Patterns of proximal humeral bone resorption after total shoulder arthroplasty with an uncemented rectangular stem

Spormann, C.; Durchholz, Holger; Audigé, Laurent; Flury, Manuel; Schwyzer, Hans‐Kaspar; Simmen, Beat R.; Kolling, Christoph

doi:10.1016/j.jse.2014.02.024

Cited by 51 publications

(25 citation statements)

References 26 publications

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“…The frequency of proximal humeral osteolysis after humeral implant placement varies widely in the literature, ranging from 5% to 43%. 24,31,32 In our study, osteolysis was observed in 56% of patients, with the significant majority occurring in group A patients, who also had more severe osteolysis. Bone resorption was frequently observed at the calcar region (zone 1).…”

Section: Discussionsupporting

confidence: 47%

“…14,29 Raiss et al 28 found that patients with osteolysis (partial or complete) at the proximal part of the humerus had a significantly lower Constant score, less shoulder elevation, and less external rotation. However, in a retrospective review of 77 primary TSAs by Denard et al 9 and a 5-year analysis of the patterns of proximal humeral osteolysis in 106 patients by Spormann et al, 31 no significant differences in functional outcomes were found for patients with bone resorption vs. those without bone resorption. Our study showed that ASES scores tended to be higher in the absence of humeral osteolysis, although the effect did not reach statistical significance (mean difference, 3.56 [95% CI, -2.07 to 9.19]; P ¼ .210).…”

Section: Discussionmentioning

confidence: 96%

“…17 Bone resorption around the glenoid component in TSAs has been the main focus of study until recently, whereas humeral osteolysis has now gained more attention in the literature. 6,9,15,16,28,30,31 The cause of glenoid radiolucent lines (and perhaps subsequent loosening) is multifactorial. It can be related to glenoid or humeral component malposition, increased mechanical stress on the glenoid, increased friction between components, or the volume of polyethylene particles generated by the head-polyethylene articulation.…”

Section: Discussionmentioning

confidence: 99%

“…Closer analysis of patients in group A (long-stem metal-head prosthesis) showed increased odds of development of humeral osteolysis by a factor of 2.36 with every 10-year increase in age. When reporting their results of an uncemented, long-stem metalhead prosthesis after a 5-year follow-up period, Spormann et al 31 found that patients older than 60 years were 4.2 times more likely to show signs of bone resorption compared with younger patients (P ¼ .032). This finding suggests that in older patients with certain combinations of prosthetic designs and biomaterials, more progressive proximal humeral osteolysis may tend to develop in the medium term.…”

Section: Discussionmentioning

confidence: 99%

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Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

Bell

Christmas

Coghlan

2020

Journal of Shoulder and Elbow Surgery

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Background: In vitro wear studies demonstrate decreased polyethylene wear with a ceramic compared with a metal humeral head. In this in vivo study, we analyzed prospectively collected 5-year data, comparing the outcomes of 2 types of humeral implants. Methods: Sixty-two anatomic total shoulder arthroplasties (TSAs) (59 patients) were performed using the same glenoid component and 2 types of modular humeral implants (metal-head long-stem prosthesis in group A vs. ceramic-head stemless prosthesis in group B). Radiographic analysis for proximal humeral osteolysis and glenoid component radiolucent lines was performed at an average of 5.5 years. Functional outcomes were prospectively evaluated according to the visual analog scale score for pain; satisfaction level; American Shoulder and Elbow Surgeons score; active elevation; Shoulder Pain and Disability Index score; and Disabilities of the Arm, Shoulder and Hand score. Results: There were 39 TSAs in group A (mean age, 68.1 years) and 23 TSAs in group B (mean age, 67 years). Clinical improvement was similar for both groups. Some proximal humeral osteolysis occurred in 56% of all TSAs. Group A showed increased osteolysis compared with group B (72% vs. 30%, P ¼ .005). Glenoid radiolucent lines were far more frequent in group A, and group A showed a direct relationship between the extent of humeral osteolysis and the severity of glenoid radiolucent lines (P < .001). Conclusion: The stemless ceramic-head replacements showed fewer glenoid radiolucent lines and less humeral osteolysis than the long-stem metal-head replacements. In the group with metal-head replacements, correlation was shown between glenoid radiolucent lines and humeral osteolysis.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

Bell

Christmas

Coghlan

2020

Journal of Shoulder and Elbow Surgery

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“…One study sought to examine patterns of proximal humeral bone resorption after TSA with a cementless stem [58] and found a 17 % prevalence of full thickness cortical bone resorption in the proximal posterolateral humerus, predominantly in the first year after surgery. They found that the risk of bone resorption is significantly related to the ratio between the humeral shaft and prosthetic diameter, and that it increased with increasing stem size.…”

Section: Total Shoulder Arthroplastymentioning

confidence: 99%

Porous metals and alternate bearing surfaces in shoulder arthroplasty

Carpenter

Urits

Murthi

2016

Curr Rev Musculoskelet Med

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Total shoulder arthroplasty (TSA) provides an effective solution for the treatment of glenohumeral arthritis. However, long-term outcomes have been limited by glenoid component aseptic loosening and polyethylene (PE) wear. Previous attempts to improve glenoid fixation with metal-backed glenoids resulted in inferior results. Newer component designs that contain porous metal allow for biological ingrowth of the prosthesis, potentially improving longevity and overall outcomes. Porous metal can also improve humeral component fixation, obviating the need for cement and simplifying revision surgery. Advances such as highly cross-linked polyethylene (HXLPE), vitamin E-doped HXLPE, and alternate bearing surfaces like ceramics and pyrolytic carbon have proven to provide superior wear characteristics in other joint replacements and may prove beneficial in the shoulder as well.

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Structural analysis of hollow versus solid‐stemmed shoulder implants of proximal humeri with different bone qualities

Soltanmohammadi

Tavakoli

Langohr

et al. 2021

Journal Orthopaedic Research

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Stress shielding of the proximal humerus following total shoulder arthroplasty (TSA) can promote unfavorable bone remodeling, especially for osteoporotic patients. The objective of this finite element (FE) study was to determine if a hollow, rather than solid, titanium stem can mitigate this effect for healthy, osteopenic, and osteoporotic bone. Using a population-based model of the humerus, representative average healthy, osteopenic, and osteoporotic humerus FE models were created. For each model, changes in bone and implant stresses following TSA were evaluated for different loading scenarios and compared between solid versus hollow-stemmed implants. For cortical bone, using an implant decreased von Mises stress with respect to intact values up to 34.4%, with a more pronounced effect at more proximal slices. In the most proximal slice, based on changes in strain energy density, hollow-stemmed implants outperformed solid-stemmed ones through reducing cortical bone volume with resorption potential by 11.7% ± 2.1% (p = .01). For cortical bone in this slice, the percentage of bone with resorption potential for the osteoporotic bone was greater than the healthy bone by 8.0% ± 1.4% using the hollow-stemmed implant (p = .04). These results suggest a small improvement in boneimplant mechanics using hollow-stemmed humeral implants and indicate osteoporosis could exacerbate stress shielding to some extent. The hollow stems maintained adequate strength and using even thinner walls may further reduce stress shielding. After further developing these models, future studies could yield optimized implant designs tuned for varying bone qualities.

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Patterns of proximal humeral bone resorption after total shoulder arthroplasty with an uncemented rectangular stem

Cited by 51 publications

References 26 publications

Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

Porous metals and alternate bearing surfaces in shoulder arthroplasty

Structural analysis of hollow versus solid‐stemmed shoulder implants of proximal humeri with different bone qualities

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