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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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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 |
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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 |
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