Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis.
Shoulder arthroplasty
bony adaptations
osteolysis
short stem
stress shielding
uncemented stem
Journal
JSES open access
ISSN: 2468-6026
Titre abrégé: JSES Open Access
Pays: Netherlands
ID NLM: 101738952
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
entrez:
1
1
2020
pubmed:
1
1
2020
medline:
1
1
2020
Statut:
epublish
Résumé
Short uncemented stems have recently been proposed as an alternative to classic long stems for shoulder arthroplasty. The early results are promising, but bony adaptations of the proximal humerus have been reported. The aim of this study was to quantify these phenomena using the Ascend Flex stem and to determine the risk factors. In a retrospective, single-center study, 183 shoulder arthroplasties were evaluated at 2-year follow-up. All patients underwent clinical evaluations preoperatively and at last follow-up. Radiographs were obtained preoperatively, postoperatively, and at last follow-up. Four types of bony adaptations were analyzed: medial cortical narrowing (MCN), medial metaphysis thinning (MMT), lateral metaphysis thinning (LMT), and under-the-baseplate osteolysis. The risk factors were analyzed in a multivariate model. MCN was found in 72.6% of cases and was severe (>50%) in 4.4%. MMT was found in 46.4% of cases and was severe in 3.3%. LMT was found in 9.8% of cases and was severe in 2.8%. The risk factors for MCN were the distal filling ratio, osteoporosis, and female sex, whereas MMT and LMT were only influenced by stem axis deviation. Under-the-baseplate osteolysis was found in 34.4% of cases. No influence of bony adaptations on the clinical outcomes was observed. We found no complications related to the stem or to stem loosening. The radiographic evolution was satisfactory at mid-term follow-up. Bony adaptations seemed to be limited phenomena, without any observed consequence. Avoiding excessive filling and axis deviation may limit these phenomena.
Sections du résumé
BACKGROUND
BACKGROUND
Short uncemented stems have recently been proposed as an alternative to classic long stems for shoulder arthroplasty. The early results are promising, but bony adaptations of the proximal humerus have been reported. The aim of this study was to quantify these phenomena using the Ascend Flex stem and to determine the risk factors.
MATERIALS AND METHODS
METHODS
In a retrospective, single-center study, 183 shoulder arthroplasties were evaluated at 2-year follow-up. All patients underwent clinical evaluations preoperatively and at last follow-up. Radiographs were obtained preoperatively, postoperatively, and at last follow-up. Four types of bony adaptations were analyzed: medial cortical narrowing (MCN), medial metaphysis thinning (MMT), lateral metaphysis thinning (LMT), and under-the-baseplate osteolysis. The risk factors were analyzed in a multivariate model.
RESULTS
RESULTS
MCN was found in 72.6% of cases and was severe (>50%) in 4.4%. MMT was found in 46.4% of cases and was severe in 3.3%. LMT was found in 9.8% of cases and was severe in 2.8%. The risk factors for MCN were the distal filling ratio, osteoporosis, and female sex, whereas MMT and LMT were only influenced by stem axis deviation. Under-the-baseplate osteolysis was found in 34.4% of cases. No influence of bony adaptations on the clinical outcomes was observed. We found no complications related to the stem or to stem loosening.
CONCLUSION
CONCLUSIONS
The radiographic evolution was satisfactory at mid-term follow-up. Bony adaptations seemed to be limited phenomena, without any observed consequence. Avoiding excessive filling and axis deviation may limit these phenomena.
Identifiants
pubmed: 31891026
doi: 10.1016/j.jses.2019.09.011
pii: S2468-6026(19)30051-8
pmc: PMC6928264
doi:
Types de publication
Journal Article
Langues
eng
Pagination
278-286Informations de copyright
© 2019 The Author(s).
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