Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties?

Lädermann, Alexandre; Chiu, Joe Chih-Hao; Cunningham, Grégory; Hervé, Anthony; Piotton, Sébastien; Bothorel, Hugo

doi:10.1016/j.otsr.2019.12.010

Cited by 24 publications

(23 citation statements)

References 32 publications

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“…If the angle of the stem relative to the humeral canal was ± 5 degrees, the inclination was considered as neutral. If the angle was >5 degrees the inclination was considered as valgus and if the angle was <5 degrees the inclination was considered as varus [ 31 ]. Cortical thickness was measured according to the method of Mather et al [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty—A Multicenter Study

Tross

Lädermann

Wittmann³

et al. 2020

JCM

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Background: The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of >5 mm (mm) is associated with an inferior clinical outcome. Methods: A total of 139 patients with an average age of 73 ± 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months. Results: No humeral component loosening was present at a mean FU of 18 (range, 12–51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 ± 18.0 points and 37.0 ± 19.5% preoperatively to 72.2 ± 13.4 points and 80.3 ± 16.5% at final FU (p < 0.001). The average subsidence of the USSP was 1.4 ± 3.7 mm. Subsidence of >5 mm was present in 15 patients (11%). No association between a subsidence >5 mm and CS or SSV was found (p = 0.456, p = 0.527). However, a subsidence of >5 mm resulted in lower strength at final FU (p = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases). Conclusions: Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU. Level of evidence: Level 4, retrospective study.

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Section: Methodsmentioning

confidence: 99%

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty—A Multicenter Study

Tross

Lädermann

Wittmann³

et al. 2020

JCM

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“… 24 While a comparative cadaveric study revealed decreased micromotion and enhanced rotational stability in cemented stems, 37 optimal stem fixation, length, and filling ratio to avoid stress shielding, 38 subsidence, 39 and misalignment remains controversial. 40 …”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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“…13,42,48 A relation between FR and bone adaptions was already described after short-stem TSA and discussed extensively by Schnetzke et al 45 In theory, an implant with a shorter stem will result in a smaller portion of the proximal humerus being subjected to stress load sharing and more proximal stress conduction from the implant to the bone. 45 In a recent study by L€ adermann et al, 29 a low FR was shown to be associated with greater risks of varus stem positioning, with misalignment of short stem found in 47% of the cases. Studies in this review report about lower rates of misalignment 2,13,19,42,48 but we agree with L€ adermann et al 29 that misalignment of short stems may be a common, but under-reported problem.…”

Section: Discussionmentioning

confidence: 94%

“…45 In a recent study by L€ adermann et al, 29 a low FR was shown to be associated with greater risks of varus stem positioning, with misalignment of short stem found in 47% of the cases. Studies in this review report about lower rates of misalignment 2,13,19,42,48 but we agree with L€ adermann et al 29 that misalignment of short stems may be a common, but under-reported problem. It is also significant that aseptic stem loosening was not a matter of concern after short-stem RSA in the short-term FU.…”

Section: Discussionmentioning

confidence: 94%

Primary reverse shoulder replacement with a short stem: A systematic literature review

Tross¹,

Woolson²,

Nolte³

et al. 2021

JSES Reviews, Reports, and Techniques

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Background: Total shoulder arthroplasty implant designs have continued to evolve over the years. One recent change has been the shortening of the humeral component to preserve bone stock and to facilitate revision surgery. Despite promising clinical results, radiographic bone adaptions occur frequently in short-stem total shoulder arthroplasty, and limited data exist on short-stem reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to provide an overview about the functional and radiographic outcomes after an uncemented short-stem RSA, as well as identify areas of clinical importance that are underreported in the current literature. Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Clinical outcome studies reporting on short-stem RSA outcomes with evidence level I-IV were included. Demographics, clinical and radiological outcomes, as well as complications and revision data were systematically analyzed and described. Results: Ten studies, published between 2014 and 2019, reporting on 555 shoulders with a mean followup of 32 months (range, 20-99.6 months) met the inclusion criteria. For all studies cuff tear arthropathy was the main indication for RSA (36%), followed by primary osteoarthritis (20%). Clinical outcome was reported in nine of ten studies, with range of motion improving in all studies. Six of the seven studies that used the Constant score (CS) demonstrated significant improvement (27.9 points to 69.3 points in weighted means). All studies reported on radiographic changes and bone adaptions. Among these, scapular notching was the most commonly observed (60 out of 327 cases, 18%) but without any described implication on clinical outcomes. No stem loosening was recorded at any final follow-up. A total of 63 complications (12.9%) were reported, with scapula fractures being the most commonly reported complication. Revision surgery was necessary in 24 cases (4.9%). Conclusion: Good clinical results, comparable with long-stem RSAs, are reported at short-term followup for short-stem RSAs. Humeral bone adaptions occur frequently but aseptic stem loosening is not a matter of concern at short-term follow-up. An area of clinical importance that is under-reported is the relation between filling ratio and stem alignment in short-stem RSA.

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Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties?

Cited by 24 publications

References 32 publications

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty—A Multicenter Study

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty—A Multicenter Study

Biomechanics of anatomic and reverse shoulder arthroplasty

Primary reverse shoulder replacement with a short stem: A systematic literature review

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