Simple preoperative radiographic and computed tomography measurements predict adequate bone quality for stemless total shoulder arthroplasty

Levin, Jay M.; Rodriguez, Kaitlyn; Polascik, Breanna A.; Zeng, Steven; Warren, Eric; Rechenmacher, Albert J.; Helmkamp, Joshua; Goltz, Daniel E.; Wickman, John R.; Klifto, Christopher S.; Lassiter, Tally; Anakwenze, Oke

doi:10.1016/j.jse.2022.05.008

Cited by 14 publications

(11 citation statements)

References 18 publications

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“… 3 Levin et al proposed a threshold for bone density using the deltoid tuberosity index and proximal humerus Hounsfield units on preoperative radiographic and computed tomography studies to allow for the preoperative determination of sufficient bone volume for stemless TSA and showed that lower deltoid tuberosity index values and bone density in the proximal humerus with Hounsfield unit values were associated with the need to switch from stemless to short stem humeral fixation in the primary TSA. 8 Further research, including the accumulation of bone density data, is needed to determine preoperative bone quality in the proximal humerus.…”

Section: Discussionmentioning

confidence: 99%

Stemless total shoulder arthroplasty for multiple epiphyseal dysplasia in a 52-year-old patient: a case report

Hiyama,

Takakuwa,

Yamaguchi

et al. 2024

JSES International

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Section: Discussionmentioning

confidence: 99%

Stemless total shoulder arthroplasty for multiple epiphyseal dysplasia in a 52-year-old patient: a case report

Hiyama,

Takakuwa,

Yamaguchi

et al. 2024

JSES International

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“…There have been a few recent attempts to predict the local bone quality at the proximal humerus for determining the surgical indication of a stemless prosthesis. Levin et al 8 compared the radiographic characteristics between patients receiving stemless and stemmed prostheses. They reported that the deltoid tuberosity index measured with X-ray and the Hounsfield units on CT were significantly different between the groups.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…7 To this end, preoperative assessments using plain radiographs, computed tomography (CT) or bone density scan (BDS) and/or intraoperative confirmation of the bony condition at the resection plane have been attempted when performing stemless aTSA. 8,9 The thumb test is commonly used as a simple technique to intraoperatively assess the cancellous bone quality at the resection plane of the proximal humerus. 7,10 As Churchill et al 10 first described, surgeons can predict the cancellous bone quality by compressing the resection plane of the proximal humerus with the thumb; if subsidence is absent at the compressed surface, it may be considered acceptable to apply a stemless prosthesis.…”

Section: Introductionmentioning

confidence: 99%

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A survey and biomechanical analysis of the feasibility of the thumb test for determining the cancellous bone quality for stemless shoulder prosthesis

Hatta,

Shinagawa,

Kawakami

et al. 2023

J Orthop Surg (Hong Kong)

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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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“…These CT scans have the potential to provide surgeons with an assessment of bone quality preoperatively by measurement of HU and allow for planning of a stemless or stemmed component. 13 …”

mentioning

confidence: 99%

Bone quality in total shoulder arthroplasty: a prospective study correlating computed tomography Hounsfield units with thumb test and fracture risk assessment tool score

Hayden¹,

Cotter²,

Hennick³

et al. 2023

JSES International

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Simple preoperative radiographic and computed tomography measurements predict adequate bone quality for stemless total shoulder arthroplasty

Cited by 14 publications

References 18 publications

Stemless total shoulder arthroplasty for multiple epiphyseal dysplasia in a 52-year-old patient: a case report

Stemless total shoulder arthroplasty for multiple epiphyseal dysplasia in a 52-year-old patient: a case report

A survey and biomechanical analysis of the feasibility of the thumb test for determining the cancellous bone quality for stemless shoulder prosthesis

Bone quality in total shoulder arthroplasty: a prospective study correlating computed tomography Hounsfield units with thumb test and fracture risk assessment tool score

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