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Radiographic Stability of Ingrowth Humeral Stems in Total Shoulder Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Cemented and uncemented stem types are available for TSA. An early uncemented stem designed for bone ingrowth had radiographic loosening of approximately 10% at intermediate followup (mean 4.6 years). Subsequent stem modifications included circumferential metaphyseal porous coating to enhance ingrowth and reduce loosening rates.

Questions/purposes

We asked whether the radiographic loosening rates would be lower after this design modification and whether the pain score and ROM would be improved.

Patients and Methods

We reviewed the medical records and radiographs of 76 patients undergoing primary TSA with circumferential metaphyseal porous-coated stems for osteoarthritis between 1995 and 2005. All patients had a complete standardized series of radiographs preoperatively, postoperatively, and at final followup. Humeral stems were evaluated for any radiolucent lines by zone, progression of lucencies, and shift in component position. The minimum radiographic followup was 25 months (average, 52 months; range, 25–90 months).

Results

There were no radiolucencies seen on the initial postoperative radiographs. Five stems had 1-mm radiolucent lines in one to four of eight zones at final followup. One had a glenoid component judged at risk. None of the humeral components were judged at risk or loose or to have shifted. The pain scores and ROM improved postoperatively.

Conclusions

Proximally coated humeral stems for TSA showed few radiolucencies and no loosening at short- to midterm followup, reflecting an improvement over previous series. We now use these stems for primary TSAs and reserve cemented stems only when uncemented fixation is not possible owing to bony deficiency.

Level of Evidence

Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Cil A, Veillette CJH, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br. 2009;91:75–81.

    Article  CAS  PubMed  Google Scholar 

  2. Cil A, Veillette CJH, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Survivorship of the humeral component in shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19:143–150.

    Article  PubMed  Google Scholar 

  3. Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am. 1984;66:899–906.

    CAS  PubMed  Google Scholar 

  4. Cofield RH. Uncemented total shoulder arthroplasty: a review. Clin Orthop Relat Res. 1994;307:86–93.

    PubMed  Google Scholar 

  5. Gartsman GM, Elkousy HA, Warnock KM, Edwards TB, O’Connor DP. Radiographic comparison of pegged and keeled glenoid components. J Shoulder Elbow Surg. 2005;14:252–257.

    Article  PubMed  Google Scholar 

  6. Lacroix D, Prendergast PJ. Stress analysis of glenoid component designs for total shoulder arthroplasty. Proc Inst Mech Eng H. 1997;211:467–474.

    Article  CAS  PubMed  Google Scholar 

  7. Lazarus MD, Jensen KL, Southworth C, Matsen FA III. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84:1174–1182.

    PubMed  Google Scholar 

  8. Matsen FA 3rd, Iannotti JP, Rockwood CA Jr. Humeral fixation by press-fitting of a tapered metaphyseal stem: a prospective radiographic study. J Bone Joint Surg Am. 2003;85:304–308.

    PubMed  Google Scholar 

  9. McElwain JP, English E. The early results of porous-coated total shoulder arthroplasty. Clin Orthop Relat Res. 1987;218:217–224.

    PubMed  Google Scholar 

  10. Mileti J, Boardman ND 3rd, Sperling JW, Cofield RH, Torchia ME, O’driscoll SW, Rowland CM. Radiographic analysis of polyethylene glenoid components using modern cementing techniques. J Shoulder Elbow Surg 2004;13:492–498.

    Article  PubMed  Google Scholar 

  11. Mileti J, Sperling JW, Cofield RH, Harrington JR, Hoskin TL. Monoblock and modular total shoulder arthroplasty for osteoarthritis. J Bone Joint Surg Br. 2005;87:496–500.

    Article  CAS  PubMed  Google Scholar 

  12. Neer CS II, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982;64:319–372.

    PubMed  Google Scholar 

  13. Nuttall D, Haines JF, Trail II. A study of the microenvironment of pegged and keeled glenoid components compared using radiostereometric analysis. J Shoulder Elbow Surg. 2007;16(3 suppl):S65–S70.

    Article  PubMed  Google Scholar 

  14. O’Driscoll SW, Wright TW, Cofield RH. Prolemes glenoideniens: evaluation radiographique du composant glenoidien dans les prostheses totals d’epaule. In: Mansat M, ed. Protheses d’Epaule. Cahiers d’enseignement de la SOCOT, Number 68. Paris, France: Expansion Scientifique Publications; 1997:337.

  15. Rispoli DM, Sperling JW, Athwal GS, Schleck CD, Cofield RH. Humeral head replacement for the treatment of osteoarthritis. J Bone Joint Surg Am. 2006;88:2637–2644.

    Article  PubMed  Google Scholar 

  16. Roper BA, Paterson JM, Day WH. The Roper-Day total shoulder replacement. J Bone Joint Surg Br. 1990;72:694–697.

    CAS  PubMed  Google Scholar 

  17. Rosenberg N, Neumann L, Modi A, Mersich IJ, Wallace AW. Improvements in survival of the uncemented Nottingham Total Shoulder prosthesis: a prospective comparative study. BMC Musculoskelet Disord. 2007;8:76.

    Article  PubMed  Google Scholar 

  18. Sanchez-Sotelo J, O’Driscoll SW, Torchia ME, Cofield RH, Rowland CM. Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg. 2001;10:526–531.

    Article  CAS  PubMed  Google Scholar 

  19. Sanchez-Sotelo J, Wright TW, O’Driscoll SW, Cofield RH, Rowland CM. Radiographic assessment of uncemented humeral components in total shoulder arthroplasty. J Arthroplasty. 2001;16:180–187.

    Article  CAS  PubMed  Google Scholar 

  20. Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM. Radiographic assessment of ingrowth total shoulder arthroplasty. J Shoulder Elbow Surg. 2000;9:507–513.

    Article  CAS  PubMed  Google Scholar 

  21. Taunton MJ, McIntosh AL, Sperling JW, Cofield RH. Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component: medium to long-term results. J Bone Joint Surg Am. 2008;90:2180–2188.

    Article  PubMed  Google Scholar 

  22. Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg. 1997;6:495–505.

    Article  CAS  PubMed  Google Scholar 

  23. Verborgt O, El-Abiad R, Gazielly DF. Long-term results of uncemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg. 2007;16(3 suppl):S13–S18.

    Article  PubMed  Google Scholar 

  24. Weiss AP, Adams MA, Moore JR, Weiland AJ. Unconstrained shoulder arthroplasty: a five-year average follow-up study. Clin Orthop Relat Res. 1990;257:86–90.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Thomas W. Throckmorton MD, Peter C. Zarkadas MD, John W. Sperling MD & Robert H. Cofield MD

Authors
  1. Thomas W. Throckmorton MD
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  2. Peter C. Zarkadas MD
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  3. John W. Sperling MD
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  4. Robert H. Cofield MD
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Corresponding author

Correspondence to Robert H. Cofield MD.

Additional information

One or more of the authors (RHC, JWS) certify that they have received or may receive payments or benefits from a commercial entity (Biomet Inc, Warsaw, IN; Smith and Nephew, Inc, Memphis, TN) related to this work. The institution of the authors has received funding from Smith and Nephew.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that an informed consent for participating in the study was obtained.

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Throckmorton, T.W., Zarkadas, P.C., Sperling, J.W. et al. Radiographic Stability of Ingrowth Humeral Stems in Total Shoulder Arthroplasty. Clin Orthop Relat Res 468, 2122–2128 (2010). https://doi.org/10.1007/s11999-010-1299-3

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  • DOI: https://doi.org/10.1007/s11999-010-1299-3

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