid height and width, and critical shoulder angle. Glenohumeral relationships were also measured and included lateral distance to the greater tuberosity and acromion, abduction lever arm, and acromial index. Parametric and nonparametric statistical analyses were used to compare population metrics.
RESULTS
East Asian glenohumeral measurements were significantly smaller for all linear metrics (p < 0.05), with the exception of acromial length, which was greater than in the North American cohort (p < 0.001). The increase in acromial length affected all measurements involving the acromion including abduction lever arms. No difference was found between the neck shaft and articular angular measurements.
CONCLUSIONS
The East Asian population exhibited smaller shoulder morphometrics than their North American cohort, with the exception of an extended acromial overhang. The morphologic data can provide some additional factors to consider when choosing an optimal shoulder implant for the East Asian population, in addition to creating future designs that may better accommodate this population.

Keyword

Shoulder; Anatomy; Acromion; Arthroplasty; East Asian

MeSH Terms

African Americans/*statistics & numerical data
Aged
Anthropometry
Asian Continental Ancestry Group/*statistics & numerical data
European Continental Ancestry Group/*statistics & numerical data
Female
Humans
Male
Prosthesis Design
Republic of Korea/epidemiology
Shoulder/*anatomy & histology
Shoulder Joint/*anatomy & histology
Shoulder Prosthesis
United States/epidemiology

Figure

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  Fig. 1 (A) Scapular plane derived from the anatomic landmark points and derived coordinate system. (B) Humerus coronal plane as determined from greater tuberosity and shaft axis, with perpendicular axial plane from coronal head center. (C) Alignment of scapular and humeral planes, creating a nonpathologic positioning of the humerus.

• 

  Fig. 2 Diagram of measurements taken from each patient in the humerus (A–C), scapula (A, D, E), and glenohumeral joint (A, E). Key available on Table 1.

Reference

1. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus: implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997; 79(5):857–865. PMID: 9331050.

2. Frankle MA, Teramoto A, Luo ZP, Levy JC, Pupello D. Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg. 2009; 18(6):874–885. PMID: 19482489.

3. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships: an anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992; 74(4):491–500. PMID: 1583043.

4. Jeong J, Bryan J, Iannotti JP. Effect of a variable prosthetic neck-shaft angle and the surgical technique on replication of normal humeral anatomy. J Bone Joint Surg Am. 2009; 91(8):1932–1941. PMID: 19651952.

5. Cheng FB, Ji XF, Lai Y, et al. Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee. 2009; 16(5):341–347. PMID: 19230678.

6. Kwak DS, Surendran S, Pengatteeri YH, et al. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007; 14(4):295–300. PMID: 17600719.

7. Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G. Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty. 2011; 26(1):124–130. PMID: 20149574.

8. Cooper WH, Manyin ME, Jurenas R, Platzer MD. The proposed U.S.-South Korea Free Trade Agreement (KORUS FTA): provisions and implications [Internet]. Washington, DC: Congressional Research Service;2011. cited 2016 Apr 20. Available from: http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1818&context=key_workplace.

9. Aroonjarattham P, Jiamwatthanachai P, Mahaisavariya B, Kiatiwat T, Aroonjaratthammd K, Sitthiseripratip K. Three-dimensional morphometric study of the Thai proximal humerus: cadaveric study. J Med Assoc Thai. 2009; 92(9):1191–1197. PMID: 19772179.

10. Zhang L, Yuan B, Wang C, Liu Z. Comparison of anatomical shoulder prostheses and the proximal humeri of Chinese people. Proc Inst Mech Eng H. 2007; 221(8):921–927. PMID: 18161252.

11. Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007-2010. Vital Health Stat 11. 2012; (252):1–48. PMID: 25204692.

12. Song YM, Smith GD, Sung J. Adult height and cause-specific mortality: a large prospective study of South Korean men. Am J Epidemiol. 2003; 158(5):479–485. PMID: 12936903.

13. Song YM, Sung J. Adult height and the risk of mortality in South Korean women. Am J Epidemiol. 2008; 168(5):497–505. PMID: 18660491.

14. Cabezas AF, Gutierrez S, Teusink MJ, et al. Kinematic impact of size on the existing glenohumeral joint in patients undergoing reverse shoulder arthroplasty. Clin Biomech (Bristol, Avon). 2014; 29(6):622–628.

15. Yeh LR, Kwak S, Kim YS, et al. Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers. Skeletal Radiol. 1998; 27(9):500–504. PMID: 9809879.

16. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006; 88(4):800–805. PMID: 16595470.

17. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014; 23(4):536–541. PMID: 24480324.

18. Lemieux PO, Hagemeister N, Tetreault P, Nuno N. Influence of the medial offset of the proximal humerus on the glenohumeral destabilising forces during arm elevation: a numerical sensitivity study. Comput Methods Biomech Biomed Engin. 2013; 16(1):103–111. PMID: 22309002.

19. Yu MY, Zhang W, Zhang DB, Zhang XD, Gu GS. An anthropometry study of the shoulder region in a Chinese population and its correlation with shoulder disease. Int J Morphol. 2013; 31(2):485–490.

20. Torrens C, Lopez JM, Puente I, Caceres E. The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elbow Surg. 2007; 16(3):347–351. PMID: 17113323.

21. Miyazaki AN, Itoi E, Sano H, et al. Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elbow Surg. 2011; 20(7):1082–1086. PMID: 21816635.

22. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD. Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg. 2012; 21(10):1289–1298. PMID: 22217644.