Reliability of stemless shoulder arthroplasty in rheumatoid arthritis: observation of early lysis around the humeral component

Plain radiographs of the shoulder are routinely used to assess implant orientation after shoulder arthroplasty. Recently, humeral inclination has come into focus especially in reverse stemless shoulder arthroplasty. But, in X-ray projections not exactly parallel to the base of the humeral component, the humeral inclination angle cannot be determined precisely. Therefore, we established a mathematical algorithm to calculate the humeral neck shaft angle and counterchecked the formula using plain radiographs of a sawbone model containing a humeral head prosthesis. With increasing angles of retroversion, the base of the humeral component forms an ellipse in plain radiographs. Knowing the width and length of the ellipse as well as the inclination angle in a plain radiograph, the exact inclination angle can be determined using the equation reported below. Thus, independent from the viewing angle or angle of retroversion, the inclination angle of a stemless humeral head implant can be estimated with an accuracy of ±1.5-degree deviation. The algorithm proposed may be the basis for further research on the impact of humeral inclination in stemless shoulder arthroplasty.

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Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019390 ◽

2021 ◽

pp. 175857322110193

Author(s):

Arjun K Reddy ◽

Jake X Checketts ◽

B Joshua Stephens ◽

J Michael Anderson ◽

Craig M Cooper ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Revisional Surgery ◽

Total Shoulder Arthroplasty ◽

Surgical Site Infections ◽

Total Sample ◽

Reverse Total Shoulder Arthroplasty ◽

Common Complication ◽

Humeral Component ◽

Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

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Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

Video Journal of Sports Medicine ◽

10.1177/2635025421997126 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542199712

Author(s):

Jordan D. Walters ◽

Stephen F. Brockmeier

Keyword(s):

Bone Quality ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Complication Rates ◽

Lesser Tuberosity ◽

Critical Elements ◽

Implant Placement ◽

Humeral Component ◽

Component Loosening ◽

Deltopectoral Approach

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

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Humeral bone grafting in stemless shoulder arthroplasty

Obere Extremität ◽

10.1007/s11678-017-0424-2 ◽

2017 ◽

Vol 12 (3) ◽

pp. 183-185 ◽

Cited By ~ 2

Author(s):

Fabian Plachel ◽

Markus Scheibel

Keyword(s):

Shoulder Arthroplasty ◽

Bone Grafting ◽

Stemless Shoulder Arthroplasty

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Prior Shoulder Surgery and Rheumatoid Arthritis Increase Early Risk of Infection after Primary Reverse Total Shoulder Arthroplasty

JSES International ◽

10.1016/j.jseint.2021.06.003 ◽

2021 ◽

Author(s):

Teron A. Nezwek ◽

Lincoln Dutcher ◽

Luke Mascarenhas ◽

Alyssa Woltemath ◽

Jeyvikram Thirumavalavan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Shoulder Surgery ◽

Reverse Total Shoulder Arthroplasty ◽

Risk Of Infection ◽

Early Risk ◽

Reverse Total Shoulder

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Impact of Humeral Component Retroversion on Clinical Outcomes of Reverse Total Shoulder Arthroplasty with Humeral Lateralization

Seminars in Arthroplasty ◽

10.1053/j.sart.2021.03.011 ◽

2021 ◽

Author(s):

Young Hoon Jang ◽

Seung Yeol. Oh ◽

Byung Sun Choi ◽

Sae H.oon Kim

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Humeral Component ◽

Reverse Total Shoulder

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Early fixation of the humeral component in stemless total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0945.r1 ◽

2022 ◽

Vol 104-B (1) ◽

pp. 76-82

Author(s):

Bart ten Brinke ◽

Brechtje Hesseling ◽

Denise Eygendaal ◽

Max A. Hoelen ◽

Nina M. C. Mathijssen

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Future Research ◽

Dash Score ◽

Term Survival ◽

Early Migration ◽

Humeral Component ◽

Initial Fixation ◽

Early Fixation

Aims Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. Methods In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the Oxford Shoulder Score (OSS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Results At two years, median translation along the x-, y-, and z-axis was -0.12 mm (interquartile range (IQR) -0.18 to 0.02), -0.17 mm (IQR -0.27 to -0.09), and 0.09 mm (IQR 0.02 to 0.31). Median rotation around the x-, y-, and z-axis was 0.12° (IQR -0.50 to 0.57), -0.98° (IQR -1.83 to 1.23), and 0.09° (IQR -0.76 to 0.30). Overall, 20 prostheses stabilized within 12 months postoperatively. Four prostheses showed continuous migration between 12 and 24 months. At two-year follow-up, with the exception of one revised prosthesis, all clinical scores improved significantly (median VAS difference at rest: -3.0 (IQR -1.5 to -6.0); OSS 22.0 (IQR 15.0 to 25.0); CMS 29.5 (IQR 15.0 to 35.75); and DASH -30.0 (IQR -20.6 to -41.67) (all p < 0.001)) with the exception of one revised prosthesis. Conclusion In conclusion, we found that 20 out of 24 implants stabilized within 12 months postoperatively. The significance of continuous migration in four implants is unclear and future research on the predictive value of early migration for future loosening in TSA is required. Clinical results revealed a clinically relevant improvement. Cite this article: Bone Joint J 2022;104-B(1):76–82.

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