Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation

2018 ◽  
Vol 27 (6) ◽  
pp. 1139-1147 ◽  
Author(s):  
Patrick J. Denard ◽  
Patric Raiss ◽  
Reuben Gobezie ◽  
T. Bradley Edwards ◽  
Evan Lederman
Keyword(s):  
Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Press Fit

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

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.

scholarly journals Short Humeral Stems in Shoulder Arthroplasty

2018 ◽  
Vol 21 (2) ◽  
pp. 105-110
Author(s):  
Hwang Kyun Oh ◽  
Tae Kang Lim
Keyword(s):  
Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Revision Arthroplasty ◽  
Porous Coating ◽  
Glenoid Component ◽  
Cylindrical Shape ◽  
Press Fit ◽  
Surface Finishes ◽  
Humeral Component ◽  
Metaphyseal Bone

Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.

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

2018 ◽  
Vol 27 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Patrick J. Denard ◽  
Matthew P. Noyes ◽  
J. Brock Walker ◽  
Yousef Shishani ◽  
Reuben Gobezie ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Short Stem

Comparison of Methods to Predict Scapular Notching From Radiographs After Reverse Total Shoulder Arthroplasty

2012 ◽  
Author(s):  
Heath B. Henninger ◽  
Michael D. Harris ◽  
Kristen R. Petersen ◽  
Robert T. Burks ◽  
Robert Z. Tashjian
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Stress Shielding ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Implant Placement ◽  
And Function ◽  
Reverse Total Shoulder

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.

Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty

2018 ◽  
Vol 27 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Patrick J. Denard ◽  
Matthew P. Noyes ◽  
J. Brock Walker ◽  
Yousef Shishani ◽  
Reuben Gobezie ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Press Fit ◽  
Radiographic Changes

scholarly journals Proximal Femoral Allograft for Major Segmental Femoral Bone Loss: A Systematic Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
B. A. Rogers ◽  
A. Sternheim ◽  
D. Backstein ◽  
O. Safir ◽  
A. E. Gross
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
Surgical Techniques ◽  
Stress Shielding ◽  
Review Article ◽  
Revision Hip Arthroplasty ◽  
Femoral Bone ◽  
Endoprosthetic Reconstruction ◽  
Press Fit ◽  
Impaction Allografting

As the indications for total hip arthroplasty increase, the prevalence of extensive proximal femoral bone loss will increase as a consequence of massive osteolysis, stress shielding and multiple revisions. Proximal femoral bone stock deficiency provides a major challenge for revision hip arthroplasty and is likely to account for a significant future caseload. Various surgical techniques have been advocated included impaction allografting, distal press-fit fixation and massive endoprosthetic reconstruction. This review article provides a systematic review of the current literature to assess the outcome of revision hip arthroplasty using allograft to reconstruction massive proximal femoral bone loss.

Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty

2019 ◽  
Vol 101-B (9) ◽  
pp. 1107-1114 ◽  
Author(s):  
M. Uy ◽  
J. Wang ◽  
N. S. Horner ◽  
A. Bedi ◽  
T. Leroux ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Optimal Choice ◽  
Complication Rates ◽  
Press Fit ◽  
Fixation Type

Aims The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). Materials and Methods A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. Results There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). Conclusion Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107–1114.

Mid-term radiological results of a cementless short humeral component in anatomical and reverse shoulder arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 610-614 ◽  
Author(s):  
W. R. Aibinder ◽  
D. W. Bartels ◽  
J. W. Sperling ◽  
J. Sanchez-Sotelo
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Radiological Findings ◽  
Humeral Component ◽  
Bone Changes ◽  
The Mean ◽  
Shoulder Arthroplasties ◽  
Glenoid Loosening

Aims Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). Patients and Methods A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4). Results Greater tuberosity stress shielding was noted in 14 shoulders (two TSA and 12 RSA) and was graded as mild in nine, moderate in two, and severe in three. Medial calcar resorption was noted in 23 shoulders (seven TSA and 16 RSA), and was graded as mild in 21 and moderate in two. No humeral components were revised for loosening or considered to be loose radiologically. Nine shoulders underwent reoperation for infection (n = 3), fracture of the humeral tray (n = 2), aseptic glenoid loosening (n = 1), and instability (n = 3). No periprosthetic fractures occurred. Conclusion Implantation of this particular short cementless humeral component at the time of TSA or RSA was associated with a low rate of adverse radiological findings on the humeral side at mid-term follow-up. Our data do not raise any concerns regarding the use of a short stem in TSA or RSA. Cite this article: Bone Joint J 2019;101-B:610–614.

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