Skip to main content
SpringerLink
Log in

Does the proximal humeral bone quality influence alignment after reverse total shoulder arthroplasty with short humeral stems?

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

When compared to standard-length humeral stem in reverse total shoulder arthroplasty (RTSA), short humeral stems in RTSA require good proximal humeral metaphyseal bone quality to gain proper and secure fixation during prosthetic implantation. Shorter humeral stems potentially carry more risk of misalignment than standard or long humeral stems. The hypothesis was that misalignment of the short humeral stems is influenced by regional bone quality.

Methods

RTSA with a short curved humeral stem with neck-shaft angle (NSA) default of 132.5° was reviewed. The study group included 35 cases at a mean age of 75.97 (± 6.23) years. Deltoid-tuberosity index (DTI) was measured to evaluate proximal humeral bone quality. The deltoid tuberosity index was measured at immediately above position of the upper end of the deltoid tuberosity. Stem alignment was given by the angle measured in degrees between the intramedullary humeral shaft axis and the axis of the humeral implant stem.

Results

The patient’s mean DTI was 1.37 ± 0.16 (median, 1.32; range, 1.12–1.80). 22 patients had poor bone quality (DTI < 1.4), compared to 13 patients with acceptable bone quality (DTI > 1.4). After RTSA, ten humeral components (29%) were neutrally aligned, whereas 25 humeral components (71%) were misaligned. There was no correlation between misalignment and DTI (r = 0.117; p = 0.504). But there was a strong correlation between misalignment and the patient’s own NSA (r = − 0.47; p = 0.004). The postoperative stem position and stem misalignment are not associated with functional outcomes (p > 0.05).

Conclusion

The misalignment of the short curved humeral stem frequently occurs. Poor reginal humeral bone quality does not influence misalignment after RTSA with a short humeral stem. Postoperative stem alignment is associated with the patient’s preoperative NSA and method of neck cut. The misalignment does not affect functional outcomes for midterm follow-up. Further long-term follow-up studies are needed to confirm its clinical relevance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Erickson BJ, Bohl DD, Cole BJ, Verma NN, Nicholson G, Romeo AA, Harris JD (2018) Reverse total shoulder arthroplasty: indications and techniques across the world. Am J Orthop. https://doi.org/10.12788/ajo.2018.0079

    Article  PubMed  Google Scholar 

  2. Raiss P, Schnetzke M, Wittmann T, Kilian CM, Edwards TB, Denard PJ, Neyton L, Godeneche A, Walch G (2019) Postoperative radiographic findings of an uncemented convertible short stem for anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg 28(4):715–723. https://doi.org/10.1016/j.jse.2018.08.037

    Article  PubMed  Google Scholar 

  3. Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AA (2015) Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma 29(1):54–59. https://doi.org/10.1097/BOT.0000000000000229

    Article  PubMed  Google Scholar 

  4. Testa EJ, Albright JA, Lemme NJ, Molla V, McCrae B, Daniels AH, Paxton ES (2023) Increased risk of periprosthetic fractures and revision arthroplasty in patients undergoing shoulder arthroplasty with a history of prior fragility fractures: a matched cohort analysis. J Am Acad Orthop Surg 31(9):e473–e480. https://doi.org/10.5435/JAAOS-D-22-00752

    Article  PubMed  Google Scholar 

  5. Ascione F, Domos P, Guarrella V, Chelli M, Boileau P, Walch G (2018) Long-term humeral complications after grammont-style reverse shoulder arthroplasty. J Shoulder Elbow Surg 27(6):1065–1071. https://doi.org/10.1016/j.jse.2017.11.028

    Article  PubMed  Google Scholar 

  6. Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, Bruguera J, Sforza G, Atoun E (2016) Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg 25(8):1362–1370. https://doi.org/10.1016/j.jse.2015.12.017

    Article  PubMed  Google Scholar 

  7. Atoun E, Van Tongel A, Hous N, Narvani A, Relwani J, Abraham R, Levy O (2014) Reverse shoulder arthroplasty with a short metaphyseal humeral stem. Int Orthop 38(6):1213–1218. https://doi.org/10.1007/s00264-014-2328-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Boileau P, Walch G (1997) The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br 79(5):857–865. https://doi.org/10.1302/0301-620x.79b5.7579

