In vitro initial stability of a stemless humeral implant

Favre, Philippe; Seebeck, J.; Thistlethwaite, Paul; Obrist, Marc; Steffens, Jason G.; Hopkins, Andrew R.; Hulme, Paul A.

doi:10.1016/j.clinbiomech.2015.12.004

Cited by 33 publications

(31 citation statements)

References 23 publications

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“…Telemeterized implant data indicate that the joint force can reach 850 N (120% body weight of 70-kg patient) by placing a 2-kg object on a shelf, 18 which has been shown to create micromotions up to 270 µm for a short-stem device. 3 Our data indicate that the peripheral bone has greater density, and this also may be used for lower profile peripheral fixation features of the humeral component. Our data also show that the highest density bone is located in the outer third and fourth concentric rings of every slice, particularly those located below the anatomic neck.…”

Section: Discussionmentioning

confidence: 62%

“…The current study shows that below the anatomic neck, the central portion of the humerus may have a density just around 0.1 g∙cm −3 , which has been shown to be an indication for increased micromotion above the commonly accepted value of 150 µm. 3 This micromotion threshold may be exceeded in the shoulder for short-stem devices, before osseointegration for normal activity. Telemeterized implant data indicate that the joint force can reach 850 N (120% body weight of 70-kg patient) by placing a 2-kg object on a shelf, 18 which has been shown to create micromotions up to 270 µm for a short-stem device.…”

Section: Discussionmentioning

confidence: 99%

“…Wirth et al, 19 using finite element simulations developed from micro-CT scans of the humeral trabecular bone, have demonstrated that an implant-bone construct located in the central region of the humerus trabecular bone has less structural stiffness than those placed peripherally. In addition, Favre et al, 3 using cadaveric humeri and displacement-measuring transducers, have shown that micromotion in short-stem designs significantly increases as the trabecular apparent bone density decreases. The data in the current study may therefore be useful for implant design but are also useful for positioning of existing designs.…”

Section: Discussionmentioning

confidence: 99%

“…The density of the bone in this region is therefore important for achieving adequate component fixation. In fact, Favre et al, 3 using cadaveric humeri, showed that in a short-stem device, micromotion between bone and implant may increase significantly with decreased apparent bone density. They showed that when bone density is lower than 0.1 g∙cm −3 , an implant may experience micromotions above the 150-µm threshold accepted to result in bone growth.…”

mentioning

confidence: 99%

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Spatial mapping of humeral head bone density

Alidousti

Giles

Emery

et al. 2017

Journal of Shoulder and Elbow Surgery

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BackgroundShort-stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high-density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus.MethodsEight computed tomography scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head. The proximal humeral head was divided into 12 slices parallel to the humeral anatomic neck. Each slice was then divided into 4 concentric circles. The slices below the anatomic neck, where short-stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated, and regions of interest were compared using a repeated-measures analysis of variance with significance set at P < .05.ResultsAverage apparent bone density was found to decrease from proximal to distal regions, with the majority of higher bone density proximal to the anatomic neck of the humerus (P < .05). Below the anatomic neck, bone density increases from central to peripheral regions, where cortical bone eventually occupies the space (P < .05). In distal slices below the anatomic neck, a higher bone density distribution in the medial calcar region was also observed.ConclusionThis study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomic neck and epiphyseal plate and to use the denser bone at the periphery.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Spatial mapping of humeral head bone density

Alidousti

Giles

Emery

et al. 2017

Journal of Shoulder and Elbow Surgery

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“…MINORS score uses a global score of 24 in comparative studies and 16 for non-comparative studies, evaluating 8 or 12 domains of bias. Methodological quality was categorized a priori as: very low-quality evidence (score 0-6); low quality of evidence (score 7-10); fair quality (score [11][12][13][14][15]; and high quality (score >16) evidence for non-randomized studies. 7 The Cochrane Risk of Bias tool was used to evaluate included randomized trials.…”

