Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty

Kim, Su Cheol; Park, Jong‐Hun; Bukhary, Hashem; Yoo, Jae Chul

doi:10.1007/s00264-022-05383-4

Cited by 14 publications

(3 citation statements)

References 33 publications

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“…The authors compared humeral stress shielding and clinical outcomes between high and low filling ratio (HFR and LFR) stems in primary reverse shoulder arthroplasty (RSA) at one-year follow-up and concluded that patients receiving LFR stems with autogenous bone grafting had significantly less humeral stress shielding compared to patients with HFR stem with press-fit in primary RSA, without compromising stem stability. Starting from this observation, this is likely to be useful when first predicting the ideal prosthetic design for a patient [12].…”

Section: Discussionmentioning

confidence: 98%

“…We hypothesized that the geometry of the proximal humerus could be a predisposing factor for aseptic loosening of stemmed implants in shoulder arthroplasty. Kim et al found in a cohort of 104 RSAs (reversed shoulder arthroplasty) a lower rate of stress shielding in patients with low filling ratio [12]. The authors compared humeral stress shielding and clinical outcomes between high and low filling ratio (HFR and LFR) stems in primary reverse shoulder arthroplasty (RSA) at one-year follow-up and concluded that patients receiving LFR stems with autogenous bone grafting had significantly less humeral stress shielding compared to patients with HFR stem with press-fit in primary RSA, without compromising stem stability.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Radiological Classification System of the Proximal Humerus

Sangaletti,

Abuljadail,

Akkaya

et al. 2023

Z Orthop Unfall

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Different anatomical variants have been reported for the proximal and distal femur. Given this context, the goal of our study was to answer the following question: Can we also identify different anatomical variants of the proximal humerus?Two hundred anteroposterior (AP) radiographs of the proximal humerus with an equal gender distribution and equal laterality per gender were reviewed. The metaphyseal diameter of the proximal humerus at the level of the anatomical neck (X) and the intramedullary diameter at 10 cm from the apex of the greater tuberosity (Y) were measured. A new ratio was established, based on both measurements (Y/X). Radiographs showed different anatomical variants: type A: Y/X < 0.3, type B: Y/X = 0.3–0.4, type C: Y/X > 0.4. Two observers reviewed the AP radiographs independently and blindly in 2 different sessions.Three different anatomical groups (A, B and C) were identified based on the 25th and 75th percentiles. A higher percentage of type C was observed among females and a higher percentage of type A among males. A high inter-observer reliability was noted, with a Cronbach’s alpha of 0.97 (ICC 0.96–0.98). The intra-observer reliability for observer 1 had a Cronbach’s alpha of 0.98.A novel radiological classification of the proximal humerus has been established based on 3 different anatomical types (A, B and C). Further studies are needed to establish whether the novel classification system can be used as an indicator for aseptic loosening of cemented or cementless total shoulder arthroplasty.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

A Novel Radiological Classification System of the Proximal Humerus

Sangaletti,

Abuljadail,

Akkaya

et al. 2023

Z Orthop Unfall

View full text Add to dashboard Cite

show abstract

“…Furthermore, it is also important to consider the potential mechanobiological impact that porous stems may have on surrounding bone. Previous studies of proximal humeral implants for the shoulder have used computational models, radiographic and clinical outcomes postoperatively to examine the effects of stem length (Razfar et al, 19 Aibinder et al, 20 Denard et al, 21 ) hollow stems (Soltanmohammadi et al, 22 ) cementing (Denard et al, 23 Kim et al 24 ) and coatings (Tan et al 25 ) Porous humeral stems, however, have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Porous versus solid shoulder implants in humeri of different bone densities: A finite element analysis

Hitchon,

Soltanmohammadi,

Milner

et al. 2024

Journal Orthopaedic Research

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Porous metallic prosthesis components can now be manufactured using additive manufacturing techniques, and may prove beneficial for promoting bony ingrowth, for accommodating drug delivery systems, and for reducing stress shielding. Using finite element modeling techniques, 36 scenarios (three porous stems, three bone densities, and four held arm positions) were analysed to assess the viability of porous humeral stems for use in total shoulder arthroplasty, and their resulting mechanobiological impact on the surrounding humerus bone. All three porous stems were predicted to experience stresses below the yield strength of Ti6Al4V (880 MPa) and to be capable of withstanding more than 10 million cycles of each loading scenario before failure. There was an indication that within an 80 mm region of the proximal humerus, there would be a reduction in bone resorption as stem porosity increased. Overall, this study shows promise that these porous structures are mechanically viable for incorporation into permanent shoulder prostheses to combat orthopedic infections.

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Finite element analysis part 1 of 2: Influence of short stem implant polyethylene configuration on glenohumeral joint biomechanics

Nourissat,

Housset,

Daudet

et al. 2024

J. exp. orthop.

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PurposeStress shielding in short‐stem arthroplasty can cause critical metaphyseal bone loss. If the size and shape of the humeral shaft are important factors, it is unknown whether the shape of the polyethylene component in reverse shoulder arthroplasty (RSA) affects bone stress around or within the stem. We explored the impact of polyethylene shape on humeral and scapular stress distribution using a finite element model.MethodsWe developed a shoulder‐specific finite element model. A defined set of muscle forces was applied to simulate movements. An intact rotator cuff state and a superior deficient rotator cuff state were modelled. We used the FX V135 short stem in three conditions: total shoulder arthroplasty (TSA), and RSA with symmetrical and asymmetrical polyethylene (145°/135°). We measured biomechanical markers related to bone stress for different implant sizes. Joint kinematics and the mechanical behaviour of the implant were compared.ResultsRupture of the supraspinatus muscle produced a functionally limited shoulder. The placement of an anatomic TSA with an intact rotator cuff restored function similar to that of a healthy shoulder. RSA in the rotator cuff‐deficient shoulder restored function regardless of stem size and polyethylene shape. While stem size had an impact on the stress distribution in the bone and implant, it did not show significant potential for increasing or decreasing overall stress. For the same stem, stress distribution at the humerus is different between TSA and RSA. Polyethylene shape did not alter the transmission of stress to the bone in RSA. Asymmetric polyethylene produced a greater abduction range of motion.ConclusionsIn terms of bone stress distribution, smaller stems seemed more appropriate for TSA, while larger stems may be more appropriate for RSA. Polyethylene shape resulted in different ranges of motion but did not influence bone stress.Level of EvidenceDiagnostic Tests or Criteria; Level IV.

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Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty

Cited by 14 publications

References 33 publications

A Novel Radiological Classification System of the Proximal Humerus

A Novel Radiological Classification System of the Proximal Humerus

Porous versus solid shoulder implants in humeri of different bone densities: A finite element analysis

Finite element analysis part 1 of 2: Influence of short stem implant polyethylene configuration on glenohumeral joint biomechanics

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