    Article  CAS  PubMed  Google Scholar 

  9. Schnetzke M, Rick S, Raiss P, Walch G, Loew M (2018) Mid-term results of anatomical total shoulder arthroplasty for primary osteoarthritis using a short-stemmed cementless humeral component. Bone Joint J 100-B. 5:603–609. https://doi.org/10.1302/0301-620X.100B5.BJJ-2017-1102.R2

    Article  Google Scholar 

  10. Razfar N, Reeves JM, Langohr DG, Willing R, Athwal GS, Johnson JA (2016) Comparison of proximal humeral bone stresses between stemless, short stem, and standard stem length: a finite element analysis. J Shoulder Elbow Surg 25(7):1076–1083. https://doi.org/10.1016/j.jse.2015.11.011

    Article  PubMed  Google Scholar 

  11. Chalmers PN, Boileau P, Romeo AA, Tashjian RZ (2019) Revision reverse shoulder arthroplasty. JAAOS-J Am Acad Orthop Surg 27(12):426–436

    Article  Google Scholar 

  12. Tross AK, Woolson TE, Nolte PC, Schnetzke M, Loew M, Millett PJ (2021) Primary reverse shoulder replacement with a short stem: a systematic literature review. JSES Rev Rep Tech 1(1):7–16. https://doi.org/10.1016/j.xrrt.2020.11.008

    Article  PubMed  Google Scholar 

  13. Aibinder WR, Bartels DW, Sperling JW, Sanchez-Sotelo J (2019) Mid-term radiological results of a cementless short humeral component in anatomical and reverse shoulder arthroplasty. Bone Joint J 101-b 5:610–614. https://doi.org/10.1302/0301-620x.101b5.Bjj-2018-1374.R1

    Article  Google Scholar 

  14. Linke P, Linke C, Neumann J, Werner AW (2023) Midterm clinical outcome of uncemented short-stem reversed shoulder arthroplasty. Arch Orthop Trauma Surg 143(6):3025–3036. https://doi.org/10.1007/s00402-022-04510-5

    Article  PubMed  Google Scholar 

  15. Schnetzke M, Coda S, Raiss P, Walch G, Loew M (2016) Radiologic bone adaptations on a cementless short-stem shoulder prosthesis. J Shoulder Elbow Surg 25(4):650–657. https://doi.org/10.1016/j.jse.2015.08.044

    Article  PubMed  Google Scholar 

  16. Abdic S, Athwal GS, Wittmann T, Walch G, Raiss P (2021) Short stem humeral components in reverse shoulder arthroplasty: stem alignment influences the neck-shaft angle. Arch Orthop Trauma Surg 141(2):183–188. https://doi.org/10.1007/s00402-020-03424-4

    Article  PubMed  Google Scholar 

  17. Lädermann A, Chiu JC, Cunningham G, Hervé A, Piotton S, Bothorel H, Collin P (2020) Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties? Orthop traumatol surg res: OTSR 106(2):241–246. https://doi.org/10.1016/j.otsr.2019.12.010

    Article  PubMed  Google Scholar 

  18. Peduzzi L, Goetzmann T, Wein F, Roche O, Sirveaux F, Mole D, Jacquot A (2019) Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis. JSES Open Access 3(4):278–286. https://doi.org/10.1016/j.jses.2019.09.011

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nagels J, Stokdijk M, Rozing PM (2003) Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg 12(1):35–39. https://doi.org/10.1067/mse.2003.22

    Article  PubMed  Google Scholar 

  20. Casp AJ, Montgomery SR Jr, Cancienne JM, Brockmeier SF, Werner BC (2020) Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty. J Am Acad Orthop Surg 28(3):121–127. https://doi.org/10.5435/JAAOS-D-18-00537

    Article  PubMed  Google Scholar 

  21. Stone MA, Namdari S (2019) Surgical considerations in the treatment of osteoporotic proximal humerus fractures. Orthop Clin North Am 50(2):223–231. https://doi.org/10.1016/j.ocl.2018.10.005

    Article  PubMed  Google Scholar 

  22. Daher M, Fares MY, Boufadel P, Khanna A, Zalaquett Z, Abboud JA (2023) Osteoporosis in the setting of shoulder arthroplasty: a narrative review. Geriatr Orthop Surg Rehabil 14:21514593231182530. https://doi.org/10.1177/21514593231182527

