scholarly journals 3D-Analysis of the Proximal Humeral Anatomy before and after Stemless Shoulder Arthroplasty—A Prospective Case Series Study

2021 ◽  
Vol 10 (2) ◽  
pp. 259
Author(s):  
Matthias Koch ◽  
Borys Frankewycz ◽  
Andreas Voss ◽  
Max Kaeaeb ◽  
Sebastian Herrmann ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Proximal Humerus ◽  
Mapping Technique ◽  
Computer Assisted ◽  
3D Analysis ◽  
Joint Geometry ◽  
Stemless Shoulder Arthroplasty ◽  
Head Height

Background: Stemless shoulder arthroplasty (SSA) is used to anatomically reconstruct proximal humerus geometry and preserve proximal humerus bone stock. The current literature lacks 3D-analysis of pre- and postoperative proximal humeral anatomy after SSA. The aim of this study was to prospectively analyze the humeral head anatomy using a computer-assisted topography mapping technique after SSA in relation to the preoperative status and the contralateral (not affected) side. Methods: Twenty-nine patients (mean age: 63.5 ± 11.7 years) affected by primary shoulder osteoarthritis and treated with SSA were included. Preoperative and postoperative CT scans of the affected and contralateral sites were analyzed regarding joint geometry. Clinical outcome was assessed by Constant and Disabilities of the Arm, Shoulder and Hand (DASH) score shortly before and one year after surgery. Results: Clinical outcome improved significantly. No correlation between clinical outcome and the evaluated anatomical parameters was found. There was a significant decrease of the humeral head height (p < 0.01) and radius (p = 0.03) in the preoperative versus the postoperative joint geometry. The comparison to the contralateral site showed also a significant decrease of the humeral head height (p < 0.01). All other parameters showed no significant differences. Conclusion: Proximal humeral anatomy can be almost anatomically reconstructed by SSA. Solely the humeral head height differs significantly to the preoperative as well as contralateral morphology.

Pectoralis Major Insertional Ratio in Proximal Humerus Fractures: A Method to Reconstruct Humeral Head Height in Arthroplasty

Orthopedics ◽  
2009 ◽  
Vol 32 (10) ◽  
pp. 729-734 ◽  
Author(s):  
S. Ashfaq Hasan ◽  
Russell B. Rauls ◽  
Cari L. Cordell ◽  
Andrew D. Heinzelmann ◽  
Eric R. Siegel
Keyword(s):  
Humeral Head ◽  
Proximal Humerus ◽  
Pectoralis Major ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Head Height

scholarly journals Results of stemless shoulder arthroplasty: a systematic review and meta-analysis

2021 ◽  
Vol 6 (1) ◽  
pp. 915-929
Author(s):  
Joost I.P. Willems ◽  
Jim Hoffmann ◽  
Inger N. Sierevelt ◽  
Michel P.J. van den Bekerom ◽  
Tjarco D.W. Alta ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Shoulder Arthroplasty ◽  
Meta Analysis ◽  
Stress Shielding ◽  
Fracture Rate ◽  
Level Of Evidence ◽  
Sufficient Power ◽  
Study Heterogeneity ◽  
Stemless Shoulder Arthroplasty

Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: EFORT Open Rev 2021;6:915-929. DOI: 10.1302/2058-5241.6.200067

Position of shoulder arthroplasty and clinical outcome in proximal humerus fractures

2011 ◽  
Vol 95 (S1) ◽  
pp. 55-58 ◽  
Author(s):  
Roberto Padua ◽  
L. Padua ◽  
M. Galluzzo ◽  
E. Ceccarelli ◽  
F. Alviti ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Determination of humeral inclination in stemless shoulder arthroplasty using plain radiographs

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Sascha Beck ◽  
Robert J. Martin ◽  
Theodor Patsalis ◽  
Manuel Burggraf ◽  
André Busch ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Plain Radiograph ◽  
Plain Radiographs ◽  
Neck Shaft Angle ◽  
Mathematical Algorithm ◽  
Humeral Component ◽  
Stemless Shoulder Arthroplasty ◽  
The Impact

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.

scholarly journals Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

2021 ◽  
Author(s):  
M. Müller ◽  
F. Greve ◽  
M. Crönlein ◽  
M. Zyskowski ◽  
S. Pesch ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Revision Rate ◽  
Plate Fixation ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Locking Plate Fixation

Abstract Introduction Surgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA). Materials and Methods All patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Results A cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 3 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal. Conclusions Reversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.

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