Humeral Bone Resorption After Reverse Shoulder Arthroplasty Using Uncemented Stem

Overview

Journal JSES Int

Date 2020 Mar 21

PMID 32195476

Citations 6

Authors

Kazuya Inoue

Naoki Suenaga

Naomi Oizumi

Hiroshi Yamaguchi

Naoki Miyoshi

Noboru Taniguchi

Shuzo Morita

Mitsuru Munemoto

Shimpei Kurata

Yasuhito Tanaka

Affiliations

Soon will be listed here.

Abstract

Background: Humeral stem loosening has gained attention as it has been identified as a cause of revision surgery in reverse shoulder arthroplasty (RSA). In RSA, humeral stem revision is very difficult if there is humeral bone loss because of stress shielding. Some studies of humeral bone resorption after anatomic shoulder arthroplasty have been published, but there are few detailed reports of humeral bone resorption after RSA. This study aimed to investigate the prevalence of humeral bone resorption after RSA procedures and to evaluate the risk factors for bone resorption.

Methods: This study included 48 shoulders that underwent RSA with an uncemented humeral stem from July 2014 to May 2017 and were followed up for more than 1 year. The prevalence of humeral bone resorption and risk factors were investigated. Logistic, multiple logistic, and multivariate logistic regression analyses were performed to evaluate the data.

Results: Grade 0 bone resorption, the most advanced grade, occurred in 8 shoulders (16.7%); grade 1, in 0 (0%); grade 2, in 17 (35.4%); grade 3, in 14 (29.2%); and grade 4, in 9 (18.8%). A high occurrence of bone absorption was observed in zones 1, 2, and 7. Grade 4 bone resorption did not occur in zones 3, 5, and 6. Female sex and an onlay-type stem were significant independent risk factors for grade 4 bone resorption.

Conclusions: Bone resorption was frequently observed in the greater tuberosity, lateral diaphysis, and calcar region. Significant risk factors included female sex and an onlay-type stem.

Citing Articles

Stress shielding in reverse shoulder arthroplasty using a proximally coated stem for proximal humeral fractures: Does it have clinical relevance?.

Gonalons-Giol F, Ventura-Parellada C, Alonso-Rodriguez-Piedra J, Llorens-Martinez X, Gamez-Banos F, Mora-Guix J Shoulder Elbow. 2025; 17585732241309899.

PMID: 39781108 PMC: 11705294. DOI: 10.1177/17585732241309899.

Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study.

Ritter D, Raiss P, Denard P, Werner B, Muller P, Woiczinski M J Imaging. 2024; 10(12.

PMID: 39728231 PMC: 11727762. DOI: 10.3390/jimaging10120334.

Stress shielding in stemmed reverse shoulder arthroplasty: an updated review.

Vasiliadis A, Giovanoulis V, Lepidas N, Bampis I, Servien E, Lustig S SICOT J. 2024; 10:37.

PMID: 39303143 PMC: 11415035. DOI: 10.1051/sicotj/2024029.

Association between the canal filling ratio and bone resorption in trabecular metal stems in reverse total shoulder arthroplasty: a radiographic analysis using tomosynthesis.

Takayama K, Ito H JSES Int. 2024; 8(5):1077-1086.

PMID: 39280137 PMC: 11401559. DOI: 10.1016/j.jseint.2024.05.010.

Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties?.

Garcia-Fernandez C, Lopiz Y, Garriguez-Perez D, Arvinius C, Ponz V, Echevarria M Eur J Orthop Surg Traumatol. 2024; 34(4):1851-1863.

PMID: 38431896 DOI: 10.1007/s00590-024-03864-3.

