Short Humeral Stems in Shoulder Arthroplasty

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.

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

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.12.020 ◽

2018 ◽

Vol 27 (6) ◽

pp. 1139-1147 ◽

Cited By ~ 25

Author(s):

Patrick J. Denard ◽

Patric Raiss ◽

Reuben Gobezie ◽

T. Bradley Edwards ◽

Evan Lederman

Keyword(s):

Shoulder Arthroplasty ◽

Stress Shielding ◽

Press Fit

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

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1374.r1 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 610-614 ◽

Cited By ~ 3

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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Registry of Shoulder Arthroplasty – The Scottish Experience

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x94922 ◽

2006 ◽

Vol 88 (2) ◽

pp. 122-126 ◽

Cited By ~ 21

Author(s):

S Sharma ◽

CR Dreghorn

Keyword(s):

Data Collection ◽

Shoulder Arthroplasty ◽

Demographic Data ◽

Glenoid Component ◽

National Guidelines ◽

Shoulder Replacement ◽

Joint Registry ◽

Data Registration ◽

Humeral Component ◽

Shoulder Arthroplasties

INTRODUCTION Recognising that timely dissemination of information in the orthopaedic community was important and in the absence of any national guidelines for shoulder arthroplasty, the Scottish shoulder arthroplasty registry, a voluntary registry, was started in 1996. The goals of the registry were to assess contemporary practice, provide a benchmark against which surgeons could compare their practice, identify risk factors for a poor outcome, and to improve outcomes through continuous feedback to the participating surgeons. PATIENTS AND METHODS A standardised proforma was used to collect information on the diagnostic and demographic data, type of procedure performed, type of implant used, any associated procedures performed in conjunction with the arthroplasty, and peri-operative complications. Postoperative pain, activity and patient satisfaction were assessed annually using another standardised proforma. RESULTS Twenty surgeons have contributed to the register and 451 shoulder arthroplasties were registered over a 5-year period. Of patients, 23.2% were male and 76.8% female. The mean age was 65 years (range, 37–90 years). Shoulder arthroplasty was commonly performed for rheumatoid arthritis followed by trauma, osteoarthritis and avascular necrosis of the humeral head. Overall, 397 (88%) patients had a hemi-arthroplasty and 54 (12%) had a total shoulder replacement. Of the 54 cases that had a glenoid replacement, 28 were performed for inflammatory arthritis, 21 for osteoarthritis and 5 were for revisions. The humeral component was cemented in 204 (45%) cases, 160 of whom had a shoulder replacement for trauma. The glenoid component was cemented in 48 (89%) cases. Cross referencing our data with the figures of the actual number of shoulder arthroplasties performed, however, indicated that our registry at best collected only 53% of all the shoulder arthroplasties performed in Scotland annually. CONCLUSIONS The value of a joint registry is dependent on the accuracy and completeness of the data entered. Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process.

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Anatomic humeral head replacement with a press-fit prosthesis: An in vivo radiographic study

Orthopedic Reviews ◽

10.4081/or.2017.7168 ◽

2017 ◽

Vol 9 (3) ◽

Author(s):

Bryan Vopat ◽

Jeremy Truntzer ◽

Daniel Aaron ◽

Jack Anavian ◽

Joel Schwartz ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Anatomic Reconstruction ◽

Implant Design ◽

Design Parameters ◽

Press Fit ◽

Humeral Component ◽

Glenohumeral Osteoarthritis ◽

The Mean

Successful total shoulder arthroplasty is, in part, dependent on anatomic reconstruction of the glenohumeral joint. The purpose of this study was to evaluate the post-operative anatomy of total shoulder arthroplasty with an anatomic implant design in patients with primary glenohumeral osteoarthritis and compare it to published normative anatomic measurements. Fifty-one patients (56 shoulders) with primary glenohumeral osteoarthritis were treated with a press-fit humeral component as part of a total shoulder arthroplasty (Aequalis, Tornier, Edina, Minnesota). Analysis of postoperative true anterior posterior radiographs was performed with use of a custom software algorithm. The mean humeral inclination (head-shaft angle), mean humeral implant anatomical humeral axis, mean greater tuberosity height, and mean humeral head center offset (medial offset) were 135.4±5.1°, 1.73±1.7°, 6.9±2.4 mm, and 3.8±1.8 mm, respectively. All parameters were within the ranges reported in the literature for normal shoulders except the mean humeral head center offset, which was less than reported in the literature. Anatomic parameters of a total shoulder arthroplasty can be achieved with an anatomically designed, modular adaptable press-fit design. Reduced medial humeral head center offset was likely dependent upon implant specific design parameters.

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Imaging of shoulder arthroplasties and their complications: a pictorial review

Insights into Imaging ◽

10.1186/s13244-019-0788-5 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Damien Combes ◽

Romain Lancigu ◽

Patrick Desbordes de Cepoy ◽

Filippo Caporilli-Razza ◽

Laurent Hubert ◽

...

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Shoulder Joint ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Humeral Component ◽

Number Of Patients ◽

Component Loosening ◽

Shoulder Arthroplasties

Abstract Currently, an increasing number of patients benefit from shoulder prosthesis implantation. Radiologists are therefore more often confronted with imaging examinations involving shoulder arthroplasty, whether during a dedicated examination or incidentally. Standard radiography is the first-line imaging modality in the follow-up of these implants, before the possible use of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging), ultrasound, or nuclear medicine examinations. Shoulder arthroplasties are divided into three categories: reverse shoulder arthroplasty, total shoulder arthroplasty, and partial shoulder joint replacement (including humeral hemiarthroplasty and humeral head resurfacing arthroplasty). Each of these prostheses can present complications, either shared by all types of arthroplasty or specific to each. Infection, periprosthetic fractures, humeral component loosening, heterotopic ossification, implant failure, and nerve injury can affect all types of prostheses. Instability, scapular notching, and acromial fractures can be identified after reverse shoulder arthroplasty implantation. Glenoid component loosening and rotator cuff tear are specific complications of total shoulder arthroplasty. Progressive wear of the native glenoid is the only specific complication observed in partial shoulder joint replacement. Knowledge of different types of shoulder prostheses and their complications’ radiological signs is crucial for the radiologist to initiate prompt and adequate management.

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Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1678686 ◽

2019 ◽

Vol 32 (08) ◽

pp. 704-709 ◽

Cited By ~ 6

Author(s):

Adam S. Driesman ◽

William Macaulay ◽

Ran Schwarzkopf

Keyword(s):

Treatment Options ◽

Revision Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Mechanical Alignment ◽

Future Directions ◽

Press Fit ◽

Implant Placement ◽

History Of ◽

Total Knee ◽

Metaphyseal Bone

AbstractSuccessful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, there remains two options to assist with fixation, either fully cementing the entire implant or using a “hybrid” system, which combines an uncemented press-fit diaphyseal stem with cement in both the metaphysis and metaphysis–diaphysis junction of the keel. In this review, we discuss the history of these two techniques, evaluate the theoretical benefits and pitfalls, and assess the best evidence supporting each in the literature. To conclude, we will examine future directions and questions needed to better elucidate the best treatment options in a variety of revision scenarios.

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