The incidence of humeral bone resorption in uncemented reverse shoulder arthroplasty and the impact on functional outcomes

Esfandiari, Alireza; Hamoodi, Zaid; Newton, Ashley; Nixon, Matthew; Webb, Mark; Kenyon, Peter

doi:10.1053/j.sart.2022.04.009

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Anatomic TSA failure rates are predominantly associated with rotator cuff failure, instability, glenoid loosening, and infection [1,3,4]. In RSA, the top causes of failure include humeral-associated complications, predominantly in the form of loosening and proximal humeral stress shielding, instability/dislocation, and infection [1,3,[5][6][7][8][9][10]. Nerve-related complications account for a minority of revisions in the case of reverse shoulder replacement procedures [5,11].…”

Section: Introductionmentioning

confidence: 99%

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Italia

Launay

Gilliland

et al. 2022

JCM

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Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost–benefit parameters for the healthcare system.

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Section: Introductionmentioning

confidence: 99%

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Italia

Launay

Gilliland

et al. 2022

JCM

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Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study

Ritter,

Raiss,

Denard

et al. 2024

J. Imaging

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Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus. Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.72): Standard stem with low (n = 10) and high (n = 10) filling ratios, a short stem with low (n = 10) and high filling ratios (n = 10). Biomechanical testing included cyclic loading of the native bone and the implanted humeral component. Optical recording allowed for spatial implant tracking and the quantification of cortical bone deformations in the proximal humerus. Results: Planned filling ratios based on 3D volumetric measures had a good-to-excellent correlation (ICC = 0.835; p < 0.001) with implanted filling ratios. Lower canal fill ratios resulted in significantly higher variability between short and standard stems regarding implant tilt (820 N: p = 0.030) and subsidence (220 N: p = 0.046, 520 N: p = 0.007 and 820 N: p = 0.005). Higher filling ratios resulted in significantly lower bone deformations in the medial calcar area compared to the native bone, while the bone deformations in lower filling ratios did not differ significantly (p > 0.177). Conclusions: Lower canal filling ratios maintain dynamic bone loading in the medial calcar of the humerus similar to the native situation in this biomechanical loading setup. Short stems implanted with a low filling ratio have an increased risk for implant tilt and subsidence compared to high filling ratios or standard stems.

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The incidence of humeral bone resorption in uncemented reverse shoulder arthroplasty and the impact on functional outcomes

Cited by 2 publications

References 15 publications

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study

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