Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty
Background: Standard stemmed humeral implants have traditionally been utilized for total shoulder arthroplasty (TSA) with a recent trend to implant smaller stems including short and stemless humeral designs. However, the rate of stress shielding after stemless TSA has not been primarily studied. The...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638323000063 |
| _version_ | 1811162654039867392 |
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| author | Kevin M. Magone, MD Austin Leonard, BS Felix H. Savoie, MD Curtis R. Noel, MD Ryan W. Simovitch, MD Alexander T. Greene, BS Oke A. Anakwenze, MD, MBA |
| author_facet | Kevin M. Magone, MD Austin Leonard, BS Felix H. Savoie, MD Curtis R. Noel, MD Ryan W. Simovitch, MD Alexander T. Greene, BS Oke A. Anakwenze, MD, MBA |
| author_sort | Kevin M. Magone, MD |
| collection | DOAJ |
| description | Background: Standard stemmed humeral implants have traditionally been utilized for total shoulder arthroplasty (TSA) with a recent trend to implant smaller stems including short and stemless humeral designs. However, the rate of stress shielding after stemless TSA has not been primarily studied. Therefore, the objective of this study is to report the short-term survivorship and radiographic analysis of a stemless humeral implant. Methods: A retrospective cohort review of a prospectively collected, multicenter database for patients undergoing total shoulder arthroplasty with a stemless humeral design (Equinoxe Stemless; Exactech, Inc., Gainesville, FL, USA) with a minimum of 2 years clinical and radiographic follow-up was performed. The primary outcomes were to report the location and rate of stress shielding from a radiographic analysis of the humeral stem. Additionally, the revision rate of the humeral stem is reported. The secondary outcomes included ASES scores, visual analog scale (VAS) pain scores, and range of motion (ROM). Radiographs (anterior-posterior/Grashey and axillary) were reviewed blindly by two fellowship trained shoulder surgeons. Radiographic analysis included stress shielding (partial or complete cortical resorption) and subsidence or shift in component position. Results: Fifty four patients were included in this study with an average follow-up of 27 months (range 24-32 months). The average age of this cohort was 65 years (range 57-73 years) with 23 patients (43%) being female. Stress shielding was observed in 4 patients (7%) with the medial calcar being the most common location of stress shielding. Three of the 4 patients (75%) had evidence of partial resorption while 1 patient (25%) had evidence of complete resorption. No humeral component shift or subsidence was observed. There were no revisions due to humeral component complications. There was 1 revision surgery for aseptic glenoid loosening. A significant improvement for all clinical outcome measures was seen including with respect to VAS pain, which improved from 6.2 to 1.8 (P < .05), ASES, which improved from 38.2 to 81.8 (P < .05), and ROM which forward flexion improved from 120 degrees to 153 degrees (P < .05) and external rotation improved from 29 degrees to 49 degrees (P < .05). Discussion: This ongoing study demonstrates a low rate of stress shielding for a stemless design humeral implant at short-term follow-up without any revision surgery due to humeral component complications. Longer term radiographic and clinical analysis with this cohort will be needed to confirm these findings and theoretical benefits for future revision surgeries. |
| first_indexed | 2024-04-10T06:32:45Z |
| format | Article |
| id | doaj.art-3d2edf3443d54f80a00f200c60592aef |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-04-10T06:32:45Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-3d2edf3443d54f80a00f200c60592aef2023-03-01T04:33:14ZengElsevierJSES International2666-63832023-03-0172285289Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplastyKevin M. Magone, MD0Austin Leonard, BS1Felix H. Savoie, MD2Curtis R. Noel, MD3Ryan W. Simovitch, MD4Alexander T. Greene, BS5Oke A. Anakwenze, MD, MBA6CHI Saint Joseph Medical Group–Orthopedic Associates, CHI Saint Joseph Health, London, KY, USADepartment of Orthopedic Surgery, Duke University Hospital, Duke University School of Medicine, Durham, NC, USADepartment of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USACrystal Clinic Orthopaedic Center, Akron, OH, USAHospital for Special Surgery–Florida, West Palm Beach, FL, USAExactech, Inc., Gainesville, FL, USADepartment of Orthopedic Surgery, Duke University Hospital, Duke University School of Medicine, Durham, NC, USA; Corresponding author: Oke A. Anakwenze, MD, MBA, Duke University School of Medicine, Duke University Hospital, 3475 Erwin Rd, Durham, NC 27705, USA.Background: Standard stemmed humeral implants have traditionally been utilized for total shoulder arthroplasty (TSA) with a recent trend to implant smaller stems including short and stemless humeral designs. However, the rate of stress shielding after stemless TSA has not been primarily studied. Therefore, the objective of this study is to report the short-term survivorship and radiographic analysis of a stemless humeral implant. Methods: A retrospective cohort review of a prospectively collected, multicenter database for patients undergoing total shoulder arthroplasty with a stemless humeral design (Equinoxe Stemless; Exactech, Inc., Gainesville, FL, USA) with a minimum of 2 years clinical and radiographic follow-up was performed. The primary outcomes were to report the location and rate of stress shielding from a radiographic analysis of the humeral stem. Additionally, the revision rate of the humeral stem is reported. The secondary outcomes included ASES scores, visual analog scale (VAS) pain scores, and range of motion (ROM). Radiographs (anterior-posterior/Grashey and axillary) were reviewed blindly by two fellowship trained shoulder surgeons. Radiographic analysis included stress shielding (partial or complete cortical resorption) and subsidence or shift in component position. Results: Fifty four patients were included in this study with an average follow-up of 27 months (range 24-32 months). The average age of this cohort was 65 years (range 57-73 years) with 23 patients (43%) being female. Stress shielding was observed in 4 patients (7%) with the medial calcar being the most common location of stress shielding. Three of the 4 patients (75%) had evidence of partial resorption while 1 patient (25%) had evidence of complete resorption. No humeral component shift or subsidence was observed. There were no revisions due to humeral component complications. There was 1 revision surgery for aseptic glenoid loosening. A significant improvement for all clinical outcome measures was seen including with respect to VAS pain, which improved from 6.2 to 1.8 (P < .05), ASES, which improved from 38.2 to 81.8 (P < .05), and ROM which forward flexion improved from 120 degrees to 153 degrees (P < .05) and external rotation improved from 29 degrees to 49 degrees (P < .05). Discussion: This ongoing study demonstrates a low rate of stress shielding for a stemless design humeral implant at short-term follow-up without any revision surgery due to humeral component complications. Longer term radiographic and clinical analysis with this cohort will be needed to confirm these findings and theoretical benefits for future revision surgeries.http://www.sciencedirect.com/science/article/pii/S2666638323000063Stemless designTotal shoulder arthroplastyRadiographic analysisStress shieldingOsteolysisHumeral lucency |
| spellingShingle | Kevin M. Magone, MD Austin Leonard, BS Felix H. Savoie, MD Curtis R. Noel, MD Ryan W. Simovitch, MD Alexander T. Greene, BS Oke A. Anakwenze, MD, MBA Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty JSES International Stemless design Total shoulder arthroplasty Radiographic analysis Stress shielding Osteolysis Humeral lucency |
| title | Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| title_full | Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| title_fullStr | Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| title_full_unstemmed | Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| title_short | Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| title_sort | short term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty |
| topic | Stemless design Total shoulder arthroplasty Radiographic analysis Stress shielding Osteolysis Humeral lucency |
| url | http://www.sciencedirect.com/science/article/pii/S2666638323000063 |
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