Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty

Scapular notching is a complication of reverse total shoulder arthroplasty (rTSA) that results in bone loss on the lateral border of the scapula. Notching has been reported in up to 86% of patients at 5 year follow-up [1], and is graded 1–4 as a function of progressive bone loss [2]. Notching may arise from impingement, erosion, periprosthetic osteolysis, stress shielding or a combination of these [1]. Glenosphere position can mitigate notching by limiting hardware impingement [3–5], but may increase the forces required to abduct the arm [6]. Clinicians might optimize patient range of motion and function via implant placement if susceptibility to notching was known a-priori.

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Long-Term Radiographic Changes in Stemless Press-Fit Total Shoulder Arthroplasty

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1079-6549 ◽

2020 ◽

Author(s):

Sascha Beck ◽

Theodor Patsalis ◽

André Busch ◽

Florian Dittrich ◽

Alexander Wegner ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Stress Shielding ◽

Shoulder Prosthesis ◽

Mild Stress ◽

Press Fit ◽

Radiographic Changes

Abstract Introduction Stemmed humeral implants have represented the gold standard in total shoulder arthroplasty (TSA) for decades. Like many other joints, the latest trends in TSA designs aim at bone preservation. Current studies have demonstrated that native proximal humeral bone stresses are most closely mimicked by stemless implants. Nevertheless, there are concerns about the long-term performance of stemless designs. The aim of the present study was to evaluate the long-term radiographic changes at the proximal humerus in anatomical stemless press-fit TSA. Materials and Methods Between 2008 and 2010, 48 shoulders in 43 patients were resurfaced using an anatomic stemless shoulder prosthesis (TESS, Biomet). Thirty shoulders in twenty-five patients who were aged 65.7 ± 9.9 (34 to 82) years were available for clinical and radiographic review at a mean follow-up of 94.0 ± 8.9 (78 to 110) months. Results Radiographic changes of the proximal humerus due to stress shielding were found in 38.4% of the stemless TESS implants. Mild stress shielding accounted for 80% of the observed radiographic changes. Radiographs exhibited stable fixation of the stemless humeral press-fit implant at early and late follow-up. In contrast, radiolucent lines at the glenoid implant were found in 96.1% of the cases. Irrespective of the degree of radiographic changes, clinical scores (VAS, Quick-DASH, Constant score) significantly improved at follow-up. Conclusions The anatomic stemless press-fit implant seems to be favorable in terms of implant-related stress shielding. Clinical outcome was not affected by radiographic changes, demonstrating an 8-year clinical performance that seems to be comparable to conventional stemmed TSA.

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Mid-term results of anatomical total shoulder arthroplasty for primary osteoarthritis using a short-stemmed cementless humeral component

The Bone & Joint Journal ◽

10.1302/0301-620x.100b5.bjj-2017-1102.r2 ◽

2018 ◽

Vol 100-B (5) ◽

pp. 603-609 ◽

Cited By ~ 22

Author(s):

M. Schnetzke ◽

S. Rick ◽

P. Raiss ◽

G. Walch ◽

M. Loew

Keyword(s):

Cortical Bone ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Bone Adaptation ◽

Filling Ratio ◽

Short Stem ◽

Primary Osteoarthritis ◽

Humeral Component ◽

High Bone

Aims The aim of this study was to evaluate the clinical and radiological outcome of using an anatomical short-stem shoulder prosthesis to treat primary osteoarthritis of the glenohumeral joint. Patients and Methods A total of 66 patients (67 shoulders) with a mean age of 76 years (63 to 92) were available for clinical and radiological follow-up at two different timepoints (T1, mean 2.6 years, sd 0.5; T2, mean 5.3 years, sd 0.7). Postoperative radiographs were analyzed for stem angle, cortical contact, and filling ratio of the stem. Follow-up radiographs were analyzed for timing and location of bone adaptation (cortical bone narrowing, osteopenia, spot welds, and condensation lines). The bone adaptation was classified as low (between zero and three features of bone remodelling around the humeral stem) or high (four or more features). Results The mean Constant score improved significantly from 28.5 (sd 11.6) preoperatively to 75.5 (sd 8.5) at T1 (p < 0.001) and remained stable over time (T2: 76.6, sd 10.2). No stem loosening was seen. High bone adaptation was present in 42% of shoulders at T1, with a slight decrease to 37% at T2. Cortical bone narrowing and osteopenia in the region of the calcar decreased from 76% to 66% between T1 and T2. Patients with high bone adaptation had a significantly higher mean filling ratio of the stem at the metaphysis (0.60, sd 0.05 vs 0.55, sd 0.06; p = 0.003) and at the diaphysis (0.65 sd 0.05 vs 0.60 sd 0.05; p = 0.007). Cortical contact of the stem was also associated with high bone adaptation (14/25 shoulders, p = 0.001). The clinical outcome was not influenced by the radiological changes. Conclusion Total shoulder arthroplasty using a short-stem humeral component resulted in good clinical outcomes with no evidence of loosening. However, approximately 40% of the shoulders developed substantial bone loss in the proximal humerus at between four and seven years of follow-up. Cite this article: Bone Joint J 2018;100-B:603–9.

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Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature

JSES International ◽

10.1016/j.jses.2019.10.112 ◽

2020 ◽

Vol 4 (1) ◽

pp. 114-119 ◽

Cited By ~ 3

Author(s):

Brandon J. Erickson ◽

Peter N. Chalmers ◽

Patrick J. Denard ◽

Reuben Gobezie ◽

Anthony A. Romeo ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Short Stem ◽

Review Of The Literature ◽

Current State

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Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.05.026 ◽

2018 ◽

Vol 27 (1) ◽

pp. 70-74 ◽

Cited By ~ 23

Author(s):

Anthony A. Romeo ◽

Robert J. Thorsness ◽

Shelby A. Sumner ◽

Reuben Gobezie ◽

Evan S. Lederman ◽

...

Keyword(s):

Clinical Outcome ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Short Stem ◽

Short Term ◽

Humeral Component

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Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.11.067 ◽

2016 ◽

Vol 25 (7) ◽

pp. 1163-1169 ◽

Cited By ~ 35

Author(s):

Danielle J. Casagrande ◽

Di L. Parks ◽

Travis Torngren ◽

Mark A. Schrumpf ◽

Samuel M. Harmsen ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Short Stem ◽

Radiographic Evaluation ◽

Short Term ◽

Press Fit

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Stress shielding following stemless anatomic total shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/17585732211058804 ◽

2021 ◽

pp. 175857322110588

Author(s):

William R Aibinder ◽

Fares Uddin ◽

Ryan T Bicknell ◽

Ryan Krupp ◽

Markus Scheibel ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Functional Outcomes ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Stress Shielding ◽

Implant Design ◽

Level Of Evidence ◽

Lesser Tuberosity ◽

Significant Difference

Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant ( p = 0.021) Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.

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