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Takayama K, Ito H. Association between the canal filling ratio and bone resorption in trabecular metal stems in reverse total shoulder arthroplasty: a radiographic analysis using tomosynthesis. JSES Int 2024; 8:1077-1086. [PMID: 39280137 PMCID: PMC11401559 DOI: 10.1016/j.jseint.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Several factors affect the incidence of osteopenia with cortical narrowing (CNO) in reverse shoulder arthroplasty. This study aimed to compare the incidence of CNO with different fixation methods (cemented or cementless) using a single implant (trabecular metal humeral stem) evaluated using tomosynthesis and to analyze the factors affecting the incidence of CNO for cementless stem fixation. Methods A total of 109 patients (cementless: 75 cases; cemented: 34 cases) who underwent reverse total shoulder arthroplasty were included in this study. The patients were divided into 2 groups (cementless or cemented), and the incidence of CNO was compared. In addition, patients in the cementless group were divided into 2 groups (canal filling ratio [CFR] of ≥ 0.7 or < 0.7), the incidence of CNO was compared, and the Cramer's coefficient of association between CNO and CFR > 0.7 (and 0.8) was calculated. Results No significant difference was observed in the incidence of CNO between the cementless and cemented groups (7/75 vs. 3/35, P value = 1.0). The association between CNO and the CFR using Cramer's coefficient of association showed that there were few correlations (coefficient: 0.14, P value = .59). Conclusion Cementless reverse total shoulder arthroplasty with a trabecular metal stem has a similar low incidence of CNO as cemented fixation, and the incidence of CNO with a trabecular metal stem was lower than that reported in previous studies. A CFR > 0.7 was not associated with the incidence of CNO.
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Affiliation(s)
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, Japan
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Montemaggi P, Lo EY, Ouseph A, Lund J, Krishnan SG. Cementless reverse total shoulder arthroplasty implantation with humeral matchstick autograft augmentation: early radiographic outcomes. J Shoulder Elbow Surg 2024; 33:e422-e428. [PMID: 38218403 DOI: 10.1016/j.jse.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Humeral-sided complications account for up to 21% of all revision reverse total shoulder arthroplasty (RTSA) surgeries. Stress shielding with large bulky stems can lead to proximal bone resorption per Wolff law, complicating further surgeries. Previously published studies suggest that lowering the metaphyseal implant fill ratio can lead to fewer adaptive radiographic changes and decreased bone resorption. Inspired by these studies, cementless primary RTSA implantation technique with humeral matchstick autografts was proposed to augment cementless humeral constructs, foster the use of a smaller size stem, and create primary stability of the humeral implant even in osteoporotic or in-between size medullary canals. In this study, retrospective review of this cementless RTSA technique with short-term radiographic evaluation was performed. METHODS Forty-six nonconsecutive patients underwent primary RTSA with a short-stem cementless prosthesis (Stryker Ascend Flex) augmented by matchstick bone grafting from January to July 2020. Patient demographics were recorded, and follow-up radiographs were retrospectively reviewed to assess metaphyseal fill ratios and incidence of stress shielding at minimum 1-year follow-up. Discrepancies between templated and final stem sizes were recorded, along with all intraoperative and postoperative complications. RESULTS Of the 46 patients originally identified, there were 5 men and 41 women with a mean age of 71 years (standard deviation [SD] 7, range 53-88). Mean templated stem size was 4 (SD 2, range 1-8), whereas the mean final implant size was 2 (SD 1, range 1-3). Mean fill ratios were 0.76 (SD 0.06, range 0.54-0.89) along the metaphysis and 0.67 (SD 0.09, range 0.49-0.83) along the diaphysis. There were no intraoperative humeral fractures from implantation. All patients were available for radiographic follow-up with a mean of 19 months (SD 8, range 12-40). There were 3 cases (7%) of proximal humeral stress shielding, with average fill ratios of 0.857 and 0.807 in the metaphysis and diaphysis, respectively. There were 3 patients (7%) who underwent revision surgeries for baseplate failure and periprosthetic humeral fracture. There were no cases of early humeral loosening. DISCUSSION Matchstick autograft humeral augmentation is a simple, promising surgical technique with low intraoperative complication rates and good short-term radiographic outcomes. When the implant fill ratio is successfully reduced, there is a possible lower risk of humeral stress shielding. The authors believe this technique can help maximize implant stability in cementless shoulder arthroplasty and preserve humeral bone stock for future revision surgeries.
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Affiliation(s)
| | - Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA.
| | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Julia Lund
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
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Ritter D, Denard PJ, Raiss P, Wijdicks CA, Bachmaier S. A stemless anatomic shoulder arthroplasty design provides increased cortical medial calcar bone loading in variable bone densities compared to a short stem implant. JSES Int 2024; 8:851-858. [PMID: 39035663 PMCID: PMC11258817 DOI: 10.1016/j.jseint.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Several studies have reported proximal bone resorption in stemless and press-fit short-stem humeral implants for anatomic total shoulder arthroplasty. The purpose of this biomechanical study was to evaluate implant and cortical bone micromotion of a cortical rim-supported stemless implant compared to a press-fit short stem implant during cyclic loading and static compression testing. Methods Thirty cadaveric humeri were assigned to 3 groups based on a previously performed density analysis, adopting the metaphyseal and epiphyseal and inferior supporting bone densities for multivariate analyses. Implant fixation was performed in stemless implant in low bone density (SL-L, n = 10) or short stem implant in low bone density (Stem-L, n = 10) and in stemless implant in high bone density (SL-H, n = 10). Cyclic loading with 220 N, 520 N, and 820 N over 1000 cycles at 1.5 Hz was performed with a constant valley load of 25 N. Optical recording allowed for spatial implant tracking and quantification of cortical bone deformations in the medial calcar bone region. Implant micromotion was measured as rotational and translational displacement. Load-to-failure testing was performed at a rate of 1.5 mm/s with ultimate load and stiffness measured. Results The SL-H group demonstrated significantly reduced implant micromotion compared to both low-density groups (SL-L: P = .014; Stem-L: P = .031). The Stem-L group showed significantly reduced rotational motion and variance in the test results at the 820-N load level compared to the SL-L group (equal variance: P = .012). Implant micromotion and reversible bone deformation were significantly affected by increasing load (P < .001), metaphyseal cancellous (P = .023, P = .013), and inferior supporting bone density (P = .016, P = .023). Absolute cortical bone deformation was significantly increased with stemless implants in lower densities and percentage reversible bone deformation was significantly higher for the SL-H group (21 ± 7%) compared to the Stem-L group (12 ± 6%, P = .017). Conclusion A cortical rim-supported stemless implant maintained proximally improved dynamic bone loading in variable bone densities compared to a press-fit short stem implant. Biomechanical time-zero implant micromotion in lower bone densities was comparable between short stem and stemless implants at rehabilitation load levels (220 N, 520 N), but with higher cyclic stability and reduced variability for stemmed implantation at daily peak loads (820 N).
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Affiliation(s)
- Daniel Ritter
- Arthrex Department of Orthopedic Research, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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Eckers F, Hochreiter B, Forsyth S, Ek ET. Proximal humerus reconstruction in reverse total shoulder arthroplasty with proximal humeral bone loss using a lower trapezius tendon transfer with Achilles tendon-bone allograft: surgical technique and report of 2 cases. JSES Int 2024; 8:508-514. [PMID: 38707582 PMCID: PMC11064716 DOI: 10.1016/j.jseint.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Affiliation(s)
- Franziska Eckers
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Sarah Forsyth
- Melbourne Orthopaedic Group, Melbourne, Australia
- Melbourne Shoulder Group, Melbourne, Australia
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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Goñalons-Giol F, Ventura-Parellada C, Gàmez-Baños F, Mora-Guix JM. Stress shielding: short-term radiological results of the reverse shoulder arthroplasty with an anatomic proximal coated stem in proximal humeral fractures. Arch Orthop Trauma Surg 2024; 144:783-790. [PMID: 38141095 DOI: 10.1007/s00402-023-05169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE This study aims to determine the stress shielding and other radiological outcomes of patients who underwent an uncemented reverse shoulder arthroplasty (RSA) with an anatomic proximal coated stem for complex proximal humeral fractures (PHF) with 3 or 4 parts at 2 years postoperatively. METHODS 37 shoulders underwent an uncemented RSA for PHF from November 2015 to February 2019 and were followed up for 2 years. A radiographic assessment of stress shielding, filling ratio, stem stability (radiolucent lines/subsidence/alignment), tuberosity healing and notch was performed. RESULTS The mean age at the time of surgery was 72 years (range, 61-85). Stress shielding was appreciated in 31 shoulders (83.8%). The most important characteristic of stress shielding is cortical resorption: Grade 3 resorption occurred in 3 shoulders (8.1%) and grade 4 in 23 (62.2%) as per the grading system defined by Inoue et al. (Inoue et al. in J Shoulder Elbow Surg 26:1984-1989, 2017). A high occurrence of bone resorption was observed in Gruen zones 2 (Lateral Stress shielding) and 7 (Medial Stress shielding). The mean distal filling ratio in patients without stress shielding was 78,48(SD 14,9), whereas in patients with stress shielding, it was slightly higher with a mean of 81,68% (SD 4,89). Tuberosity healing was found in 94.6% (35/37) of the shoulders. No patient had any radiolucent line. No notch was observed. CONCLUSION At short-term follow-up, a high rate of tuberosity healing was achieved (94.6%) even though stress shielding was found in 83.8% (31/37) of the shoulders. Bone resorption was most frequently observed externally at zone 2 (Lateral stress shielding) and internally at zone 7 (Medial stress shielding). A higher filling ratio was associated with an increased occurrence of stress shielding. The uncemented anatomic humeral component did not result in early loosening. LEVEL OF EVIDENCE IV; Case Series; Treatment study.
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Affiliation(s)
- Francesc Goñalons-Giol
- Department of Orthopaedic Surgery, Hospital Consorci Sanitari de Terrassa, Terrassa, Spain.
| | | | - Ferran Gàmez-Baños
- Department of Orthopaedic Surgery, Hospital Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Jose María Mora-Guix
- Department of Orthopaedic Surgery, Hospital Consorci Sanitari de Terrassa, Terrassa, Spain
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Kramer M, Olach M, Zdravkovic V, Manser M, Raiss P, Jost B, Spross C. The effects of length and width of the stem on proximal humerus stress shielding in uncemented primary reverse total shoulder arthroplasty. Arch Orthop Trauma Surg 2024; 144:663-672. [PMID: 38010377 PMCID: PMC10822783 DOI: 10.1007/s00402-023-05129-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION To preserve humeral bone during RTSA, stems have been made shorter and cement avoided whenever possible. However, with the increased use of uncemented RTSA, a phenomenon comparable to the stress shielding of the hip has been described for the proximal humerus. The aim of this study was to investigate the influence of stem length and width on proximal humeral bone resorption after primary uncemented RTSA. MATERIALS AND METHODS The prospective shoulder arthroplasty database of our institution was reviewed for all primary uncemented RTSAs from 2017 to 2020 in osteoarthritis and cuff tear arthropathy cases with > 2-year follow-up. We compared the clinical and the radiographic 2-year outcome of the short and standard length stems of the same prosthesis design. This allowed us to assess the effects of stem length and width with regard to stress shielding. Furthermore, we defined a cut-off value for the filling ratios to prevent stress shielding. RESULTS Fifty patients were included in the analysis, nineteen were in the short stem group (SHORT) and thirty-one in the standard stem group (STANDARD). After 2 years, SHORT showed a relative Constant Score of 91.8% and STANDARD of 98.3% (p = 0.256). Stress shielding was found in 4 patients (21%) in SHORT and in 16 patients (52%) in STANDARD (p = 0.03); it occurred more frequently in patients with higher humeral filling ratios (p < 0.05). The calculated cut-off to prevent stress shielding was 0.7 (± 0.03) for the metaphyseal and distal filling ratio. CONCLUSION While short and standard stems for RTSA have good results after 2 years, we found a significant negative effect of higher length and width of the stem with regard to stress shielding. Even though the clinical effects of stress shielding have to be assessed, short stems should be chosen with a filling ratio at the metaphyseal and distal position below 0.7. LEVEL OF EVIDENCE (A RETROSPECTIVE CASE-CONTROL STUDY) III.
