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Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty

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Abstract

Purpose

Some patients show severe humeral bone stress shielding even one year after press-fit humeral stem, which can be a risk factor for implant durability. This study compared humeral stress shielding and clinical outcomes between high and low filling ratio (HFR and LFR) stems in primary reverse shoulder arthroplasty (RSA).

Methods

From 2015 to 2020, 104 patients who underwent RSA with a non-cemented standard-length humeral stem were examined. The humeral stems included large press-fit stems (HFR group, 53 patients) or small non-press-fit stems with autogenous cancellous bone grafting (LFR group, 51 patients). The radiologic and clinical outcomes were compared between the groups one year post-operatively.

Results

One patient in the LFR group with early infectious dislocation was excluded from the 1-one year evaluation. No stress shielding was observed in 27/50 (54.0%) and 5/53 (9.4%) of patients in the LFR and HFR groups, while 3/50 (6%) and 19/53 (35.8%) patients showed high-stress shielding, respectively. However, the stem alignment change, subsidence, complications and evidence of loosening did not differ between the groups. The final range-of-motion and functional scores were significantly poorer in the LFR group than those in the HFR group, although the difference was minimal.

Conclusion

Even at one year follow-up, patients receiving LFR stems with autogenous bone grafting had significantly less humeral stress shielding compared to patients with HFR stem with press-fit in primary RSA, without compromising stem stability.

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Data availability

The data of this study is not stored in a public repository and is not available for public use.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Su Cheol Kim, Jong Hun Park, Hashem Bukhary & Jae Chul Yoo

Authors
  1. Su Cheol Kim
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  2. Jong Hun Park
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  3. Hashem Bukhary
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  4. Jae Chul Yoo
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Contributions

Conceptualization: Jae Chul Yoo, Su Cheol Kim.

Methodology: Jong Hun Park, Su Cheol Kim.

Formal analysis and investigation: Su Cheol Kim, Hashem Bukhary.

Writing—original draft preparation: Su Cheol Kim, Hashem Bukhary.

Writing—review and editing: Jae Chul Yoo, Jong Hun Park.

Supervision: Jae Chul Yoo.

All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jae Chul Yoo.

Ethics declarations

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Samsung Medical Center (No. SMC 2020–01-117–001) approved the study.

Consent to participate

Consent for participation was waived because of the retrospective study design and no additional harm to the patients.

Consent to publish

Consent for publication was waived because of the retrospective study design and no additional harm to the patients.

Competing interests

The authors declare no competing interests.

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Level of Evidence: III, Retrospective comparative study

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Kim, S., Park, J., Bukhary, H. et al. Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty. International Orthopaedics (SICOT) 46, 1341–1349 (2022). https://doi.org/10.1007/s00264-022-05383-4

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  • DOI: https://doi.org/10.1007/s00264-022-05383-4

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