Cargando…

A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length

While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in...

Descripción completa

Detalles Bibliográficos
Autores principales: Bents, Easton J., Werner, Brian C., Griffin, Justin W., Raiss, Patric, Denard, Patrick J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148163/
https://www.ncbi.nlm.nih.gov/pubmed/35628993
http://dx.doi.org/10.3390/jcm11102867
_version_ 1784716985425199104
author Bents, Easton J.
Werner, Brian C.
Griffin, Justin W.
Raiss, Patric
Denard, Patrick J.
author_facet Bents, Easton J.
Werner, Brian C.
Griffin, Justin W.
Raiss, Patric
Denard, Patrick J.
author_sort Bents, Easton J.
collection PubMed
description While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in progressive increments distal to the greater tuberosity to provide anatomic information about the optimal length of press-fit short stems for alignment and stability in TSA. We hypothesized that the humeral canal diameter will remain variable for the first 50 to 75 mm distal to the greater tuberosity and will become consistent thereafter. A retrospective review of 99 consecutive patients undergoing TSA with CT scans was performed. Intramedullary anterior-posterior (AP) and medial-lateral (ML) width as well as diameter were analyzed on two-dimensional computed tomography following multiplanar reconstruction. Measurements were taken at consistent distances distal to the greater tuberosity (GT). The transition point was measured at the proximal level of the humerus where endosteal borders of the medial and lateral cortices became parallel. The mean transition point was 73 mm from the GT (range: 53 to 109 mm). ML and AP widths became consistent 80 mm distal to the GT. IM diameter became consistent after 90 mm distal to the GT and a stem length of 90 mm extended past the transition point in 91.9% of cases. In TSA, a humeral stem length of 90 mm is required to predictably reach points at which the humeral canal becomes cylindrical and consistent in diameter. This information may aid data-driven decisions on humeral stem length during press-fit fixation, assuring consistency of alignment and implant stability, while maintaining ease of revision associated with a short stem implant. Level of evidence: III
format Online
Article
Text
id pubmed-9148163
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-91481632022-05-29 A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length Bents, Easton J. Werner, Brian C. Griffin, Justin W. Raiss, Patric Denard, Patrick J. J Clin Med Article While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in progressive increments distal to the greater tuberosity to provide anatomic information about the optimal length of press-fit short stems for alignment and stability in TSA. We hypothesized that the humeral canal diameter will remain variable for the first 50 to 75 mm distal to the greater tuberosity and will become consistent thereafter. A retrospective review of 99 consecutive patients undergoing TSA with CT scans was performed. Intramedullary anterior-posterior (AP) and medial-lateral (ML) width as well as diameter were analyzed on two-dimensional computed tomography following multiplanar reconstruction. Measurements were taken at consistent distances distal to the greater tuberosity (GT). The transition point was measured at the proximal level of the humerus where endosteal borders of the medial and lateral cortices became parallel. The mean transition point was 73 mm from the GT (range: 53 to 109 mm). ML and AP widths became consistent 80 mm distal to the GT. IM diameter became consistent after 90 mm distal to the GT and a stem length of 90 mm extended past the transition point in 91.9% of cases. In TSA, a humeral stem length of 90 mm is required to predictably reach points at which the humeral canal becomes cylindrical and consistent in diameter. This information may aid data-driven decisions on humeral stem length during press-fit fixation, assuring consistency of alignment and implant stability, while maintaining ease of revision associated with a short stem implant. Level of evidence: III MDPI 2022-05-19 /pmc/articles/PMC9148163/ /pubmed/35628993 http://dx.doi.org/10.3390/jcm11102867 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bents, Easton J.
Werner, Brian C.
Griffin, Justin W.
Raiss, Patric
Denard, Patrick J.
A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title_full A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title_fullStr A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title_full_unstemmed A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title_short A Radiographic Analysis of Proximal Humeral Anatomy in Patients with Primary Glenohumeral Arthritis and Implications for Press-Fit Stem Length
title_sort radiographic analysis of proximal humeral anatomy in patients with primary glenohumeral arthritis and implications for press-fit stem length
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148163/
https://www.ncbi.nlm.nih.gov/pubmed/35628993
http://dx.doi.org/10.3390/jcm11102867
work_keys_str_mv AT bentseastonj aradiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT wernerbrianc aradiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT griffinjustinw aradiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT raisspatric aradiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT denardpatrickj aradiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT bentseastonj radiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT wernerbrianc radiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT griffinjustinw radiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT raisspatric radiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength
AT denardpatrickj radiographicanalysisofproximalhumeralanatomyinpatientswithprimaryglenohumeralarthritisandimplicationsforpressfitstemlength