Stress shielding and bone resorption in shoulder arthroplasty

Nagels, Jochem; Stokdijk, M.; Rozing, P. M.

doi:10.1067/mse.2003.22

Cited by 610 publications

(322 citation statements)

References 15 publications

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“…The first such problem includes incompatibility of mechanical properties of metallic alloys and natural bone; for example, metal alloys have greater elastic modulus to that of bone [8,9]. Under in vivo conditions, the mechanical mismatch between bone and implants leads to clinical phenomena called stress shielding [10,11]. In stress shielding, the implant carries much of the bulk load and the surrounding bone tissue experiences a reduced load stress.…”

Section: Introductionmentioning

confidence: 99%

“…In stress shielding, the implant carries much of the bulk load and the surrounding bone tissue experiences a reduced load stress. This triggers the resorption of surrounding bone tissue [11]. To address this problem, permanent metallic alloys such as Co-Cr-Mo and Ti-6Al-4V have been manufactured into porous forms to reduce the modulus mismatch with natural bone [12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

Agarwal

Curtin²,

Duffy

et al. 2016

Materials Science and Engineering: C

773

363

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Magnesium (Mg) and its alloys have been extensively explored as potential biodegradable implant materials for orthopaedic applications (e.g. Fracture fixation). However, the rapid corrosion of Mg based alloys in physiological conditions has delayed their introduction for therapeutic applications to date. The present review focuses on corrosion, biocompatibility and surface modifications of biodegradable Mg alloys for orthopaedic applications. Initially, the corrosion behaviour of Mg alloys and the effect of alloying elements on corrosion and biocompatibility is discussed. Furthermore, the influence of polymeric deposit coatings, namely sol-gel, synthetic aliphatic polyesters and natural polymers on corrosion and biological performance of Mg and its alloy for orthopaedic applications are presented. It was found that inclusion of alloying elements such as Al, Mn, Ca, Zn and rare earth elements provides improved corrosion resistance to Mg alloys. It has been also observed that sol-gel and synthetic aliphatic polyesters based coatings exhibit improved corrosion resistance as compared to natural polymers, which has higher biocompatibility due to their biomimetic nature. It is concluded that, surface modification is a promising approach to improve the performance of Mg-based biomaterials for orthopaedic applications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

Agarwal

Curtin²,

Duffy

et al. 2016

Materials Science and Engineering: C

773

363

View full text Add to dashboard Cite

show abstract

“…In one study, 9% of patients had a major reduction in cortical thickness in the proximolateral region of the humeral stem after shoulder arthroplasty at an average followup of 5.3 years [10]. Of the patients in that study [10], five of six with cortical thinning had rheumatoid arthritis. In our case, the entire humerus was spanned with interlocking implants in a patient with preexisting osteoporosis because our primary concern was fracture between components.…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by bone remodeling according to Wolff's Law as the stressors on the bone are changed with the introduction of an implant [1]. In one study, 9% of patients had a major reduction in cortical thickness in the proximolateral region of the humeral stem after shoulder arthroplasty at an average followup of 5.3 years [10]. Of the patients in that study [10], five of six with cortical thinning had rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Shoulder and Elbow Arthroplasty Using Custom Interlocking Prostheses

McConkey

Baslaim

Regan

2008

Clinical Orthopaedics &Amp; Related Research

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Ipsilateral shoulder and elbow arthritis is not an uncommon problem seen in patients of upper extremity surgeons. If arthroplasty is required in both joints, there is a significant risk of periprosthetic fracture resulting from the stress riser occurring between the implants. We report the placement of custom interlocking shoulder and elbow prostheses in a patient with rheumatoid arthritis. The elbow prosthesis with an uncemented humeral component was placed followed 18 months later by a custom-designed shoulder prosthesis. An internal strut between the two prostheses was created. Seven years postoperatively, the patient was asymptomatic with no radiographic signs of impending failure.

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“…Raiss et al described a very low revision rate with all humeral components but did describe radiographic evidence of stress shielding in as many as 82.5% of traditional humeral components [7]. The diaphyseal portion of a humeral stem serves to transfer some of the load away from the proximal humerus and can generate osteopenia [15].…”

Section: Introductionmentioning

confidence: 99%

Total shoulder arthroplasty: are the humeral components getting shorter?

Harmer

Throckmorton

Sperling

2016

Curr Rev Musculoskelet Med

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Each generation of total shoulder arthroplasy has improved on the previous. The newest humeral component innovation is shortening the humeral component or eliminating the stem entirely to rely on stemless fixation in the humeral metaphysis. This offers theoretical advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, ease of stem removal at revision, and humeral head placement independent from the humeral shaft axis. There are a number of short term cohorts that have shown low complication rates and outcomes similar to previous generations of stemmed humeral components. Longer term and better designed studies are needed in order for short stems and stemless components to become the standard of care.

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Stress shielding and bone resorption in shoulder arthroplasty

Cited by 610 publications

References 15 publications

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

Biodegradable magnesium alloys for orthopaedic applications: A review on corrosion, biocompatibility and surface modifications

Ipsilateral Shoulder and Elbow Arthroplasty Using Custom Interlocking Prostheses

Total shoulder arthroplasty: are the humeral components getting shorter?

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