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Affiliation(s)
- Manuel Kramer
- Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Martin Olach
- Orthopaedic Surgery and Traumatology, Spital Wil, SRFT, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Melanie Manser
- Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Patric Raiss
- OCM (Orthopädische Chirurgie München) Clinic, Munich, Germany
| | - Bernhard Jost
- Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Christian Spross
- Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Dukan R, Juvenspan M, Scheibel M, Moroder P, Teissier P, Werthel JD. Non-operative management of humeral periprosthetic fracture after stemless shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:253-259. [PMID: 37857856 DOI: 10.1007/s00264-023-06005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Periprosthetic fractures around a stemless implant often involve lesser and greater tuberosities with a well-fixed implant in the metaphysis. This exposes the surgeon to unique questions and challenges as no surgical option (open reduction and internal fixation or revision to a stem) appears satisfactory to address them. Purpose of this study was to evaluate the clinical outcomes after non-operative management of periprosthetic fractures after stemless shoulder arthroplasty. METHODS A retrospective multicenter study was conducted to identify all patients who had sustained non-operative management of a periprosthetic fracture after a stemless shoulder. Exclusion criteria were as follows: (1) intraoperative fractures and (2) implant loosening. Primary outcomes included mean Constant score and mean active range of motion. Secondary outcomes were VAS, radiological analysis, and complications. RESULTS Nine patients were included. One was excluded due to the loss of follow-up at three months. Mean age was 79 years. At the last follow-up, no significant difference was observed between the Constant score, VAS, or the range of motion before fracture and at the last follow-up. Fracture healing did not result in any change in angulation in the frontal plane in seven cases and was responsible for a varus malunion in two cases of anatomic arthroplasty. No change in lateralization or distalization was reported. No cases of implant loosening after fracture have been observed. CONCLUSIONS Conservative management seems to be appropriate in cases of minimally displaced fractures without implant loosening.
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Affiliation(s)
| | - Marc Juvenspan
- Institut Français de Chirurgie de la Main, Paris, France
| | | | | | | | - Jean David Werthel
- Hopital Ambroise Pare, Orthopedic Department, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
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Hatta T, Shinagawa K, Kawakami J, Kanazawa K, Hayakawa T, Yamamoto N, Yamakado K. A survey and biomechanical analysis of the feasibility of the thumb test for determining the cancellous bone quality for stemless shoulder prosthesis. J Orthop Surg (Hong Kong) 2023; 31:10225536231218869. [PMID: 38009331 DOI: 10.1177/10225536231218869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The effect of the thumb test for assessing the cancellous bone quality at the resection plane of the proximal humerus on determining the application of a stemless shoulder prosthesis remains unclear. This study was conducted to survey the current utilization of the thumb test among surgeons and to investigate biomechanical features of the thumb test. METHOD A survey among shoulder surgeons who had experience with stemless prostheses was conducted to investigate the current utilization of preoperative assessments and intraoperative thumb test when applying stemless prosthesis. Biomechanical experiments for the thumb test using artificial bone models were performed to assess the compression force, contact pressure and area. According to the preliminary survey, three compression techniques were assessed: compression perpendicular to the surface with thumb pad (P-pad technique) or tip of the thumb (P-tip technique), or compression in the vertical direction simulating compression along the longitudinal axis of the humeral shaft with tip-pad of the thumb (H-axis technique). The contact area was separated into three subregions (proximal, middle and distal) to assess the distribution of contact pressure. RESULTS Among 38 surgeons, 66% utilized the thumb test intraoperatively. The P-pad technique was more frequently applied than the P-tip or H-axis techniques (80%, 4% and 16%, respectively). Although with wide variation among the examiners, biomechanical assessments revealed the P-pad technique showed larger contact area and less compression force than the P-tip technique. The P-pad technique provided no significant localized differences in the mean contact pressure on the compressed plane, whereas the P-tip and H-axis techniques showed significant differences among subregions. CONCLUSION This survey demonstrated relatively frequent application of the thumb test on applying the stemless shoulder prosthesis. Biomechanical assessment revealed the thumb test can hinder objective reproducibility among examiners; therefore, further investigations to identify feasible assessments of the bone quality is required.
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Affiliation(s)
- Taku Hatta
- Department of Orthopedic Surgery, Joint Surgery, Sports Clinic Ishinomaki, Ishinomaki, Japan
| | | | - Jun Kawakami
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kenji Kanazawa
- Department of Orthopedic Surgery, South Miyagi Medical Center, Shibata-gun, Japan
| | - Takashi Hayakawa
- Department of Orthopedic Surgery, Niigata Central Hospital, Niigata, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kotaro Yamakado
- Department of Orthopedic Surgery, Fukui General Hospital, Fukui, Japan
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Ardebol J, Tagliero AJ, Werner BC, Menendez ME, Raiss P, Wittmann T, Denard PJ. Multiplanar analysis of proximal humerus anatomy of patients with rotator cuff arthropathy and relevance to reverse shoulder press-fit stems. JSES Int 2023; 7:848-854. [PMID: 37719818 PMCID: PMC10499854 DOI: 10.1016/j.jseint.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Short stems have become increasingly popular in reverse shoulder arthroplasty (RSA) due to their ability to preserve bone stock for revision surgery. However, short stems may be more at risk for malalignment or loosening, and commercially available stems have varied designs. The purpose of this study was to perform a multiplanar analysis of proximal humerus anatomy in patients with rotator cuff arthropathy to better define canal geometry and identify differences based on sex. Methods A retrospective review was performed of a consecutive series of patients undergoing RSA for rotator cuff arthropathy. A total of 117 patients were identified with preoperative computed tomography scans. Measurements were undertaken following multiplanar reconstruction of the computed tomography scans. Measured parameters included the following: transition point (TP), anteroposterior (AP) and mediolateral (ML) distances, intramedullary (IM) and bone diameter, and cortical thickness. The TP was defined as the distance from the periosteal border of the greater tuberosity to the level of the IM canal where the endosteal borders became parallel. Measurements started at the metaphysis, and then proceeded 25 and 50 mm distal to the metaphysis followed by 10 mm increments thereafter. Each level was compared to the level above with t tests in the overall cohort and separately by sex. Height was correlated to ML-AP difference and IM diameter with Pearson correlation coefficient. Potential stem sizes that extended 50, 60, 70, and 80 mm from the metaphysis were analyzed to record the percentage of patients in whom the stem would reach past the TP. Results The mean TP for all patients was 55.6 ± 7.4 mm (37.5-78.4) from the greater tuberosity, 53.3 ± 6.6 mm (37.5-67.0) in females and 58.1 ± 7.5 mm (41.9-78.4) in males. ML and AP distances and IM diameter became consistent at level 3 (mean, 83 mm distal to the greater tuberosity) in the overall cohort and in both sexes. Height positively correlated with IM diameter. Males had significantly larger IM diameters compared to females at all levels. Cortical thickness remained relatively consistent throughout the proximal humerus. A stem length of 70 mm would extend past the TP in 98% of patients. Conclusion Humeral implants in RSA with a stem of at least 70 mm in length would extend distally past the TP in the majority of cases regardless of sex. At this point, the canal's area remains consistent which would facilitate diaphyseal fixation if required.
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Affiliation(s)
| | - Adam J. Tagliero
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Patric Raiss
- Department for Shoulder and Elbow Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany
| | - Thomas Wittmann
- Department for Shoulder and Elbow Surgery, Orthopädische Chirurgie München Clinic, Munich, Germany
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Raiss P, Wittmann T, Blakeney W, Urvoy M, Walch G. Validation of the distal filling ratio in uncemented convertible short-stem shoulder arthroplasty. Arch Orthop Trauma Surg 2023; 143:1833-1839. [PMID: 35174410 DOI: 10.1007/s00402-022-04389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/05/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Radiographic stress shielding is a common finding in uncemented convertible short-stem shoulder arthroplasty (UCSSSA). The distal filling ratio (DFR) has been described as a predictor for the occurrence of stress shielding. A DFR > 70% was mentioned as a risk factor for the occurrence of stress shielding for some UCSSSA. However, measurements were only performed on conventional radiographs and no validation exists for 3D automated planning tools. METHODS DFR was manually measured on postoperative true ap radiographs of 76 shoulder arthroplasties using a standardized protocol and were compared to preoperative CT scans with an automated calculation of the DFR after virtual implantation of the stem. RESULTS The mean DFR measured on X-rays was 75.9% (SD = 8.7; 95% CI = 74-78) vs. 78.9% (SD = 9.1; 95% CI = 76.8-83) automatically measured on CT scans. This difference was significant (p < 0.001). In 7 out of 76 cases (9%) the difference between manual measurement on radiographs and computerized measurement on CT scans was > 10%. CONCLUSION Manual measurement of the DFR is underestimated on conventional radiographs compared to automated calculation on CT scans be a mean of 3%. Therefore, automated measurement of the DFR on CT scans seems to be beneficial, especially in cases with osteopenic cortices. Manual measurement of the DFR on conventional ap radiographs in cases without CT scans, however, is still a viable alternative. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Patric Raiss
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, München, Germany.
