Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis

Peduzzi, Lisa; Goetzmann, Thomas; Wein, Frank; Roche, Olivier; Sirveaux, François; Molé, Daniel; Jacquot, Adrien

doi:10.1016/j.jses.2019.09.011

Cited by 22 publications

(39 citation statements)

References 24 publications

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“…Five studies evaluated the phenomenon of subsidence between 2014 and 2019 for reverse USSPs [ 22 , 27 , 37 , 38 , 39 ]. Atoun et al [ 22 ] examined the radiographic outcome including subsidence of a reverse USSP (Verso; Biomet, Swindon, UK) in 31 patients after a mean follow-up of 36 months.…”

Section: Discussionmentioning

confidence: 99%

“…No case of subsidence occurred at final follow-up of a minimum of two years. Peduzzi et al [ 39 ] evaluated the radiological outcome including subsidence of 81 shoulders after surgical treatment with a reverse USSP (Tornier Ascend TM Flex Shoulder System, Memphis, TN, USA) at a minimum follow-up of 24 months, but no case of subsidence was present. Again, all studies evaluated the radiographic outcomes only at short-term follow-up and neither subsidence nor aseptic loosening was described as a potential “risk” within this timeframe.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Five studies reported on pain improvement from preoperative until the final FU using the Constant score (CS, 0 ¼ worst, 15 ¼ best) as an instrument for pain determination. 5,20,36,40,48 In four of these studies the pain score improved significantly. 2,20,40,48 Weighted means changed from 5.4 to 12.9 points at final FU.…”

Section: Clinical Outcomementioning

confidence: 91%

“…5,20,36,40,48 In four of these studies the pain score improved significantly. 2,20,40,48 Weighted means changed from 5.4 to 12.9 points at final FU. The standard visual analog scale (VAS; 0 ¼ best, 10 ¼ worst) was used to determine pain by Merolla et al 36 who reported significant improvement (8.5 to 0.8).…”

Section: Clinical Outcomementioning

confidence: 91%

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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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Humeral short stem varus–valgus alignment affects bone stress

Tavakoli

Spangenberg

Reeves

et al. 2021

Journal Orthopaedic Research

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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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Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis

Cited by 22 publications

References 24 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

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

Humeral short stem varus–valgus alignment affects bone stress

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