Stemless Humeral Implants in Total Shoulder Arthroplasty

Brabston, Eugene W.; Fehringer, Edward V.; Owen, Matthew T.; Ponce, Brent A.

doi:10.5435/jaaos-d-16-00747

Cited by 35 publications

(35 citation statements)

References 47 publications

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“…Stemless humeral implants specifically have seen increased adoption, in part, due to potential advantages in decreased surgical time, greater bone preservation, less stress shielding, and easier revision. 5,34,35 Comparisons of stemless with stemmed TSA have thus far shown comparable, promising patient outcomes, and it is likely that their use will continue to increase in the future. 5,34-36…”

Section: Discussionmentioning

confidence: 99%

Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty

Rechenmacher

Goltz

Wickman

et al. 2022

J Am Acad Orthop Surg

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Introduction: Recent advances in preoperative 3D templating software allow surgeons to plan implant size and position for stemless total shoulder arthroplasty (TSA). Whether these preoperative plans accurately reflect intraoperative decisions is yet unknown, and the purpose of this study was to evaluate concordance between planned and actual implant sizes in a series of patients undergoing stemless TSA. Methods: A retrospective cohort of consecutive, anatomic, stemless TSA cases performed by two surgeons between September 2019 and February 2021 was examined. Preoperative templated plans were collected using 3D planning software, and the sizes of planned glenoid, humeral head, and nucleus "stem" implants and other procedural data were recorded, along with sociodemographic information. These predicted parameters were compared with the implant sizes, and the concordance of these templated plans was quantified by direct comparison and bootstrapped simulations. Results: Fifty cases met inclusion criteria, among which perfect concordance across all three implants was observed in 11 cases (22%). The glenoid implant had the highest concordance (80%) relative to the humeral head and nucleus implants (38% and 60%, respectively), which was statistically significant (P , 0.001). Planned humeral head implants were more often oversized relative to their actual implanted size. However, 84% of the planned humeral heads were within 1 diameter size; in addition, 98% of the planned glenoid implants were within one size and all were within 10 mm of the implanted glenoid backside radius. All nucleus implants were within one size. Discussion: Final implant sizes demonstrated variable concordance relative to preoperative plans, with glenoid implants having the highest accuracy and humeral heads having the highest variability. Multiple factors contributed to the varying concordances for the different implants, suggesting possible areas of improvement in this

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Section: Discussionmentioning

confidence: 99%

Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty

Rechenmacher

Goltz

Wickman

et al. 2022

J Am Acad Orthop Surg

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“…Several stemless designs are now on the market, all with the aim of providing 3-dimensional reconstruction of the humeral head, recreating the humeral center of rotation independent of the shaft axis [ 5 ], avoiding additional greater tuberosity osteotomy in post-traumatic cases, and avoiding the above-listed stem-related complications [ 4 ]. Advantages of stemless implants also include decreased surgical time, less blood loss, low stress shielding, and lower risk of diaphyseal stress risers [ 6 , 7 ]. As previously mentioned, particularly in the setting of post-traumatic malalignment or deformities of the glenohumeral joint, stemless designs allow the surgeon to recreate the glenohumeral center of rotation independent of the humeral shaft [ 5 ].…”

Section: New Perspectives and Innovations In Anatomic Shoulder Arthro...mentioning

confidence: 99%

“…Though there are many potential advantages of stemless implants, several notable limitations remain [ 7 ]. These implants lack a convertible platform and therefore require implant removal in the revision to RSA setting.…”

Section: New Perspectives and Innovations In Anatomic Shoulder Arthro...mentioning

confidence: 99%

Innovations in Shoulder Arthroplasty

Leafblad

Asghar

Tashjian

2022

JCM

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Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.

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“…Gaining Food and Drug Administration approval in 2015, recent interest has grown in stemless humeral head implant designs with proposed benefits, including bone preservation, lower blood loss, and decreased surgical times 4 . However, the fixation and structural stability of these implants can be influenced by the quality of the patient's trabecular bone within the metaphysis of the proximal humerus 5 . Therefore, an understanding of the mechanical properties and local load carrying capabilities of trabecular bone within the humeral head–neck junction of patients undergoing TSA would be beneficial to ensure the longevity of stemless humeral head implants that continue to be designed and redeveloped.…”

Section: Introductionmentioning

confidence: 99%

Full‐field experimental analysis of the influence of microstructural parameters on the mechanical properties of humeral head trabecular bone

Kusins

Knowles

Martensson

et al. 2021

Journal Orthopaedic Research

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Understanding the mechanical properties of trabecular bone within the metaphysis of the proximal humerus is becoming increasingly important for the design of humeral head joint replacement components that prioritize bone preservation. The aim of this study was to perform full‐field mechanical testing methods on isolated trabecular bone cores from the humeral head to experimentally measure the local magnitude of strain before macroscopic failure and to characterize the ultimate strength of each core. Isolated cubic trabecular bone cores were extracted from the center of humeral head osteotomies retrieved from (1) patients with end‐stage osteoarthritis (OA) undergoing total shoulder arthroplasty (TSA) and (2) normal nonpathologic cadaveric humeral heads. A custom computed tomography (CT)‐compatible loading device was used to perform compressive mechanical testing. For 10 of the OA specimens, stepwise loading was performed directly within a microCT scanner and digital volume correlation (DVC) was used to measure full‐field strains throughout the trabecular structure. A higher variability in ultimate strength was measured for the trabecular cores retrieved from OA humeral heads (range: 2.8–7.6 MPa) compared to the normal cadaveric humeral heads (range: 2.2–5.4 MPa), but no statistically significant difference between the groups was found (p = 0.06). Ultimate strength was strongly correlated with bone volume fraction (OA r2 = 0.72; normal r2 = 0.76) and bone mineral content (OA r2 = 0.79; normal r2 = 0.77). At the trabecular level, 95th percentile of third principal strains, measured at a subvolume size of 152 µm, exceeded 19,000 µε for each of the 10 specimens (range: −19,551 to −36,535 µε) before macroscopic failure of the cores occured. No strong linear correlations (r2 ≥ 0.50) were found between the median or 95th percentile of DVC third principal strain and the corresponding morphometric parameters of each individual bone core. The results of this study indicate that bone volume fraction and bone mineral content heavily influence the apparent ultimate strength of trabecular bone cores collected from OA patients undergoing TSA. Clinical significance: The strong correlations observed within this study further emphasize the importance of considering bone mineral content or bone volume fraction measurements in assessing the localized risk of trabecular bone fracture for orthopedic applications.

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Stemless Humeral Implants in Total Shoulder Arthroplasty

Cited by 35 publications

References 47 publications

Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty

Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty

Innovations in Shoulder Arthroplasty

Full‐field experimental analysis of the influence of microstructural parameters on the mechanical properties of humeral head trabecular bone

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