| | - Thomas Wittmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, München, Germany
| | - William Blakeney
- Department of Orthopaedic Surgery, Royal Perth Hospital, Victoria Square, Perth, WA, 6000, Australia
| | - Manuel Urvoy
- IMASCAP, 145 Rue René Descartes, 29280, Plouzané, France
| | - Gilles Walch
- Centre Orthopedique Santy, 24, Avenue Paul Santy, 69008, Lyon, France
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Magone KM, Leonard A, Savoie FH, Noel CR, Simovitch RW, Greene AT, Anakwenze OA. Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty. JSES Int 2023; 7:285-289. [PMID: 36911768 PMCID: PMC9998871 DOI: 10.1016/j.jseint.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Standard stemmed humeral implants have traditionally been utilized for total shoulder arthroplasty (TSA) with a recent trend to implant smaller stems including short and stemless humeral designs. However, the rate of stress shielding after stemless TSA has not been primarily studied. Therefore, the objective of this study is to report the short-term survivorship and radiographic analysis of a stemless humeral implant. Methods A retrospective cohort review of a prospectively collected, multicenter database for patients undergoing total shoulder arthroplasty with a stemless humeral design (Equinoxe Stemless; Exactech, Inc., Gainesville, FL, USA) with a minimum of 2 years clinical and radiographic follow-up was performed. The primary outcomes were to report the location and rate of stress shielding from a radiographic analysis of the humeral stem. Additionally, the revision rate of the humeral stem is reported. The secondary outcomes included ASES scores, visual analog scale (VAS) pain scores, and range of motion (ROM). Radiographs (anterior-posterior/Grashey and axillary) were reviewed blindly by two fellowship trained shoulder surgeons. Radiographic analysis included stress shielding (partial or complete cortical resorption) and subsidence or shift in component position. Results Fifty four patients were included in this study with an average follow-up of 27 months (range 24-32 months). The average age of this cohort was 65 years (range 57-73 years) with 23 patients (43%) being female. Stress shielding was observed in 4 patients (7%) with the medial calcar being the most common location of stress shielding. Three of the 4 patients (75%) had evidence of partial resorption while 1 patient (25%) had evidence of complete resorption. No humeral component shift or subsidence was observed. There were no revisions due to humeral component complications. There was 1 revision surgery for aseptic glenoid loosening. A significant improvement for all clinical outcome measures was seen including with respect to VAS pain, which improved from 6.2 to 1.8 (P < .05), ASES, which improved from 38.2 to 81.8 (P < .05), and ROM which forward flexion improved from 120 degrees to 153 degrees (P < .05) and external rotation improved from 29 degrees to 49 degrees (P < .05). Discussion This ongoing study demonstrates a low rate of stress shielding for a stemless design humeral implant at short-term follow-up without any revision surgery due to humeral component complications. Longer term radiographic and clinical analysis with this cohort will be needed to confirm these findings and theoretical benefits for future revision surgeries.
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Affiliation(s)
- Kevin M Magone
- CHI Saint Joseph Medical Group-Orthopedic Associates, CHI Saint Joseph Health, London, KY, USA
| | - Austin Leonard
- Department of Orthopedic Surgery, Duke University Hospital, Duke University School of Medicine, Durham, NC, USA
| | - Felix H Savoie
- Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | | - Oke A Anakwenze
- Department of Orthopedic Surgery, Duke University Hospital, Duke University School of Medicine, Durham, NC, USA
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Aibinder WR, Uddin F, Bicknell RT, Krupp R, Scheibel M, Athwal GS. Stress shielding following stemless anatomic total shoulder arthroplasty. Shoulder Elbow 2023; 15:54-60. [PMID: 36895609 PMCID: PMC9990105 DOI: 10.1177/17585732211058804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant (p = 0.021). Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.
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Affiliation(s)
- William R Aibinder
- Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Fares Uddin
- Bahrain Royal Guard, Bahrain Defense Force, Riffa, Bahrain
| | - Ryan T Bicknell
- Department of Surgery and Mechanical and Materials Engineering, Human Mobility Research Centre, Queen's University, Kingston, ON, Canada
| | - Ryan Krupp
- Norton Orthopaedic Specialists, Louisville, KY, USA
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.,Department of Shoulder and Elbow Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - George S Athwal
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada
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Zhou Y, Frampton C, Hirner M. Medium-term results of stemless, short, and conventional stem humeral components in anatomic total shoulder arthroplasty: a New Zealand Joint Registry study. J Shoulder Elbow Surg 2022; 32:1001-1008. [PMID: 36473693 DOI: 10.1016/j.jse.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to compare the medium-term results for anatomic total shoulder arthroplasty by humeral component stem length. We hypothesize that the newer stemless implants may have comparable results to short-stem and conventional stemmed implants. METHODS The 12 most used anatomic total shoulder arthroplasty implants on the New Zealand Joint Registry were included in the study. Implants were categorized by stem length-conventional, short, and stemless. The primary outcome was revision up to 7 years postsurgery. Secondary outcomes included revision cause, implant survival, and early functional outcomes as evaluated by the Oxford Shoulder Score. Analysis was stratified by age and surgeon volume to control for potential confounding. RESULTS A total of 3952 patients (conventional, 3114; short, 360; stemless, 478) were included in the study. No significant difference in revision rate per 100 component-years was found between stemless, short-stem, and conventional stemmed implants (revision rate per 100 component-years: conventional, 1.01 [95% confidence interval (CI) 0.89-1.14]; short, 0.54 [95% CI 0.25-1.03]; stemless, 0.99 [95% CI 0.51-1.74]). This finding was irrespective of patient age or surgeon volume. There were no cases of humeral loosening up to 7 years' follow-up and no cases of intraoperative humeral fracture in the stemless group. Functional outcomes at 6 months postsurgery suggested better outcomes in the stemless group compared with the conventional stem group (mean Oxford Shoulder Score: conventional, 39.4; stemless, 40.7; P value = .023). CONCLUSION The medium-term survival of stemless implants for anatomic total shoulder arthroplasty appears comparable to short-stem and conventional stemmed implants. Further follow-up is required to understand the long-term survivorship and functional outcomes between these groups.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand.
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marc Hirner
- Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand
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Kramer M, Olach M, Zdravkovic V, Manser M, Jost B, Spross C. Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly-a retrospective case-control study. BMC Musculoskelet Disord 2022; 23:1043. [PMID: 36457072 PMCID: PMC9714093 DOI: 10.1186/s12891-022-05994-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Uncemented reverse total shoulder arthroplasty (RTSA) for the primary treatment of proximal humerus fractures (PHF) in elderly patients was introduced at our institution in 2017. Recent reports have raised concerns about increased rates of early bone resorption at the proximal humerus with uncemented fracture stems. The aim of this study was to find out whether there was any difference in functional or radiographic outcomes between cemented and uncemented RTSA for PHF. METHODS Seventeen consecutive patients who underwent uncemented RTSA (group nC) in 2017 and 2018 were age and sex matched (propensity score matching 1:2) to 34 patients with cemented RTSA implanted between 2011 and 2016 (group C) for the primary treatment of PHF. These two groups were compared in terms of clinical and radiographic outcomes at 2 years after the index surgery. RESULTS The mean bone quality was low in both groups: in group nC the deltoid tuberosity index (DTI) was 1.43 (1.22-1.72) and in group C 1.42 (1.22-1.67). At the final 2 year follow-up, the relative CS was 98.3% (71-118) in group nC and 97.9% (36-125) in group C (p = 0.927); the absolute CS was 70.2 (49-89) in group nC and 68.0 (30-94) in group C (p = 0.509). Lucent lines at the humeral site were seen in 8 cases (47%) in group nC and in 13 cases (38%) in group C (p = 0.056). Compared to 3% in group C, all patients in group nC showed at least grade 1 and 65% showed grade 3 bone resorption at the proximal humerus (p < 0.001). CONCLUSION Compared to cemented RTSA bone resorption at the proximal humerus was significantly more frequent in patients with uncemented RTSA for PHF. So far, this is rather a radiographic than a clinical finding, because both groups showed very satisfying functional outcomes and low revision rates at the 2 year follow-up. LEVEL OF EVIDENCE III A retrospective case-control study.
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Affiliation(s)
- Manuel Kramer
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
| | - Martin Olach
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
| | - Melanie Manser
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
| | - Bernhard Jost
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
| | - Christian Spross
- grid.413349.80000 0001 2294 4705Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007 St. Gallen, Switzerland
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15
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Brogren E, Abramo A, Tägil M. Bone Remodeling after Ulna Head Replacement in Distal Radioulnar Joint Arthroplasty: A Radiographic Comparison between a Partial and a Total Ulna Head Concept. J Wrist Surg 2022; 11:425-432. [PMID: 36339080 PMCID: PMC9633151 DOI: 10.1055/s-0041-1742098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Background Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood. Purpose The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement. Patients and Methods We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10-17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs. Results The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery ( p <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs. Conclusion The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.
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Affiliation(s)
- Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Antonio Abramo
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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16
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Mao C, Yu W, Jin M, Wang Y, Shang X, Lin L, Zeng X, Wang L, Lu E. Mechanobiologically optimized Ti-35Nb-2Ta-3Zr improves load transduction and enhances bone remodeling in tilted dental implant therapy. Bioact Mater 2022; 16:15-26. [PMID: 35386333 PMCID: PMC8958422 DOI: 10.1016/j.bioactmat.2022.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/13/2022] Open
Abstract
The tilted implant with immediate function is increasingly used in clinical dental therapy for edentulous and partially edentulous patients with excessive bone resorption and the anatomic limitations in the alveolar ridge. However, peri-implant cervical bone loss can be caused by the stress shielding effect. Herein, inspired by the concept of “materiobiology”, the mechanical characteristics of materials were considered along with bone biology for tilted implant design. In this study, a novel Ti–35Nb–2Ta–3Zr alloy (TNTZ) implant with low elastic modulus, high strength and favorable biocompatibility was developed. Then the human alveolar bone environment was mimicked in goat and finite element (FE) models to investigate the mechanical property and the related peri-implant bone remodeling of TNTZ compared to commonly used Ti–6Al–4V (TC4) in tilted implantation under loading condition. Next, a layer-by-layer quantitative correlation of the FE and X-ray Microscopy (XRM) analysis suggested that the TNTZ implant present better mechanobiological characteristics including improved load transduction and increased bone area in the tilted implantation model compared to TC4 implant, especially in the upper 1/3 region of peri-implant bone that is “lower stress”. Finally, combining the static and dynamic parameters of bone, it was further verified that TNTZ enhanced bone remodeling in “lower stress” upper 1/3 region. This study demonstrates that TNTZ is a mechanobiological optimized tilted implant material that enhances load transduction and bone remodeling. The mechanical properties and deformation mechanisms of Ti–35Nb–2Ta–3Zr alloys were studied. The cell biocompatibility, a layer-by-layer correlation of the finite element and X-ray Microscopy analysis were evaluated. Ti–35Nb–2Ta–3Zr implant improves load transduction and enhances bone remodeling in tilted implantation models. Mechanobiologically optimized Ti–35Nb–2Ta–3Zr alloy meets the clinical application requirements of tilted implant therapy.
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Affiliation(s)
- Chuanyuan Mao
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Weijun Yu
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Min Jin
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yingchen Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Materials Genome Initiative Centre, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xiaoqing Shang
- National Engineering Research Center of Light Alloy Net Forming, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Lu Lin
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xiaoqin Zeng
- National Engineering Research Center of Light Alloy Net Forming, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- Corresponding author.
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Materials Genome Initiative Centre, Shanghai Jiao Tong University, Shanghai, 200240, China
- Corresponding author.
| | - Eryi Lu
- Department of Stomatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Corresponding author.