    Article  PubMed  PubMed Central  Google Scholar 

  23. Anderson KD, Ko FC, Virdi AS, Sumner DR, Ross RD (2020) Biomechanics of implant fixation in osteoporotic bone. Curr Osteoporos Rep 18(5):577–586. https://doi.org/10.1007/s11914-020-00614-2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bernatz JT, Brooks AE, Nguyen BP, Shin ED, Binkley NC, Anderson PA, Grogan BF (2020) Prevalence and treatment of osteoporosis prior to elective shoulder arthroplasty. J Am Acad Orthop Surg Global res rev. https://doi.org/10.5435/JAAOSGlobal-D-20-00204

    Article  Google Scholar 

  25. Hawi N, Tauber M, Messina MJ, Habermeyer P, Martetschlager F (2016) Anatomic stemless shoulder arthroplasty and related outcomes: a systematic review. BMC Musculoskelet Disord 17(1):376. https://doi.org/10.1186/s12891-016-1235-0

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mazzucchelli RA, Jenny K, Zdravkovic V, Erhardt JB, Jost B, Spross C (2018) The influence of local bone quality on fracture pattern in proximal humerus fractures. Injury 49(2):359–363. https://doi.org/10.1016/j.injury.2017.12.020

    Article  PubMed  Google Scholar 

  27. Pervaiz K, Cabezas A, Downes K, Santoni BG, Frankle MA (2013) Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications. J Shoulder Elbow Surg 22(3):e1-8. https://doi.org/10.1016/j.jse.2012.05.029

    Article  PubMed  Google Scholar 

  28. Mather J, MacDermid JC, Faber KJ, Athwal GS (2013) Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. J Shoulder Elbow Surg 22(6):732–738. https://doi.org/10.1016/j.jse.2012.08.018

    Article  PubMed  Google Scholar 

  29. Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85(4):611–617. https://doi.org/10.1302/0301-620x.85b4.12843

    Article  PubMed  Google Scholar 

  30. Wilson J, Bonner TJ, Head M, Fordham J, Brealey S, Rangan A (2009) Variation in bone mineral density by anatomical site in patients with proximal humeral fractures. J Bone Joint Surg Br 91(6):772–775. https://doi.org/10.1302/0301-620X.91B6.22346

    Article  CAS  PubMed  Google Scholar 

  31. Krappinger D, Roth T, Gschwentner M, Suckert A, Blauth M, Hengg C, Kralinger F (2012) Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol 41(3):299–304. https://doi.org/10.1007/s00256-011-1174-7

    Article  PubMed  Google Scholar 

  32. El Maghraoui A, Roux C (2008) DXA scanning in clinical practice QJM. Int J Med 101(8):605–617. https://doi.org/10.1093/qjmed/hcn022

    Article  Google Scholar 

  33. Buch B, Vall M, Consigliere P, Guillén JA, Cruz E, Natera L (2022) Short stems and stemless shoulder arthroplasty: current concepts review. Arch Bone Joint Surg 10(8):633–647. https://doi.org/10.22038/abjs.2021.53555.2664

    Article  PubMed  PubMed Central  Google Scholar 

  34. Keener JD, Chalmers PN, Yamaguchi K (2017) The humeral implant in shoulder arthroplasty. J Am Acad Orthop Surg 25(6):427–438. https://doi.org/10.5435/jaaos-d-15-00682

    Article  PubMed  Google Scholar 

  35. Ballmer FT, Sidles JA, Lippitt SB, Matsen FA 3rd (1993) Humeral head prosthetic arthroplasty: surgically relevant geometric considerations. J Shoulder Elbow Surg 2(6):296–304. https://doi.org/10.1016/1058-2746(93)90075-r

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea

    Ho-Jae Lee, Byung-Kook Kim & Jinmyoung Dan

Authors
  1. Ho-Jae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Byung-Kook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jinmyoung Dan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jinmyoung Dan.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was performed in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and with the HIPAA regulation. The Institutional Review Board (IRB) of CHA Medical Center reviewed and approved the present retrospective single-center study (IRB No. GM 23-04).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, HJ., Kim, BK. & Dan, J. Does the proximal humeral bone quality influence alignment after reverse total shoulder arthroplasty with short humeral stems?. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03909-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00590-024-03909-7

Keywords

Search

Navigation