Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

Abstract

Background: In vitro wear studies demonstrate decreased polyethylene wear with a ceramic compared with a metal humeral head. In this in vivo study, we analyzed prospectively collected 5-year data, comparing the outcomes of 2 types of humeral implants. Methods: Sixty-two anatomic total shoulder arthroplasties (TSAs) (59 patients) were performed using the same glenoid component and 2 types of modular humeral implants (metal-head long-stem prosthesis in group A vs. ceramic-head stemless prosthesis in group B). Radiographic analysis for proximal humeral osteolysis and glenoid component radiolucent lines was performed at an average of 5.5 years. Functional outcomes were prospectively evaluated according to the visual analog scale score for pain; satisfaction level; American Shoulder and Elbow Surgeons score; active elevation; Shoulder Pain and Disability Index score; and Disabilities of the Arm, Shoulder and Hand score. Results: There were 39 TSAs in group A (mean age, 68.1 years) and 23 TSAs in group B (mean age, 67 years). Clinical improvement was similar for both groups. Some proximal humeral osteolysis occurred in 56% of all TSAs. Group A showed increased osteolysis compared with group B (72% vs. 30%, P ¼ .005). Glenoid radiolucent lines were far more frequent in group A, and group A showed a direct relationship between the extent of humeral osteolysis and the severity of glenoid radiolucent lines (P < .001). Conclusion: The stemless ceramic-head replacements showed fewer glenoid radiolucent lines and less humeral osteolysis than the long-stem metal-head replacements. In the group with metal-head replacements, correlation was shown between glenoid radiolucent lines and humeral osteolysis.

Results of stemless shoulder arthroplasty: a systematic review and meta-analysis

“…Radiographic abnormalities are of interest, as they possibly influence outcome 4 and may be a predictor for aseptic loosening as is seen in hip 61 or knee 62 arthroplasty. Bell et al 25 compared osteolysis rates of 23 stemless TSAs with 39 stemmed TSAs at 5.5 years follow-up and found a significantly higher rate of osteolysis in the stemmed group (p = 0.005). However, clinical outcome was not worse in the stemmed group.…”

Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up Study

“…The rTSR was radiologically assessed in a standard technique for scapular notching according to the classification by Sirveaux et al for the glenoid component [19,20]. The humeral component was assessed for RLL around the implant in seven different zones as previously described by Levigne et al and Bell et al [16,21,22].…”

The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review

“…One option in the treatment of either primary glenohumeral joint osteoarthritis, post‐traumatic arthritis or inflammatory arthritis is shoulder arthroplasty, which has been shown to reduce pain and improve joint function significantly (Bell, Christmas, & Coghlan, 2020; Grey et al, 2020; John, 2019; Leung et al, 2012; Norris & Iannotti, 2002; Papadonikoakis, Neradilek, & Matsen, 2013; Stavrev, Ganev, & Papathanasiou, 2020). The number of shoulder arthroplasty and hemiarthroplasty procedures has increased in the last two decades, with glenohumeral joint osteoarthritis being the primary diagnosis for 43% and 77% of hemiarthroplasties and total shoulder arthroplasties respectively (Bell et al, 2020; Grey et al, 2020; Kim, Wise, Zhang, & Szabo, 2011; Papadonikoakis et al, 2013). As the prevalence of shoulder arthroplasty increases, the prevalence of shoulder revision procedures has also dramatically increased (Day et al, 2010; Kim et al, 2011).…”

“…One of the most challenging issues in the treatment of glenohumeral joint osteoarthritis is glenoid bone loss. In such individuals total shoulder arthroplasty associated with either bone grafting (including the coracoid, distal clavicle, iliac crest and allograft distal tibia), or augmented glenoid component implantation aiming to correct version, or structural bone grafting, or metallic augmentation of the bone deficiency are available treatment options (Bell et al, 2020; Grey et al, 2020; John, 2019; Rabinowitz, Friedman, & Eichinger, 2017; Sabesan, Callanan, Sharma, et al, 2014; Sabesan, Callanan, Youderian, et al, 2014). Therefore, a thorough history, physical, laboratory and radiographic examination are keys to understanding the etiology of arthritis, as well as any associated secondary humeral and glenoid bone deformity.…”