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17
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Imiolczyk JP, Krukenberg A, Mansat P, Bartsch S, McBirnie J, Gotterbarm T, Wiedemann E, Soderi S, Scheibel M. Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study. JSES Int 2022; 7:1-9. [PMID: 36820431 PMCID: PMC9937825 DOI: 10.1016/j.jseint.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Stemless shoulder arthroplasty using 4 open-fin press-fit anchors has been showing promising short-term clinical and radiographic results for patients' primary osteoarthritis. This prospective, multicenter study presents 5-year postoperative clinical and radiological outcomes of a stemless shoulder arthroplasty for primary osteoarthritis. Methods Between November 2012 and December 2015, 100 patients were treated for primary osteoarthritis with the Sidus stem-free shoulder system at 7 European centers. Clinical assessment included the Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, Subjective Shoulder Value, and range of motion. True anteroposterior, axial and lateral radiographs were reviewed for osteolysis, glenoid and humerus loosening, heterotopic ossification, radiolucent lines, component migration and humeral bone resorption. In addition to a Kaplan-Meier survival analysis, a comparative analysis between total shoulder arthroplasty and hemiarthroplasty was performed. Results Seventy-one patients (36 females) with a mean age of 63.8 years (range: 47-79 years) were available for the 5-year clinical and radiographic follow-up (range: 52-79 months). There was a significant increase (P < .0001) in all outcome scores compared to baseline values. Patients with total shoulder arthroplasty (n = 48) achieved significantly better functional outcome than patients with shoulder hemiarthroplasty (n = 23) with regard to the absolute and relative Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, and Subjective Shoulder Value as well as greater abduction strength and range of motion in forward elevation and external rotation (P ≤ .004). There were no cases of osteolysis or humeral loosening. There were some cases of heterotopic ossification (1.4%), radiolucency around the humerus (1.4%) or glenoid (25%), glenoid migration (2.1%), inferior osteophytes (1.4%) or humerus bone resorption (9.9%). The 5-year survival was 94%. Conclusion Patients treated with the Sidus stem-free shoulder system for primary osteoarthritis continue to achieve good clinical and radiographic results without any signs of aseptic humeral implant loosening at 5 years postsurgery.
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Affiliation(s)
| | - Anna Krukenberg
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany
| | - Pierre Mansat
- Centre Hospitalier Universitaire Toulouse, Hôpital Purpan, Toulouse, France
| | | | - Julie McBirnie
- Department of Orthopaedics, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | | | - Stefano Soderi
- Orthopedic Clinic, Department of NeuroMuscoloSkeletal and Sense Organs, Azienda Ospedaliero Universitaria Careggi, Centro Traumatologico Ortopedico, Florence, Italy
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland,Corresponding author: Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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18
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Nourissat G, Corsia S, Muller JH, Saffarini M, Lenoble E. Mid- to long-term clinical outcomes after press-fit short stem reverse shoulder arthroplasty. JSES Int 2022; 6:896-902. [DOI: 10.1016/j.jseint.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Tavakoli A, Spangenberg G, Reeves JM, Faber KJ, Langohr GDG. Humeral short stem varus-valgus alignment affects bone stress. J Orthop Res 2022; 40:2169-2178. [PMID: 34914123 DOI: 10.1002/jor.25239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 02/04/2023]
Abstract
The use of uncemented humeral stems in total shoulder arthroplasty (TSA) is associated with stress shielding. Shorter length stems have shown to decrease stress shielding; however, the effect of stem varus-valgus alignment is currently not known. The purpose of this study was to quantify the effect of short stem distal humeral endosteal contact due to varus-valgus angulation on bone stresses after TSA. Three-dimensional models of eight male cadaveric humeri were constructed from computed tomography data. Bone models were reconstructed with a short stem humeral component implant in three positions (standard, varus, and valgus). Modeling was performed at 45° and 75° of abduction and the resulting differentials in bone stress compared to the intact state and the expected time-zero bone response were determined. In cortical and trabecular bone, the standard position (STD) altered bone stress less than the valgus (VAL) and varus (VAR) positions relative to the intact state. For both cortical (p = 0.033) and trabecular (p = 0.012) bone, the VAL position produced a larger volume of bone with resorbing potential compared to the STD position.
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Affiliation(s)
- Amir Tavakoli
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - Gregory Spangenberg
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - Jacob M Reeves
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - Kenneth J Faber
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - G Daniel G Langohr
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
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20
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Wittmann T, Befrui N, Rieger T, Raiss P. Stem size prediction in shoulder arthroplasty with preoperative 3D planning. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04571-6. [PMID: 35963979 DOI: 10.1007/s00402-022-04571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Three-dimensional surgical planning software provides virtual reconstructions of the shoulder with automated joint indices for a preoperative case assessment. The aim of this single center study was to evaluate the concordance between the preoperatively selected humeral components and the final implants used in shoulder arthroplasty. METHODS 129 cases who had undergone anatomic (n = 16) or reverse shoulder arthroplasty (n = 117) using the same type of uncemented short stem implant and were included for review in this study. The type of arthroplasty, stem size, stem inclination, tray-offset and liner-thickness were noted preoperatively and compared to the final implant specifications used in surgery. RESULTS The type of arthroplasty matched the surgical plan in 99.2% of cases, as one case was converted from RSA to TSA. The concordance of planned to implanted stem size was 44.2% and the planned size was in range of one adjacent size in 87.6% of cases. Stem inclination in TSA matched the surgical plan in 50% of cases. Tray offset in RSA was predicted correctly in 65% and liner-thickness matched the surgical plan in 98.3% of cases. CONCLUSION Despite a low degree of concordance of planned to implanted stem sizes of 44.2%, the choice of stem size was found to be in range of one adjacent size in 87.6% of cases. Further investigations of other contributing factors are necessary to increase the accuracy of the preoperative selection of humeral implants. LEVEL OF EVIDENCE level IV, retrospective case study.
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Affiliation(s)
- Thomas Wittmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany.
| | - Nima Befrui
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
| | - Tim Rieger
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
| | - Patric Raiss
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
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21
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Xue H, Zhang Z, Liu M, Lin Z, Endo Y, Liu G, Mi B, Zhou W, Liu G. Finite element analysis of different fixation methods of screws on absorbable plate for rib fractures. Front Bioeng Biotechnol 2022; 10:960310. [PMID: 35935502 PMCID: PMC9354002 DOI: 10.3389/fbioe.2022.960310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple rib fractures caused by trauma are common injuries and the internal fixation methods of these injuries have been paid more and more attention by surgeons. Absorbable plates and screws are the effective way to treat rib fractures, but there are no reports on which type of screw fixation method is most effective. In this study, finite element analysis was used to study the effects of five different types of screw fixation methods on anterior rib, lateral rib and posterior rib. The finite element model of the ribs was reconstructed from CT images, and the internal pressure (40 kPa) and intercostal force (30 N) on the surfaces of the ribs were simulated accordingly. An intercostal force of 30 N was applied to the upper and lower surfaces of the ribs to simulate the effect of intercostal muscle force. The pressure of 40 kPa was applied to the inner surface of the ribs, and the normal direction was applied to the inner surface of the ribs. The positive direction was considered inspiratory pressure, and the negative direction was considered expiratory pressure. The results indicate the optimal type of screw fixation on the absorbable plate for rib fractures, and provide a basis and reference for clinical application.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yori Endo
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Guodong Liu
- Medical Center of Trauma and War Injuries, Daping Hospital, Army Medical University, Chongqing, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Guohui Liu, ; Wu Zhou,
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22
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Proximal humeral bone loss in stemless shoulder arthroplasty: potential factors influencing bone loss and a new classification system. Arch Orthop Trauma Surg 2022; 143:3085-3090. [PMID: 35852597 DOI: 10.1007/s00402-022-04493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/18/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Proximal humeral bone loss in total shoulder arthroplasty (TSA) is more frequent than in hemiarthroplasty. Factors such as age, gender, inclination angle, and radiolucent lines may also contribute. Additionally, current bone loss grading systems are often not sensitive enough to detect slight bone changes, especially at the medial calcar where bone loss is commonly observed. This study uses a new, more detailed bone loss grading system to evaluate factors that could influence bone loss at the proximal humerus. MATERIALS AND METHODS In this single-center prospective study, patients underwent hemiarthroplasty or TSA with an anatomic stemless prosthesis. Bone loss was measured at the proximal humerus using the new grading system. The effect of treatment type, age, gender, radiolucent lines, and inclination angle on bone loss was evaluated. The Constant-Murley score of patients was assessed and complications recorded. RESULTS Ninety-one shoulders were available for the final follow-up examination at a median of 85.0 months (range 82.6-121.1 months). Bone loss was found at the proximal humerus in approximately one-third of shoulders, and significantly more shoulders had bone loss in TSA than in hemiarthroplasty (P = 0.03). However, this difference was no longer significant after stratifying by gender and age (P > 0.05). Bone loss significantly correlated with gender (P = 0.03) but not with treatment type, radiolucent lines, and the postoperative inclination angle (P > 0.05). Most Constant-Murley score components did not differ significantly between shoulders with and without bone loss (P > 0.05). Lastly, six complications and four revisions were reported. CONCLUSIONS Results showed gender had the greatest influence on bone loss after stemless shoulder arthroplasty. Furthermore, both patients with or without bone loss can expect similar clinical outcomes with the stemless prosthesis used in this study. Lastly, the new grading system is simple and straightforward to use.
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23
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Gauci MO, Diaz MA, Christmas KN, Simon P, Frankle MA. Do preoperative factors and implant design features influence humeral stem extraction efforts? J Shoulder Elbow Surg 2022; 31:1515-1523. [PMID: 35085600 DOI: 10.1016/j.jse.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Variations in humeral component designs in hemiarthroplasty and anatomic total shoulder arthroplasty cases can impact the degree of difficulty during a revision surgery that necessitates the removal of the humeral stem. However, no metric exists to define stem extraction effort nor to identify associated factors that contribute to extraction difficulty. The purpose of this study is to describe a method to quantify stem extraction difficulty and to define features that will impact the effort during stem removal. METHODS This was a retrospective review of 58 patients undergoing revision of hemiarthroplasty or anatomic total shoulder arthroplasty requiring stem extraction. Each included patient had existing preoperative radiographic examination, an intraoperative video of the stem removal process, and explants available for analysis by 3 surgeons. The following factors were assessed for the impact on extraction difficulty: (1) preoperative features such as cement use, fill of proximal humerus, and stem design features; (2) intraoperative data on extraction time and bone removal; and (3) postoperative findings related to extraction artifacts (EAs). A scoring system was established to distinguish easy (Easy group) and difficult (Difficult group) stem removal cases and further used to identify the features that may affect intraoperative difficulty of stem removal. RESULTS The Difficult group accounted for 26% (15/58) of the study population with an 18-minute average stem extraction time, average EA count of 69, and 35 mm of bone removed. The Easy group accounted for 74% (43/58) of patients, with a 4-minute average extraction time, average EA count of 23, and 10 mm of bone removed. Logistic regression model was able to correctly classify 82% of the cases, explaining 26.7% of the variance in humeral stem removal with cement and proximal coating variables. The likelihood of cemented stem removal being difficult is 5 times greater compared to an uncemented stem, and having proximal coating doubles the likelihood of a difficult stem removal compared to cases with no coating. CONCLUSIONS Quantifying stem extraction difficulty is possible with intraoperative video as well as explant analysis. Preoperative features of the fixation type and specific features of stem design such as proximal coating will impact difficulty of stem extraction.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Miguel A Diaz
- Foundation for Orthopaedic Research and Education, Translational Research, Tampa, FL, USA
| | - Kaitlyn N Christmas
- Foundation for Orthopaedic Research and Education, Translational Research, Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Translational Research, Tampa, FL, USA; University of South Florida, Department of Medical Engineering, College of Engineering & Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
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24
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Nixon RA, Dang KH, Haberli JE, O'Donnell EA. Surgical time and outcomes of stemmed versus stemless total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:S83-S89. [PMID: 35172208 DOI: 10.1016/j.jse.2022.01.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless total shoulder arthroplasty (TSA) was approved for use in the United States in 2015, and there remains a paucity of data on its performance in this market. Decreased operative time without compromise of clinical outcomes is a theoretical advantage of stemless TSA, but no studies have evaluated this in a comparative study to date. Herein, the operative times and clinical outcomes of stemless vs. conventional stemmed TSA are investigated. METHODS This is a retrospective cohort study, evaluating all consecutive TSAs performed by a single surgeon between 2015 and 2018. Data were collected from 59 patients who underwent TSA with conventional, stemmed humeral implants and 115 patients in whom a stemless humeral implant was used. Operative times and demographic data were collected retrospectively from the anesthesia record, and prospectively collected patient-reported outcome measures were collected from the Surgical Outcomes System database. For patient-reported outcome measure, visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores were recorded serially until a minimum 2-year follow-up. RESULTS The average operative time was 24 minutes less in the stemless cohort compared with the stemmed cohort (104 minutes vs. 128 minutes, P < .001). Cost analysis showed a decreased personnel cost of 15.9% that correlates to a 3.1% overall reduction in operating room-associated cost. Patient-reported outcome scores significantly improved postoperatively in both cohorts across all time points. There was no difference found in visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores between the cohorts at the 2-year follow-up. CONCLUSIONS Stemless TSA significantly reduces operative time with equivalent functional outcomes at a minimum 2-year follow-up.
