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Proximal humeral bone loss in stemless shoulder arthroplasty: potential factors influencing bone loss and a new classification system

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Proximal humeral bone loss in total shoulder arthroplasty (TSA) is more frequent than in hemiarthroplasty. Factors such as age, gender, inclination angle, and radiolucent lines may also contribute. Additionally, current bone loss grading systems are often not sensitive enough to detect slight bone changes, especially at the medial calcar where bone loss is commonly observed. This study uses a new, more detailed bone loss grading system to evaluate factors that could influence bone loss at the proximal humerus.

Materials and methods

In this single-center prospective study, patients underwent hemiarthroplasty or TSA with an anatomic stemless prosthesis. Bone loss was measured at the proximal humerus using the new grading system. The effect of treatment type, age, gender, radiolucent lines, and inclination angle on bone loss was evaluated. The Constant-Murley score of patients was assessed and complications recorded.

Results

Ninety-one shoulders were available for the final follow-up examination at a median of 85.0 months (range 82.6–121.1 months). Bone loss was found at the proximal humerus in approximately one-third of shoulders, and significantly more shoulders had bone loss in TSA than in hemiarthroplasty (P = 0.03). However, this difference was no longer significant after stratifying by gender and age (P > 0.05). Bone loss significantly correlated with gender (P = 0.03) but not with treatment type, radiolucent lines, and the postoperative inclination angle (P > 0.05). Most Constant–Murley score components did not differ significantly between shoulders with and without bone loss (P > 0.05). Lastly, six complications and four revisions were reported.

Conclusions

Results showed gender had the greatest influence on bone loss after stemless shoulder arthroplasty. Furthermore, both patients with or without bone loss can expect similar clinical outcomes with the stemless prosthesis used in this study. Lastly, the new grading system is simple and straightforward to use.

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Acknowledgements

We thank Dr. Dominik Pfluger at numerics data GmbH for statistical analysis and Medical Minds GmbH for providing medical writing and editorial support.

Funding

The author(s) received no financial support for research, authorship, and/or publication of this manuscript.

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Authors and Affiliations

  1. Marienstift Arnstadt, Clinic for Orthopaedic Surgery, Wachsenburgallee 12, 99310, Arnstadt, Germany

    Marco Greis, Karsten Heubach & Maik Hoberg

  2. Sports Clinic Erfurt, Am Urbicher Kreuz 7, 99099, Erfurt, Germany

    Ulrich Irlenbusch

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  1. Marco Greis
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  2. Karsten Heubach
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  3. Maik Hoberg
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  4. Ulrich Irlenbusch
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Contributions

All authors have substantially contributed to the conception and design of the study, the acquisition, analysis interpretation of data, and drafting of the manuscript. All authors commented on previous versions of the manuscript and also read and approved the final manuscript.

Corresponding author

Correspondence to Ulrich Irlenbusch.

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Conflict of interest

Financial interests: the authors declare they have no financial interests. Non-financial interests: U.I. is a medical advisor for Mathys Ltd Bettlach.

Ethical approval

This study was approved by The Comité intercantonal d’éthique (Jura, Fribourg, Neuchatel) in February 2012 (number 012/10770). It is compliant with the Declaration of Helsinki.

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Greis, M., Heubach, K., Hoberg, M. et al. Proximal humeral bone loss in stemless shoulder arthroplasty: potential factors influencing bone loss and a new classification system. Arch Orthop Trauma Surg 143, 3085–3090 (2023). https://doi.org/10.1007/s00402-022-04493-3

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  • DOI: https://doi.org/10.1007/s00402-022-04493-3

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