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Restoration of humeral head geometry in posttraumatic fracture sequelae with stemless or resurfacing arthroplasty: a matched-paired analysis

Humeral geometry in resurfacing or stemless arthroplasty

Rekonstruktion der Humeruskopfgeometrie bei posttraumatisch fehlverheilten Frakturen mit einer schaftfreien Gelenkprothese oder Oberflächenersatzprothese: eine Matched-Pair-Analyse.

Humeruskopfgeometrie bei Oberflächenersatzprothese oder schaftfreier Gelenkprothese

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Abstract

Background

The objective of this study was to analyze proximal humeral geometry in two groups of patients with posttraumatic fracture sequelae who were treated with either resurfacing (R) or stemless (S) arthroplasty. The hypothesis was that there is no difference in the radiographic restoration of postoperative proximal humeral geometry after resurfacing or stemless arthroplasties.

Material and methods

A match-paired analysis of 48 cases was completed (R = 24, S = 24). Proximal geometry was assessed reviewing true anterior–posterior x-rays, measuring the inclination angle of osteotomy (IAO), distance above tuberosity (DAT), superior humeral translation (SHT) according to Torchia, medial offset (MO), and lateral offset (LO).

Results

The average follow-up was 32.4 ± 9.2 months for group R and 37.9 ± 22.9 months for group S (p = 0.317). Except for MO and SHT, no significant differences were found. Restoration of the anatomical MO was more accurate for group S. SHT of the humerus was detected more frequently for group R.

Conclusions

In this match-paired analysis, stemless arthroplasty reconstructed an anatomic MO more consistently than resurfacing arthroplasty as evaluated on x-rays; we did not document differences in the remaining evaluated parameters. However, no significant differences were found between both groups regarding clinical outcomes.

Zusammenfassung

Hintergrund

Ziel dieser Studie war die Analyse der proximalen Humerusgeometrie in zwei Patientengruppen mit posttraumatisch fehlverheilten Frakturen, die entweder mit einer Oberflächenersatzprothese (Resurfacing – R) oder mit einer schaftfreien Gelenkprothese (S) versorgt wurden.

Die Hypothese war, dass es postoperativ keine radiologischen Unterschiede der proximalenHumerusgeometrie zwischen der Rekonstruktion mit einer Oberflächenersatzprothese oder mit einer schaftfreien Gelenkprothese gibt.

Materialien und Methoden

Es wurde eine Matched-Pair-Analyse mit 48 Fällen (R = 24, S = 24) durchgeführt. Die proximale Geometrie wurde anhand von AP-Röntgenaufnahmen beurteilt, wobei der Inklinationswinkel der Osteotomie (IAO), der Abstand über dem Tuberculum majus (Distance Above Tuberosity – DAT), die kraniale Verschiebung des Humerus (Superior Humeral Translation – SHT) nach Torchia, sowie die mediale und laterale Abweichung (Medial Offset – MO; Lateral Offset – LO) gemessen wurden.

Ergebnisse

Die durchschnittliche Verlaufsbeobachtung betrug 32,4 ± 9,2 Monate für die Gruppe R und 37,9 ± 22,9 Monate für die Gruppe S (p = 0,317). Außer bei der MO und der SHT wurden keine signifikanten Unterschiede festgestellt. Die Wiederherstellung der anatomischen MO war in der Gruppe S genauer. Eine kraniale Verschiebung des Humerus (SHT) wurde in der Gruppe R häufiger beobachtet.

Schlussfolgerungen

Die Beurteilung der Röntgenaufnahmen in dieser Matched-Pair- Analyse ergab, dass die anatomische MO mit einer schaftfreien Gelenkprothese besser wiederhergestellt werden konnte als mit einer Oberflächenersatzprothese. Bei den übrigen beurteilten Parametern konnten wir keine Unterschiede feststellen. Hinsichtlich der klinischen Ergebnisse konnten allerdings keine signifikanten Unterschiede beobachtet werden.

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Authors and Affiliations

  1. Shoulder Surgery and Upper Extremity Arthroscopy Unit, Hospital del Trabajador Traumatologia, 3er piso Providencia, 7500000, Santiago, Chile

    Patricio Melean MD

  2. Shoulder and Elbow Surgery Department, ATOS Clinic, Heidelberg, Germany

    Patricio Melean MD, Markus Loew MD, PhD, Petra Magosch MD, Stephan Riedmann MD & Peter Habermeyer MD, PhD

  3. Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany

    Patric Raiss MD

Authors
  1. Patricio Melean MD
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  2. Markus Loew MD, PhD
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  3. Petra Magosch MD
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  4. Stephan Riedmann MD
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  5. Peter Habermeyer MD, PhD
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  6. Patric Raiss MD
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Correspondence to Patricio Melean MD.

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Level of evidence III: therapeutic series, retrospective comparative study

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Melean, P., Loew, M., Magosch, P. et al. Restoration of humeral head geometry in posttraumatic fracture sequelae with stemless or resurfacing arthroplasty: a matched-paired analysis. Obere Extremität 9, 45–50 (2014). https://doi.org/10.1007/s11678-013-0230-4

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