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Affiliation(s)
- Ryan A Nixon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Khang H Dang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jillian E Haberli
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evan A O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length. J Clin Med 2022; 11:jcm11102867. [PMID: 35628993 PMCID: PMC9148163 DOI: 10.3390/jcm11102867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in progressive increments distal to the greater tuberosity to provide anatomic information about the optimal length of press-fit short stems for alignment and stability in TSA. We hypothesized that the humeral canal diameter will remain variable for the first 50 to 75 mm distal to the greater tuberosity and will become consistent thereafter. A retrospective review of 99 consecutive patients undergoing TSA with CT scans was performed. Intramedullary anterior-posterior (AP) and medial-lateral (ML) width as well as diameter were analyzed on two-dimensional computed tomography following multiplanar reconstruction. Measurements were taken at consistent distances distal to the greater tuberosity (GT). The transition point was measured at the proximal level of the humerus where endosteal borders of the medial and lateral cortices became parallel. The mean transition point was 73 mm from the GT (range: 53 to 109 mm). ML and AP widths became consistent 80 mm distal to the GT. IM diameter became consistent after 90 mm distal to the GT and a stem length of 90 mm extended past the transition point in 91.9% of cases. In TSA, a humeral stem length of 90 mm is required to predictably reach points at which the humeral canal becomes cylindrical and consistent in diameter. This information may aid data-driven decisions on humeral stem length during press-fit fixation, assuring consistency of alignment and implant stability, while maintaining ease of revision associated with a short stem implant. Level of evidence: III
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26
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Hu K, Yang Z, Zhao Y, Wang Y, Luo J, Tuo B, Zhang H. Bioinspired Surface Functionalization of Poly(ether ether ketone) for Enhancing Osteogenesis and Bacterial Resistance. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2022; 38:5924-5933. [PMID: 35446583 DOI: 10.1021/acs.langmuir.2c00600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In orthopedics, developing functionalized biomaterials to enhance osteogenesis and bacterial resistance is crucial. Although poly(ether ether ketone) (PEEK) is regarded as an important engineering plastic for biomedical material with excellent mechanical properties and biocompatibility, its biological inertness has greatly compromised its application in biomedical engineering. Inspired by the catecholamine chemistry of mussels, we propose a universal and versatile approach for enhancing the osteogenesis and antibacterial performances of PEEK based on surface functionalization of polydopamine-modified nanohydroxyapatite and lysozyme simultaneously. The characterizations of surface morphology and elemental composition revealed that the composite coating was successfully added to the PEEK surface. Additionally, the in vitro cell experiment and biomineralization assay indicated that the composite coating-modified PEEK was biocompatible with significantly improved bioactivity to promote osteogenesis and biomineralization compared with the untreated PEEK. Furthermore, the antibacterial test demonstrated that the composite coating had a strongly destructive effect on two bacteria (Staphylococcus aureus and Escherichia coli) with antibacterial ratios of 98.7% and 96.1%, respectively. In summary, the bioinspired method for surface functionalization can enhance the osteogenesis and bacterial resistance of biomedical materials, which may represent a potential approach for designing functionalized implants in orthopedics.
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Affiliation(s)
- Keming Hu
- College of Mining, Guizhou University, Guiyang 550025, China
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Zeyuan Yang
- Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - Yanlong Zhao
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Yuguang Wang
- Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - Jing Luo
- Beijing Research Institute of Automation for Machinery Industry Company, Ltd., Beijing 100120, China
| | - Biyang Tuo
- College of Mining, Guizhou University, Guiyang 550025, China
| | - Hongyu Zhang
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
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27
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Valenti P, Zampeli F, Caruso G, Nidtahar I, Martinez-Catalan N, Kazum E. Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome. Orthop Traumatol Surg Res 2022; 108:103263. [PMID: 35248792 DOI: 10.1016/j.otsr.2022.103263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RSA) associated with modified L'Episcopo (isolated LD) or L'Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. MATERIAL AND METHODS A retrospective review of 24 RSAs (mean age 68.71 years, range 52-83) associated with modified L'Episcopo procedure (9) and L'Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. RESULTS With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). CONCLUSION At short-term follow-up, RSA combined with L'Episcopo or modified l'Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\TM tendon transfer. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris 247/255, 10134 Turin, Italy
| | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Natalia Martinez-Catalan
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France; Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
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28
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Kim SC, Park JH, Bukhary H, Yoo JC. Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1341-1349. [PMID: 35353240 DOI: 10.1007/s00264-022-05383-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Some patients show severe humeral bone stress shielding even one year after press-fit humeral stem, which can be a risk factor for implant durability. This study compared humeral stress shielding and clinical outcomes between high and low filling ratio (HFR and LFR) stems in primary reverse shoulder arthroplasty (RSA). METHODS From 2015 to 2020, 104 patients who underwent RSA with a non-cemented standard-length humeral stem were examined. The humeral stems included large press-fit stems (HFR group, 53 patients) or small non-press-fit stems with autogenous cancellous bone grafting (LFR group, 51 patients). The radiologic and clinical outcomes were compared between the groups one year post-operatively. RESULTS One patient in the LFR group with early infectious dislocation was excluded from the 1-one year evaluation. No stress shielding was observed in 27/50 (54.0%) and 5/53 (9.4%) of patients in the LFR and HFR groups, while 3/50 (6%) and 19/53 (35.8%) patients showed high-stress shielding, respectively. However, the stem alignment change, subsidence, complications and evidence of loosening did not differ between the groups. The final range-of-motion and functional scores were significantly poorer in the LFR group than those in the HFR group, although the difference was minimal. CONCLUSION Even at one year follow-up, patients receiving LFR stems with autogenous bone grafting had significantly less humeral stress shielding compared to patients with HFR stem with press-fit in primary RSA, without compromising stem stability.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Hun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hashem Bukhary
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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29
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Frank JK, Siegert P, Plachel F, Heuberer PR, Huber S, Schanda JE. The Evolution of Reverse Total Shoulder Arthroplasty-From the First Steps to Novel Implant Designs and Surgical Techniques. J Clin Med 2022; 11:1512. [PMID: 35329837 PMCID: PMC8949196 DOI: 10.3390/jcm11061512] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. RECENT FINDINGS Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont's design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.
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Affiliation(s)
- Julia K. Frank
- Vienna Shoulder and Sports Clinic, Baumgasse 20A, 1030 Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with the AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria;
| | - Paul Siegert
- 1st Orthopaedic Department, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria;
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Mitte, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Philipp R. Heuberer
- HealthPi Medical Center, Wollzeile 1/3, 1010 Vienna, Austria;
- Austrian Research Group for Regenerative and Orthopaedic Medicine, 1010 Vienna, Austria
| | - Stephanie Huber
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Jakob E. Schanda
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with the AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria;
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria
- AUVA Trauma Center Vienna-Meidling, Kundratstraße 37, 1120 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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30
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Are short press-fit stems comparable to standard-length cemented stems in reverse shoulder arthroplasty? A prospective, randomized clinical trial. J Shoulder Elbow Surg 2022; 31:580-590. [PMID: 34968694 DOI: 10.1016/j.jse.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature comparing humeral implants in reverse shoulder arthroplasty is sparse. With minimal supporting literature, there has been a trend away from standard-length cemented humeral implants to press-fit stems and, recently, to shorter-stem implants. It is known that early implant migration, within the first 2 years postoperatively, is predictive of later implant loosening and possible revision surgery. Therefore, the purpose of this study was to compare clinical outcomes and implant migration between cemented standard-length humeral stems and press-fit short stems using model-based radiostereometric analysis. METHODS After a power analysis, 41 shoulders were prospectively randomized to receive either a cemented standard-length or press-fit short humeral stem for primary reverse shoulder arthroplasty between July 2017 and June 2019. Following surgery, participants were imaged with stereo radiographs acquired at 6 weeks (baseline), 3 months, 6 months, 1 year, and 2 years. Migration of the humeral stem at each time point was compared with baseline, with differences in migration between cohorts assessed using a mixed-effects model with the Bonferroni test for multiple comparisons. Patient-reported outcome measures (Subjective Shoulder Value; American Shoulder and Elbow Surgeons shoulder score; Simple Shoulder Test score; Disabilities of the Arm, Shoulder and Hand score; and Constant score) were also compared. RESULTS At 6 months (P = .025), 1 year (P = .004), and 2 years (P = .001) postoperatively, press-fit short stems migrated significantly more than cemented stems along the superior-inferior translation axis; in addition, they showed greater total translation at 2 years (P = .003). Mean total translation (± standard deviation) at 2 years was 0.4 ± 0.2 mm and 1.0 ± 1.1 mm for the cemented and press-fit cohorts, respectively. Mean migration between the 1- and 2-year time points was minimal for both stem fixation groups along all axes (<0.1 mm and 0.6°). There was no difference in active range of motion, pain, or validated outcome measures between the cohorts at 2 years (P ≥ .170). CONCLUSION This randomized clinical trial shows that press-fit short humeral stems subside substantially more than standard-length cemented stems but ultimately achieve stability from 1 year through 2 years. Conversely, no significant differences were observed in clinical outcomes between cohorts.
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Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; School of Biomedical Engineering, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - George S Athwal
- Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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31
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Nourissat G, Corsia S, Harris HW, Bouché PA. Specific Design of a Press Fit Humeral Stem Provides low Stress Shielding in Reverse Shoulder Arthroplasty at minimum 5 Years FU. J Shoulder Elb Arthroplast 2022; 6:24715492221112543. [PMID: 35832511 PMCID: PMC9272197 DOI: 10.1177/24715492221112543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Press fit fixation is becoming more popular in RSA to preserve, in theory, bone capital. Several studies report that bone resorption can be very high around humeral stems depending on their size, shape and mode of fixation. The aim of the current study is to mid-term follow-up clinical and radiological result of a press fit ovoid regular stem RSA in non acute trauma cases.