Section: Data Extractionmentioning

confidence: 99%

Templating in shoulder arthroplasty – A comparison of 2D CT to 3D CT planning software: A systematic review

et al. 2019

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Background Computed tomography (CT) utilizing computer software technology to generate three-dimensional (3D) rendering of the glenoid has become the preferred method for preoperative planning. It remains largely unknown what benefits this software may have to the intraoperative placement of the components and patient outcomes. Purpose The purpose of this systematic review is to compare 2D CT to 3D CT planning in total shoulder arthroplasty. Study design Systematic review. Methods A systematic database search was conducted for relevant studies evaluating the role of 3D CT planning in total shoulder arthroplasty. The primary outcome was component placement variability, and the secondary outcomes were intra- and inter-observer reliability in the context of preoperative planning. Results Following title-abstract and full-text screening, six eligible studies were included in the review (n = 237). The variability in glenoid measurements between 3D CT and 2D CT planning ranged from no significant difference to a 5° difference in version and 1.7° difference in inclination (p<0.05). Posterior bone loss was underestimated in 52% of the 2D measured patients relative to 3D CT groups. Irrespective of 2D and 3D planning (39% and 43% of cases respectively), surgeons elected to implant larger components than those templated. There was no literature identified comparing differences in time, cost, functional outcomes, complications, or patient satisfaction. Conclusion The paucity of evidence exploring clinical parameters makes it difficult to comment on clinical outcomes using different methods of templating. More studies are required to identify how improved radiographic outcomes translate into improvements that are clinically meaningful to patients.

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Full‐field experimental analysis of the influence of microstructural parameters on the mechanical properties of humeral head trabecular bone

Kusins

Knowles

Martensson

et al. 2021

Journal Orthopaedic Research

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Understanding the mechanical properties of trabecular bone within the metaphysis of the proximal humerus is becoming increasingly important for the design of humeral head joint replacement components that prioritize bone preservation. The aim of this study was to perform full‐field mechanical testing methods on isolated trabecular bone cores from the humeral head to experimentally measure the local magnitude of strain before macroscopic failure and to characterize the ultimate strength of each core. Isolated cubic trabecular bone cores were extracted from the center of humeral head osteotomies retrieved from (1) patients with end‐stage osteoarthritis (OA) undergoing total shoulder arthroplasty (TSA) and (2) normal nonpathologic cadaveric humeral heads. A custom computed tomography (CT)‐compatible loading device was used to perform compressive mechanical testing. For 10 of the OA specimens, stepwise loading was performed directly within a microCT scanner and digital volume correlation (DVC) was used to measure full‐field strains throughout the trabecular structure. A higher variability in ultimate strength was measured for the trabecular cores retrieved from OA humeral heads (range: 2.8–7.6 MPa) compared to the normal cadaveric humeral heads (range: 2.2–5.4 MPa), but no statistically significant difference between the groups was found (p = 0.06). Ultimate strength was strongly correlated with bone volume fraction (OA r2 = 0.72; normal r2 = 0.76) and bone mineral content (OA r2 = 0.79; normal r2 = 0.77). At the trabecular level, 95th percentile of third principal strains, measured at a subvolume size of 152 µm, exceeded 19,000 µε for each of the 10 specimens (range: −19,551 to −36,535 µε) before macroscopic failure of the cores occured. No strong linear correlations (r2 ≥ 0.50) were found between the median or 95th percentile of DVC third principal strain and the corresponding morphometric parameters of each individual bone core. The results of this study indicate that bone volume fraction and bone mineral content heavily influence the apparent ultimate strength of trabecular bone cores collected from OA patients undergoing TSA. Clinical significance: The strong correlations observed within this study further emphasize the importance of considering bone mineral content or bone volume fraction measurements in assessing the localized risk of trabecular bone fracture for orthopedic applications.

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In vitro initial stability of a stemless humeral implant

Cited by 33 publications

References 23 publications

Spatial mapping of humeral head bone density

Spatial mapping of humeral head bone density

Templating in shoulder arthroplasty – A comparison of 2D CT to 3D CT planning software: A systematic review

Full‐field experimental analysis of the influence of microstructural parameters on the mechanical properties of humeral head trabecular bone

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