Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Abstract

Purpose Shoulder arthroplasty is one of the options for the treatment of complex proximal humeral fractures. The purpose of this study was to assess the clinical and radiographic results of the trabecular metal shoulder prosthesis in the treatment of complex proximal humeral fractures. Methods Fifty-one consecutive patients with complex proximal humeral fractures who underwent primary shoulder arthroplasties with the trabecular metal™ prosthesis were enrolled in this study. At the final follow-up appointment, 42 of the patients (82.4 % of the total patients enrolled) were available for both clinical and radiographic evaluation. There were 28 women and 14 men with a mean age of 65.4±10.7 years. The dominant arm was involved in 30 of the cases. According to Neer's classification, there were seven three-part fractures, 27 four-part fractures and eight head-splitting fractures. Additionally, there were 37 hemiarthroplasties and five total shoulder arthroplasties.Results After a mean follow-up of 37.0±8.4 months (range 24-52 months), the average ranges of motion were: 38.6±15.0°f or external rotation, L3 level for internal rotation and 132.3±36.0°for forward elevation. The mean American Shoulder and Elbow Surgeons, visual analogue scale and University of California, Los Angeles scores were 82.1±14.1, 0.4±1.1 and 28.8±5.1, respectively. The post-operative radiographs exhibited an anatomically attached greater tuberosity in 39 of the 42 shoulders. Of the three patients with greater tuberosity complications, as displayed by their radiographs, two were observed with malpositioned tuberosities, while the other greater tuberosity was resorbed. Proximal migration of the prosthesis was observed in all three shoulders with greater tuberosity complications and in two shoulders with an anatomically attached greater tuberosity. No neurovascular injury, infection or prosthetic loosening was identified during the final follow-up appointments.Conclusions Satisfactory results can be expected with the trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures. The post-operative radiographs demonstrated an anatomically healed greater tuberosity in 93 % of the patients at a minimum follow-up time of two years.

Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique

“…21 With a common goal of secure tuberosity fixation, multiple suture and bone grafting techniques together with updated implant designs have been developed in an attempt to increase the healing rates of the tuberosities. 1,13,[19][20][21]24,25,27 Reported tuberosity healing rates after RSA for fracture range from 47% to 100% (Table II). 6,8,10,14,15,21,28,36 Several of the surgical techniques and implant characteristics used to enhance tuberosity healing after hemiarthroplasty have been applied to RSA.…”

“…1,13 Implant design has been adapted to accommodate suture fixation to the stem, fins to resist rotational stress, and larger surface areas for tuberosity healing with bone-graft voids and ongrowth/ingrowth surfaces. 19,24,25 Structural bone grafts have also been used to enlarge the area for tuberosity repair and healing potential. 21 Last, partially cemented techniques for the humeral stem have been proposed to shield the intact proximal humerus and tuberosities from cement-induced thermal necrosis that may occur at the junction of the cement mantle and the tuberosities.…”

“…1,13,[19][20][21]24,25,27 The suture construct chosen for tuberosity repair is critical to prevent displacement and to maintain position of the fracture fragments. 1,13 Implant design has been adapted to accommodate suture fixation to the stem, fins to resist rotational stress, and larger surface areas for tuberosity healing with bone-graft voids and ongrowth/ingrowth surfaces.…”

Porous metals and alternate bearing surfaces in shoulder arthroplasty

“…In a retrospective analysis of 42 patients with a minimum of 2-year follow-up, Li and Jiang [48] showed satisfactory results and anatomic healing of the greater tuberosity in 93 % of the patients when a trabecular metal prosthesis was utilized.…”

The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering

“…The migrated great tuberosity is the main cause of subacromial impingement, shoulder joint stiffness and persistent pain [116]. Humeral stem prostheses fabricated with porous Ta have been proposed to accelerate anatomic union of greater tuberosity which can effectively minimize the occurrence of greater tuberosity malposition after surgery and ensure the surgical efficacy eventually [117,118].…”