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Affiliation(s)
- Geoffroy Nourissat
- Clinique de l’épaule, COS Ramsay Santé, Clinique des Maussins & Clinique Saint Jean de Dieu, Paris, France
| | - Simon Corsia
- Service de Chirurgie Orthopédique Hôpital Cochin, APHP, Paris, France
| | | | - Pierre-Alban Bouché
- Service de Chirurgie Orthopédique Hôpital Lariboisière Saint Louis, Paris, France
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32
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Ten Brinke B, Hesseling B, Eygendaal D, Hoelen MA, Mathijssen NMC. Early fixation of the humeral component in stemless total shoulder arthroplasty : a radiostereometric and clinical study with 24-month follow-up. Bone Joint J 2022; 104-B:76-82. [PMID: 34969283 DOI: 10.1302/0301-620x.104b1.bjj-2021-0945.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. METHODS In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the Oxford Shoulder Score (OSS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS At two years, median translation along the x-, y-, and z-axis was -0.12 mm (interquartile range (IQR) -0.18 to 0.02), -0.17 mm (IQR -0.27 to -0.09), and 0.09 mm (IQR 0.02 to 0.31). Median rotation around the x-, y-, and z-axis was 0.12° (IQR -0.50 to 0.57), -0.98° (IQR -1.83 to 1.23), and 0.09° (IQR -0.76 to 0.30). Overall, 20 prostheses stabilized within 12 months postoperatively. Four prostheses showed continuous migration between 12 and 24 months. At two-year follow-up, with the exception of one revised prosthesis, all clinical scores improved significantly (median VAS difference at rest: -3.0 (IQR -1.5 to -6.0); OSS 22.0 (IQR 15.0 to 25.0); CMS 29.5 (IQR 15.0 to 35.75); and DASH -30.0 (IQR -20.6 to -41.67) (all p < 0.001)) with the exception of one revised prosthesis. CONCLUSION In conclusion, we found that 20 out of 24 implants stabilized within 12 months postoperatively. The significance of continuous migration in four implants is unclear and future research on the predictive value of early migration for future loosening in TSA is required. Clinical results revealed a clinically relevant improvement. Cite this article: Bone Joint J 2022;104-B(1):76-82.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Brechtje Hesseling
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Erasmus Medical Center, Delft, Netherlands
| | - Max A Hoelen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
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Goldberg SS, Baranek ES, Korbel KC, Blaine TA, Levine WN. Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages. J Shoulder Elbow Surg 2021; 30:e572-e582. [PMID: 33486059 DOI: 10.1016/j.jse.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stem-free shoulder arthroplasty has recently been shown to have comparable results to stemmed arthroplasty, though stemless designs are typically used in a younger patient population. Additionally, although the native humeral head is elliptical in shape, clinical results with ellipsoid implants in shoulder arthroplasty have not been reported on previously. This case series reports on the outcomes of a recently introduced anatomic total shoulder arthroplasty with an ellipsoid-shaped articular surface and unique multiplanar platform type of stemless fixation. METHODS This retrospective case series examines the initial cohort of patients who received an anatomic total shoulder arthroplasty using an ellipsoid stem-free humeral prosthesis and an all-polyethylene glenoid component from the Catalyst CSR Total Shoulder System (Catalyst OrthoScience) over a 1-year period. Inclusion criteria were patients with a diagnosis of advanced glenohumeral joint arthritis with an intact rotator cuff, regardless of patient age. Clinical outcomes including shoulder range of motion and patient-reported outcome measures, as well as radiographs, were evaluated at multiple time points postoperatively, with minimum 2-year follow-up. RESULTS Sixty-three shoulders in 57 patients with a mean age of 73.0 years (range 60-85 years) were included in the study with a mean follow-up period of 30.5 months (range 24-41 months). Forward elevation improved from 121° to 150° (P < .0001), external rotation improved from 28° to 48° (P < .0001), and internal rotation improved from L3 to L1 (P < .001). There were statistically significant improvements exceeding the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score (37 to 94, P < .001), Single Assessment Numeric Evaluation (SANE) (40 to 93, P < .001), visual analog scale (6.3 to 0.4, P < .001), and Patient-Reported Outcomes Measurement Information System physical domain T score (44 to 57, P < .001). The improvement in the ASES score also exceeded the threshold for the substantial clinical benefit. Age, sex, and preoperative glenoid morphology did not appear to have an effect on the clinical outcome scores. There were no implant failures or evidence of radiographic loosening of the humerus component in any patients. CONCLUSION At 2-year minimum follow-up, this stem-free ellipsoid humerus total shoulder arthroplasty provides very good results with high patient satisfaction, clinical improvement in all outcome measures studied, and no signs of loosening.
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Affiliation(s)
- Steven S Goldberg
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA.
| | - Eric S Baranek
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Kayla C Korbel
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA
| | - Theodore A Blaine
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
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The advances of topology optimization techniques in orthopedic implants: A review. Med Biol Eng Comput 2021; 59:1673-1689. [PMID: 34363576 DOI: 10.1007/s11517-021-02361-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/05/2021] [Indexed: 10/20/2022]
Abstract
Metal implants are widely used in the treatment of orthopedic diseases. However, owing to the mismatched elastic modulus of the bone and implants, stress shielding often occurs clinically which can result in failure of the implant or fractures around the implant. Topology optimization (TO) is a technique that can provide more efficient material distribution according to the objective function under the special load and boundary conditions. Several researchers have paid close attention to TO for optimal design of orthopedic implants. Thanks to the development of additive manufacturing (AM), the complex structure of the TO design can be fabricated. This article mainly focuses on the current stage of TO technique with respect to the global layout and hierarchical structure in orthopedic implants. In each aspect, diverse implants in different orthopedic fields related to TO design are discussed. The characteristics of implants, methods of TO, validation methods of the newly designed implants, and limitations of current research have been summarized. The review concludes with future challenges and directions for research. Wang TO design of global layout and local structure of implants in diverse fields of orthopedic.
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Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma. J Clin Med 2021; 10:jcm10153424. [PMID: 34362209 PMCID: PMC8347309 DOI: 10.3390/jcm10153424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023] Open
Abstract
(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3–9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23–57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference.
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Nguyen NTV, Martinez-Catalan N, Songy CE, Sanchez-Sotelo J. Radiological humeral adaptative changes five years after anatomical total shoulder arthroplasty using a standard-length cementless hydroxyapatite-coated humeral component. Bone Joint J 2021; 103-B:958-963. [PMID: 33934651 DOI: 10.1302/0301-620x.103b5.bjj-2020-1619.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to report bone adaptive changes after anatomical total shoulder arthroplasty (TSA) using a standard-length hydroxyapatite (HA)-coated humeral component, and to report on a computer-based analysis of radiographs to determine changes in peri-implant bone density objectively. METHODS A total of 44 TSAs, performed between 2011 and 2014 using a cementless standard-length humeral component proximally coated with HA, were included. There were 23 males and 21 females with a mean age of 65 years (17 to 65). All shoulders had good quality radiographs at six weeks and five years postoperatively. Three observers graded bone adaptive changes. All radiographs were uploaded into a commercially available photographic software program. The grey value density of humeral radiological areas was corrected to the grey value density of the humeral component and compared over time. RESULTS Stress shielding was graded as mild in 14 shoulders and moderate in three; the greater tuberosity was the predominant site for stress shielding. The mean metaphyseal and diaphyseal fill-fit ratios were 0.56 (SD 0.1) and 0.5 (SD 0.07), respectively. For shoulders with no radiologically visible stress shielding, the mean decrease in grey value in zones 1 and 7 was 20%, compared with 38% in shoulders with radiologically visible stress shielding. CONCLUSION The rate of moderate stress shielding was 7%, five years after implantation of a cementless standard-length HA-coated humeral component. Clinical observation of stress shielding identified on radiographs seems to represent a decrease in grey value of 25% or more. Cite this article: Bone Joint J 2021;103-B(5):958-963.
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Dukan R, Mal H, Castier Y, Rousseau MA, Boyer P. Safety of shoulder arthroplasty in lung transplant recipients. Arch Orthop Trauma Surg 2021; 141:795-801. [PMID: 32451618 DOI: 10.1007/s00402-020-03485-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Although shoulder arthroplasty is relatively safe in general population, it remains unclear in transplant recipient. Aim of this study was to determine outcomes and morbidity after shoulder arthroplasty in lung transplant recipients. METHODS A retrospective analysis was performed at our university hospital center from 2001 to 2015. Main inclusion criterion was all lung transplant recipient who underwent shoulder arthroplasty. Clinical outcomes including Constant score, visual analogue scale (VAS), American Shoulder and Elbow Surgeons score (ASES) were determined in pre-operative period and a minimum follow-up of 36 months. Special attention was taken about complications. RESULTS Among 700 lung transplant recipients, we identified 12 patients who underwent 14 shoulder arthroplasties. Arthroplasties were performed after proximal humeral avascular necrosis (n = 10), degenerative osteoarthritis (n = 1) and non-union of proximal humeral fracture (n = 1). 8 anatomical total shoulder arthroplasties and 6 reversed shoulder arthroplasties were performed. Mean follow-up was 61.4 months (± 22.1). Mean age was 47.1 (± 9.3) years. All patients had immunosuppression therapy at the time of surgery. Mean Constant score was improved at last follow-up [43(± 9.7) vs 94(± 4), p < 0.001]. VAS decreased from 6.4 (± 1.2) to 0.4 (± 0.8), p < 0.001. Mean ASES was improved from 33 (± 6) to 91 (± 5) at last follow-up (p < 0.001). Range of motion were improved between early post-operative evaluation and last follow-up: forward flexion: 85° (± 8°) vs 119°(± 13°); abduction: 83° (± 14°) vs 106°(± 23°); external rotation (RE1): 26° (± 7°) vs 36°(± 10°). At last follow-up, one revision was required for humeral prothesis loosening at 2 years post-surgery. One patient died due to acute pulmonary decompensation on chronic rejection 66 months after shoulder arthroplasty. CONCLUSION Shoulder arthroplasty is a safe procedure in this vulnerable population of lung transplant recipients. Such results encourage us to continue arthroplasty surgery when required. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ruben Dukan
- Orthopaedic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France.
| | - Herve Mal
- Pneumology, Lung Transplantation Department, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Yves Castier
- Thoracic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Marc-Antoine Rousseau
- Orthopaedic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Patrick Boyer
- Orthopaedic Surgery Department, Universite Paris Diderot UFR de Medecine, Paris, France
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Wodarek J, Shields E. Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results. J Shoulder Elb Arthroplast 2021; 5:24715492211008408. [PMID: 34993377 PMCID: PMC8492026 DOI: 10.1177/24715492211008408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.
