Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Short Humeral Stems in Shoulder Arthroplasty

  • Oh, Hwang Kyun (Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine) ;
  • Lim, Tae Kang (Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine)
  • Received : 2018.05.02
  • Accepted : 2018.05.07
  • Published : 2018.06.01
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Abstract

Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.

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References

  1. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br. 2009;91(1):75-81.
  2. Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20(1):146-57. https://doi.org/10.1016/j.jse.2010.08.001
  3. Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Periprosthetic humeral fractures during shoulder arthroplasty. J Bone Joint Surg Am. 2009;91(3):594-603. https://doi.org/10.2106/JBJS.H.00439
  4. Bohsali KI, Wirth MA, Rockwood CA Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279-92.
  5. Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg. 2006;15(1):19-22. https://doi.org/10.1016/j.jse.2005.05.005
  6. Farng E, Zingmond D, Krenek L, Soohoo NF. Factors predicting complication rates after primary shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20(4):557-63. https://doi.org/10.1016/j.jse.2010.11.005
  7. Kumar S, Sperling JW, Haidukewych GH, Cofield RH. Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am. 2004;86(4):680-9. https://doi.org/10.2106/00004623-200404000-00003
  8. Sperling JW, Cofield RH, Rowland CM. Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger. J Shoulder Elbow Surg. 2004;13(6):604-13. https://doi.org/10.1016/j.jse.2004.03.013
  9. Cisneros LG, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter? J Shoulder Elbow Surg. 2016;25(5):747-55. https://doi.org/10.1016/j.jse.2015.10.007
  10. Sahota S, Sperling JW, Cofield RH. Humeral windows and longitudinal splits for component removal in revision shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(10):1485-91. https://doi.org/10.1016/j.jse.2014.02.004
  11. Razfar N, Reeves JM, Langohr DG, Willing R, Athwal GS, Johnson JA. Comparison of proximal humeral bone stresses between stemless, short stem, and standard stem length: a finite element analysis. J Shoulder Elbow Surg. 2016;25(7):1076-83. https://doi.org/10.1016/j.jse.2015.11.011
  12. Raiss P, Edwards TB, Deutsch A, et al. Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014;96(7):e54. https://doi.org/10.2106/JBJS.M.00378
  13. Lee M, Chebli C, Mounce D, Bertelsen A, Richardson M, Matsen F 3rd. Intramedullary reaming for press-fit fixation of a humeral component removes cortical bone asymmetrically. J Shoulder Elbow Surg. 2008;17(1):150-5. https://doi.org/10.1016/j.jse.2007.03.032
  14. Giuseffi SA, Streubel P, Sperling J, Sanchez-Sotelo J. Short-stem uncemented primary reverse shoulder arthroplasty: clinical and radiological outcomes. Bone Joint J. 2014;96(4):526-9. https://doi.org/10.1302/0301-620X.96B3.32702
  15. Atoun E, Van Tongel A, Hous N, et al. Reverse shoulder arthroplasty with a short metaphyseal humeral stem. Int Orthop. 2014;38(6):1213-8. https://doi.org/10.1007/s00264-014-2328-8
  16. Jost PW, Dines JS, Griffith MH, Angel M, Altchek DW, Dines DM. Total shoulder arthroplasty utilizing mini-stem humeral components: technique and short-term results. HSS J. 2011;7(3):213-7. https://doi.org/10.1007/s11420-011-9221-4
  17. Casagrande DJ, Parks DL, Torngren T, et al. Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: shortterm follow-up. J Shoulder Elbow Surg. 2016;25(7):1163-9. https://doi.org/10.1016/j.jse.2015.11.067
  18. Morwood MP, Johnston PS, Garrigues GE. Proximal ingrowth coating decreases risk of loosening following uncemented shoulder arthroplasty using mini-stem humeral components and lesser tuberosity osteotomy. J Shoulder Elbow Surg. 2017;26(7):1246-52. https://doi.org/10.1016/j.jse.2016.11.041