References

Denard P, Noyes M, Walker J, Shishani Y, Gobezie R, Romeo A . Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 27(1):53-58. DOI: 10.1016/j.jse.2017.06.042. View

Ascione F, Domos P, Guarrella V, Chelli M, Boileau P, Walch G . Long-term humeral complications after Grammont-style reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27(6):1065-1071. DOI: 10.1016/j.jse.2017.11.028. View

Denard P, Noyes M, Walker J, Shishani Y, Gobezie R, Romeo A . Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 27(2):217-223. DOI: 10.1016/j.jse.2017.08.010. View

Raiss P, Edwards T, Deutsch A, Shah A, Bruckner T, Loew M . Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014; 96(7):e54. DOI: 10.2106/JBJS.M.00378. View

Casagrande D, Parks D, Torngren T, Schrumpf M, Harmsen S, Norris T . Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up. J Shoulder Elbow Surg. 2016; 25(7):1163-9. DOI: 10.1016/j.jse.2015.11.067. View

Harmsen S, Norris T . Radiographic changes and clinical outcomes associated with an adjustable diaphyseal press-fit humeral stem in primary reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 26(9):1589-1597. DOI: 10.1016/j.jse.2017.02.006. View

Schnetzke M, Preis A, Coda S, Raiss P, Loew M . Anatomical and reverse shoulder replacement with a convertible, uncemented short-stem shoulder prosthesis: first clinical and radiological results. Arch Orthop Trauma Surg. 2017; 137(5):679-684. DOI: 10.1007/s00402-017-2673-3. View

Merolla G, Walch G, Ascione F, Paladini P, Fabbri E, Padolino A . Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up. J Shoulder Elbow Surg. 2018; 27(4):701-710. DOI: 10.1016/j.jse.2017.10.016. View

Boileau P . Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016; 102(1 Suppl):S33-43. DOI: 10.1016/j.otsr.2015.06.031. View

10.

Schnetzke M, Coda S, Raiss P, Walch G, Loew M . Radiologic bone adaptations on a cementless short-stem shoulder prosthesis. J Shoulder Elbow Surg. 2015; 25(4):650-7. DOI: 10.1016/j.jse.2015.08.044. View

11.

Schnetzke M, Coda S, Walch G, Loew M . Clinical and radiological results of a cementless short stem shoulder prosthesis at minimum follow-up of two years. Int Orthop. 2015; 39(7):1351-7. DOI: 10.1007/s00264-015-2770-2. View

12.

Spormann C, Durchholz H, Audige L, Flury M, Schwyzer H, Simmen B . Patterns of proximal humeral bone resorption after total shoulder arthroplasty with an uncemented rectangular stem. J Shoulder Elbow Surg. 2014; 23(7):1028-35. DOI: 10.1016/j.jse.2014.02.024. View

13.

Nagels J, Stokdijk M, Rozing P . Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg. 2003; 12(1):35-9. DOI: 10.1067/mse.2003.22. View

14.

Zumstein M, Pinedo M, Old J, Boileau P . Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2010; 20(1):146-57. DOI: 10.1016/j.jse.2010.08.001. View

15.

Melis B, DeFranco M, Ladermann A, Mole D, Favard L, Nerot C . An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg Br. 2011; 93(9):1240-6. DOI: 10.1302/0301-620X.93B9.25926. View

16.

Al-Hadithy N, Domos P, Sewell M, Pandit R . Reverse shoulder arthroplasty in 41 patients with cuff tear arthropathy with a mean follow-up period of 5 years. J Shoulder Elbow Surg. 2014; 23(11):1662-8. DOI: 10.1016/j.jse.2014.03.001. View

17.

McElwain J, English E . The early results of porous-coated total shoulder arthroplasty. Clin Orthop Relat Res. 1987; (218):217-24. View

18.

Grey B, Rodseth R, Roche S . Humeral Stem Loosening Following Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2018; 6(5):e5. DOI: 10.2106/JBJS.RVW.17.00129. View

19.

Szerlip B, Morris B, Laughlin M, Kilian C, Edwards T . Clinical and radiographic outcomes after total shoulder arthroplasty with an anatomic press-fit short stem. J Shoulder Elbow Surg. 2017; 27(1):10-16. DOI: 10.1016/j.jse.2017.08.012. View

20.

Roche C, Diep P, Hamilton M, Crosby L, Flurin P, Wright T . Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013). 2013; 71(4):284-93. View