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Affiliation(s)
- Jeremy Wodarek
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Edward Shields
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
- Orthopedic Associates of Muskegon, Muskegon, Michigan
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Herber V, Okutan B, Antonoglou G, Sommer NG, Payer M. Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives. J Clin Med 2021; 10:jcm10091842. [PMID: 33922759 PMCID: PMC8123017 DOI: 10.3390/jcm10091842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Bone preservation and primary regeneration is a daily challenge in the field of dental medicine. In recent years, bioresorbable metals based on magnesium (Mg) have been widely investigated due to their bone-like modulus of elasticity, their high biocompatibility, antimicrobial, and osteoconductive properties. Synthetic Mg-based biomaterials are promising candidates for bone regeneration in comparison with other currently available pure synthetic materials. Different alloys based on Mg were developed to fit clinical requirements. In parallel, advances in additive manufacturing offer the possibility to fabricate experimentally bioresorbable metallic porous scaffolds. This review describes the promising clinical results of resorbable Mg-based biomaterials for bone repair in osteosynthetic application and discusses the perspectives of use in oral bone regeneration.
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Affiliation(s)
- Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
- Correspondence:
| | - Begüm Okutan
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Georgios Antonoglou
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
| | - Nicole G. Sommer
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Michael Payer
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
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Duplantier MJ, Marschall JS, Ritto F, Welch A, Alpert B, Tiwana PS. Anatomical Location of Initial and Repeat Mandible Fractures: A 5-Year, Multi-Institution Retrospective Study. J Oral Maxillofac Surg 2021; 79:1712-1722. [PMID: 33951449 DOI: 10.1016/j.joms.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the present study was to investigate new fracture patterns resulting from low velocity mechanisms in subjects who had previously fractured their mandible and had been treated with open reduction and internal fixation (ORIF) or closed reduction. METHODS AND MATERIALS A multi-institutional retrospective cohort study was designed to analyze subjects presenting at 2 tertiary care centers with mandibular fractures with specific interest in subjects who had repeat mandible fractures. Variables recorded included demographic (age, sex, etc) data, fracture location of all fractures treated, and the location of previous fracture. Descriptive and bivariate analyses were completed of the data. RESULTS The sample included a total of 492 subjects and 875 total fractures from both institutions. Four hundred fourty-four (91.1%) were male. The average age of all subjects was 36.4 ± 14.9 years. Twenty-six (5.28%) subjects were previously treated for a mandible fracture. All subjects' subsequent fractures occurred outside of previous ORIF except for 1 subject. Original fracture location (P = .596) and previous ORIF type (P = .689) did not influence if the subsequent fracture was within a site of previous ORIF. CONCLUSIONS The present study demonstrates that repeat mandible fractures are relatively rare, likely to occur only 5% of the time at large tertiary care centers. The repeat fracture is not likely to occur in a site of previous ORIF, regardless of the ORIF modality. Furthermore, the fracture is likely to occur on the contralateral side. This is 1 of the largest data sets on repeat mandible fractures, which, given their rarity, are difficult to study.
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Affiliation(s)
- Martin J Duplantier
- Resident, Department of Oral and Maxillofacial Surgery, University of Oklahoma, Oklahoma City, OK
| | - Jeffrey S Marschall
- Resident, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
| | - Fabio Ritto
- Professor, Department of Oral and Maxillofacial Surgery University of Oklahoma, Oklahoma City, OK
| | - Austin Welch
- Resident, Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City, MO
| | - Brian Alpert
- Professor, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
| | - Paul S Tiwana
- Professor and Reichmann Chair, Department of Oral and Maxillofacial Surgery, University of Oklahoma, Oklahoma City, OK
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Ramírez A CE, Hurtado-Macías A, Talamantes R, Flores E, Ladrón de Guevara HP, Delgado JI, Estrella RA, Riestra JM, Montes JM, Esmonde-White K, Vardaki M, González-Hernández J, Viveros JM. Assessing mechanical behavior of ostrich and equine trabecular and cortical bone based on depth sensing indentation measurements. J Mech Behav Biomed Mater 2021; 117:104404. [PMID: 33667799 DOI: 10.1016/j.jmbbm.2021.104404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/23/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Guided bone regeneration surgeries are based on grafting a scaffold in the site to be repaired. The main focus of the scaffold is to provide mechanical support to newly formed blood vessels and cells that will colonize the grafted site, achiving bone regenertation. In this regards, the aim of this study was to characterize the anatomy, structular, surface morphologycal, chemical composition, and nanomechanical properties of ostrich and equine trabecular bone. Ostrich and equine specimens were obtained from a local abattoir and bone was obtained by blunt dissection, n = 5. Tissue bone anatomy and trabecular structure were measured using Computerized Axial Tomography (CAT). Atomic Force Microscopy (AFM) and Energy dispersion spectrometry of X-ray (EDS) were used to examine surface morphology and chemical composition of the trabecular ostrich and equine bone. Mechanical behavior was analysted by nanoindentation. Equine specimens were examined as control. CAT results suggest that in terms of anthropometry, ostrich tarsometatarsus bone is more suitable due to its length is 432.56 ± 3.12 mm vs. the highest human bone structures reported, which femur length is 533.66 ± 18.81 mm. Besides, the low radiodensity in the Hounsfield scale exhibits equine trabecular bone more brittle (Av = 1538.4 ± 0.9) than ostrich trabecular bone (Av = 462.1 ± 1.5). EDS showed a slight variation of the element Calcium (Ca2+) ranging from 20% to 25.5% wt in equine bone; the Ca2+ content variation is consistent with the ring-shaped morphology, while in ostrich bone the chemical composition is homogeneous. The elastic modulus, nanohardness (E = 5.3 ± 0.7 GPa, H = 220 ± 10 MPa) and average roughness (Ra = 207 nm) are similar to the human trabecular bone which could reduce the stress shielding, all of these findings suggest that ostrich bone can be promising for native tissue scaffolds for mechanically demanding applications. This research makes innovative contributions to science and provides a framework, which will allow us to address future biomedical tests, and rapidly identify promising organic and sustainable waste for tissue scaffold.
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Affiliation(s)
- Cecilia E Ramírez A
- Departamento de Química, Departamento de Farmacología, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Mexico
| | - Abel Hurtado-Macías
- Departamento de Metalugría e Integridad Estructural, Centro de Investigación de Materiales Avanzados-CIMAV, Chihuahua, Mexico.
| | - Roberto Talamantes
- Departamento de Metalugría e Integridad Estructural, Centro de Investigación de Materiales Avanzados-CIMAV, Chihuahua, Mexico
| | - Edgardo Flores
- Departamento de Biología Celular y Molecular, División de Ciencias Biológica y Agropecuarias, Universidad de Guadalajara, Jalisco, Mexico
| | - Héctor Pérez Ladrón de Guevara
- Departamento de Ciencias Exactas e Ingeniería, Centro Universitario de Lagos, Universidad de Guadalajara, Jalisco, Mexico
| | - J Iván Delgado
- Departamento de Química, Departamento de Farmacología, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Mexico
| | - Rubén Anguiano Estrella
- Departamento de Cultivo Celular y Biología Molecular, División de Ciencias Veterinarias, Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, Jalisco, Mexico
| | - Juan Manuel Riestra
- Departamento de Neurocirugía y Columna Vertebral, Instituto Mexicano del Seguro Social-IMSS, Jalisco, Mexico
| | - Jesús Máximo Montes
- Smart Cities Innovation Center, Centro Universitario de Ciencias Económico Administrativas, Universidad de Guadalajara, Jalisco, Mexico
| | | | - Martha Vardaki
- Michael Smith Laboratories, The University of British Columbia, Vancouver, Canada
| | - J González-Hernández
- Centro de Ingeniería y Desarrollo Industrial, Santiago de Querétaro, 76130, Qro, Mexico
| | - Juan M Viveros
- Departamento de Química, Departamento de Farmacología, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Mexico
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Willems JIP, Hoffmann J, Sierevelt IN, van den Bekerom MPJ, Alta TDW, van Noort A. Results of stemless shoulder arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:35-49. [PMID: 33532085 PMCID: PMC7845565 DOI: 10.1302/2058-5241.6.200067] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another.
Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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Grzeskowiak RM, Schumacher J, Dhar MS, Harper DP, Mulon PY, Anderson DE. Bone and Cartilage Interfaces With Orthopedic Implants: A Literature Review. Front Surg 2020; 7:601244. [PMID: 33409291 PMCID: PMC7779634 DOI: 10.3389/fsurg.2020.601244] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
The interface between a surgical implant and tissue consists of a complex and dynamic environment characterized by mechanical and biological interactions between the implant and surrounding tissue. The implantation process leads to injury which needs to heal over time and the rapidity of this process as well as the property of restored tissue impact directly the strength of the interface. Bleeding is the first and most relevant step of the healing process because blood provides growth factors and cellular material necessary for tissue repair. Integration of the implants placed in poorly vascularized tissue such as articular cartilage is, therefore, more challenging than compared with the implants placed in well-vascularized tissues such as bone. Bleeding is followed by the establishment of a provisional matrix that is gradually transformed into the native tissue. The ultimate goal of implantation is to obtain a complete integration between the implant and tissue resulting in long-term stability. The stability of the implant has been defined as primary (mechanical) and secondary (biological integration) stability. Successful integration of an implant within the tissue depends on both stabilities and is vital for short- and long-term surgical outcomes. Advances in research aim to improve implant integration resulting in enhanced implant and tissue interface. Numerous methods have been employed to improve the process of modifying both stability types. This review provides a comprehensive discussion of current knowledge regarding implant-tissue interfaces within bone and cartilage as well as novel approaches to strengthen the implant-tissue interface. Furthermore, it gives an insight into the current state-of-art biomechanical testing of the stability of the implants. Current knowledge reveals that the design of the implants closely mimicking the native structure is more likely to become well integrated. The literature provides however several other techniques such as coating with a bioactive compound that will stimulate the integration and successful outcome for the patient.
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Affiliation(s)
- Remigiusz M. Grzeskowiak
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Jim Schumacher
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Madhu S. Dhar
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David P. Harper
- The Center for Renewable Carbon, Institute of Agriculture, University of Tennessee, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
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Abstract
This chapter provides an overview of the growth factors active in bone regeneration and healing. Both normal and impaired bone healing are discussed, with a focus on the spatiotemporal activity of the various growth factors known to be involved in the healing response. The review highlights the activities of most important growth factors impacting bone regeneration, with a particular emphasis on those being pursued for clinical translation or which have already been marketed as components of bone regenerative materials. Current approaches the use of bone grafts in clinical settings of bone repair (including bone grafts) are summarized, and carrier systems (scaffolds) for bone tissue engineering via localized growth factor delivery are reviewed. The chapter concludes with a consideration of how bone repair might be improved in the future.
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Three-dimensional Volumetric Filling Ratio Predicts Stress Shielding in Short-stem Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2020; 28:1047-1054. [PMID: 32301819 DOI: 10.5435/jaaos-d-19-00444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Three-dimensional (3-D) CT volumetric filling ratio (VFR) is a better predictor of proximal humerus stress shielding after short-stem anatomic total shoulder arthroplasty (aTSA) than using plain radiographs. METHODS Forty-four patients with short-stem aTSAs, preoperative CT scans, and a minimum 3-year radiographic follow-up were included. Patients were divided into group A (stress shielding) and group B (no stress shielding) based on the radiographic analysis. Standard implant filling ratios were measured on plain radiographs. The 3-D VFR of the metaphyseal and diaphyseal segments of the aTSA stem was measured using MIMICS (Materialise). The area under a receiver operator characteristic curve was used to determine the predictive strength of the 3-D VFR method. RESULTS The average age and radiographic follow-up was 69 years and 44 months. Group A had 19 patients and statistically higher filling ratios using 3-D VFR method than group B, whereas no notable differences were found between the groups using standard techniques. The 3-D VFR had an area under a receiver operator characteristic curve of 92%, which supports it as a good predictor of stress shielding. CONCLUSIONS These methods enable early identification of patients at risk for stress shielding and can also be valuable in improving humeral stem designs. LEVEL OF EVIDENCE Level III. Case-control study.
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Yu Y, Sun Y, Zhou X, Mao Y, Liu Y, Ye L, Kuang L, Yang J, Deng Y. Ag and peptide co-decorate polyetheretherketone to enhance antibacterial property and osteogenic differentiation. Colloids Surf B Biointerfaces 2020; 198:111492. [PMID: 33296823 DOI: 10.1016/j.colsurfb.2020.111492] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023]
Abstract
Polyetheretherketone (PEEK) has been well concerned as a promising material for hard tissue repair because of its outstanding mechanical behavior and superior biocompatibility. However, its clinical application is limited by its biological inertness and the susceptibility to bacterial infection during implantation. To improve the original shortcomings, self-polymerized dopamine (PDA) was used to enrich silver ions on the PEEK surface. Moreover, a layer of carboxymethyl chitosan (CMC) film was formed on the PEEK surface by the spin-coating method, aiming to control the release of silver ions on the surface. At the same time, bone forming peptide (BFP) was modified onto the PEEK surface by 1-(3-dimethylaminopropyl)-3-ethylcarbonimide hydrochloride (EDC) / N-hydroxy succinimide (NHS). The characterization results showed that PEEK-Ag-CMC-BFP could be obtained successfully. The inhibition zone and bacterial kinetic curve showed a favorable inhibitory effect of the sliver-modified PEEK on gram-negative and gram-positive bacteria. In vitro experiments exhibited that PEEK-Ag-CMC-BFP had a better biological activity than that of PEEK, which could promote cell proliferation and osteogenic differentiation. It is expected that this dual-function material with antibacterial and bone-promoting properties has a vast potential applied in the field of hard tissue repair.
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Affiliation(s)
- Yue Yu
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Yimin Sun
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Xiong Zhou
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Yurong Mao
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Yunxiu Liu
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Ling Ye
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China
| | - Li Kuang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jing Yang
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China.
| | - Yi Deng
- School of Chemical Engineering, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, 611065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China; Department of Mechanical Engineering, The University of Hong Kong, Hong Kong Special Administrative Region.
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Wiater JM, Levy JC, Wright SA, Brockmeier SF, Duquin TR, Wright JO, Codd TP. Prospective, Blinded, Randomized Controlled Trial of Stemless Versus Stemmed Humeral Components in Anatomic Total Shoulder Arthroplasty: Results at Short-Term Follow-up. J Bone Joint Surg Am 2020; 102:1974-1984. [PMID: 33208640 DOI: 10.2106/jbjs.19.01478] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless humeral components for anatomic total shoulder arthroplasty (aTSA) have several reported potential benefits compared with stemmed implants. However, we are aware of no Level-I, randomized controlled trials (RCTs) that have compared stemless implants with stemmed implants in patients managed with aTSA. We sought to directly compare the short-term clinical and radiographic outcomes of stemless and stemmed implants to determine if the stemless implant is noninferior to the stemmed implant. METHODS We performed a prospective, multicenter, single-blinded RCT comparing stemless and short-stemmed implants in patients managed with aTSA. Range-of-motion measurements and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant scores were obtained at multiple time points. Device-related complications were recorded. Radiographic evaluation for evidence of loosening, fractures, dislocation, or other component complications was performed. Statistical analysis for noninferiority was performed at 2 years of follow-up for 3 primary end points: ASES score, absence of device-related complications, and radiographic signs of loosening. All other data were compared between cohorts at all time points as secondary measures. RESULTS Two hundred and sixty-five shoulders (including 176 shoulders in male patients and 89 shoulders in female patients) were randomized and received the allocated treatment. The mean age of the patients (and standard deviation) was 62.6 ± 9.3 years, and 99% of the shoulders had a primary diagnosis of osteoarthritis. At 2 years, the mean ASES score was 92.5 ± 14.9 for the stemless cohort and 92.2 ± 13.5 for the stemmed cohort (p value for noninferiority test, <0.0001), the proportion of shoulders without device-related complications was 92% (107 of 116) for the stemless cohort and 93% (114 of 123) for the stemmed cohort (p value for noninferiority test, 0.0063), and no shoulder in either cohort had radiographic signs of loosening. Range-of-motion measurements and ASES, SANE, and Constant scores did not differ significantly between cohorts at any time point within the 2-year follow-up. CONCLUSIONS At 2 years of follow-up, the safety and effectiveness of the stemless humeral implant were noninferior to those of the stemmed humeral implant in patients managed with aTSA for the treatment of osteoarthritis. These short-term results are promising given the potential benefits of stemless designs over traditional, stemmed humeral components. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- J Michael Wiater
- Department of Orthopedic Surgery, William Beaumont Hospital, Beaumont Health, Royal Oak, Michigan
| | - Jonathan C Levy
- Holy Cross Orthopedic Research Institute, Fort Lauderdale, Florida
| | - Stephen A Wright
- Orthopaedics Northeast, Parkview Orthopaedic Hospital, Fort Wayne, Indiana
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Thomas R Duquin
- Department of Orthopaedic Surgery, Jacobs School of Medicine, University at Buffalo, The State University of New York, Buffalo, New York
| | - Jonathan O Wright
- Department of Orthopedic Surgery, William Beaumont Hospital, Beaumont Health, Royal Oak, Michigan
| | - Timothy P Codd
- Department of Orthopaedic Surgery, University of Maryland Medical System and St Joseph's Hospital, Towson, Maryland
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Kleim BD, Garving C, Brunner UH. Cementless curved short stem shoulder prostheses with a proximal porous coating: ingrowth properties at 2-5 years of radiological follow-up with clinical correlation. J Shoulder Elbow Surg 2020; 29:2299-2307. [PMID: 32666922 DOI: 10.1016/j.jse.2020.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the way the newest generation of stems integrate into the proximal humerus and their effect on the surrounding bone. Factors that may influence ingrowth have not been investigated. METHODS A consecutive cohort study was conducted that examined 74 anatomical, reverse, or pyrocarbon hemiprostheses, using a curved modular short stem with a proximal porous coating 2-5 years postoperatively (mean 35 months). X-rays were reviewed by 2 examiners independently. Bone loss was scored with 1 point per zone with partial and 2 points per zone with complete resorption (10 zones). The Constant score was used for clinical correlation. Multiple linear regression was employed to investigate correlations between variables. RESULTS No subsidence or shift of the stems occurred. Two of 74 patients showed 1 zone of periprosthetic lucency of 1 mm. The filling ratio averaged 0.54 (range: 0.36-0.75). Thirty patients (40.5%) displayed bone resorption, first seen at 16.6 months (range: 3-40 months), commonly in zones 1 and 5. A total of 22 patients had ≥1 zone with partial resorption, and 8 (10.8%) developed full thickness resorption after 32 (range: 10-49) months.One new finding was that female sex and older age accounted for 51% of the variation of the filling ratio. A high filling ratio, especially when >0.55, correlated with bone resorption (P < .001). Age, sex, and prosthesis type did not directly predict bone resorption. Bony sclerosis correlated with a high filling ratio (P = .019) and thereby indirectly with resorption. A direct correlation between sclerosis and resorption was narrowly insignificant (P = .058) once correcting for the filling ratio. Reverse shoulder prosthesis had a higher filling ratio than total shoulder prosthesis patients (P < .001), resulting indirectly in more bone resorption. The preoperative diagnosis did not significantly correlate with the filling ratio (P = .59) or the resorption score (P = .69). A varus or valgus alignment did not predict resorption (P = .21) or the formation of sclerotic lines (P = .93). Bone loss did not correlate with clinical results. CONCLUSIONS These short stems are firmly anchored 2-5 years postoperatively. However, significant bone loss, linked to a high filling ratio (>0.55), is observed proximally around these stems. The development of sclerotic lines around the stem indicates oversizing. Other factors were not found to have a significant effect on stem ingrowth. The implantation of stems with a large filling ratio is more common in older females and in patients receiving reverse shoulder prosthesis. Autologous impaction bone grafting could downsize the required stem. If adequate hold is not afforded by a suitably small stem, cementation is advisable.
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Affiliation(s)
- Benjamin D Kleim
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany
| | - Christina Garving
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany
| | - Ulrich H Brunner
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany.
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Pogrel MA. The Concept of Stress Shielding in Nonvascularized Bone Grafts of the Mandible-A Review of 2 Cases. J Oral Maxillofac Surg 2020; 79:266.e1-266.e5. [PMID: 33069674 DOI: 10.1016/j.joms.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Two cases are shown to demonstrate stress shielding in nonvascularized bone grafts to the mandible to reconstruct segmental defects, where rigid fixation is used. The effects are reversed on removal of the rigid fixation.
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Affiliation(s)
- Michael Anthony Pogrel
- Professor, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA.
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LaChaud GY, Schoch BS, Wright TW, Roche C, Flurin PH, Zuckerman JD, King JJ. Humeral stem lucencies correlate with clinical outcomes in anatomic total shoulder arthroplasty. JSES Int 2020; 4:669-674. [PMID: 32939504 PMCID: PMC7479044 DOI: 10.1016/j.jseint.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Humeral stem lucencies are uncommon after uncemented anatomic total shoulder arthroplasty (aTSA), and their clinical significance is unknown. This study compares clinical outcomes of aTSA with and without humeral stem lucencies. Methods Two-hundred eighty aTSAs using an uncemented grit-blasted metaphyseal-fit humeral stem between 2005 and 2013 were retrospectively evaluated for radiographic humeral stem lucencies. All shoulders were evaluated at a minimum 5-year follow-up from a multicenter database. Clinical outcomes included range of motion (ROM) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant score, University of California-Los Angeles Shoulder Score (UCLA), Simple Shoulder Test (SST), and Shoulder Pain and Disability Index (SPADI) scores. Postoperative radiographs were evaluated and complications were recorded. Results Two-hundred forty-three humeral stems showed no radiolucent lines. Among the 37 humeral stems with lucent lines, lines were most common in zones 8, 4, 7, and 3. Preoperative ROM and functional outcomes were similar between groups. Postoperative change in outcomes exceeded the minimal clinically important difference (MCID) for all ROM and outcomes in both groups. Postoperative change between groups showed no significant difference in ROM or outcome scores, but improved mean abduction exceeded the MCID in the patients without humeral lines. The complication rate after omitting patients with humeral loosening was higher in patients with humeral lucencies, as was the revision rate. There was also a higher glenoid-loosening rate in patients with humeral lucencies. Conclusion Humeral lucent lines after uncemented stemmed aTSA have a small negative effect on ROM and functional outcomes compared with patients without lucent humeral lines, which may not be clinically significant. The complication and revision rates were significantly higher in patients with humeral lucencies.
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Affiliation(s)
- Gregory Y LaChaud
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | | - Joseph D Zuckerman
- NYU Center for Musculoskeletal Care, NYU Langone Medical Center, New York, NY, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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