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Halm-Pozniak A, Riediger C, Kopsch E, Awiszus F, Lohmann CH, Berth A. Influence of humeral position of the Affinis Short stemless shoulder arthroplasty system on long-term survival and clinical outcome. J Shoulder Elbow Surg 2024; 33:2202-2212. [PMID: 38514008 DOI: 10.1016/j.jse.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of humeral position of the Affinis Short implant in stemless anatomic total shoulder arthroplasties (STSAs) on clinical and radiologic results and mid- to long-term survival in the treatment of primary osteoarthritis (OA) of the shoulder. METHODS Eighty patients treated with a stemless shoulder arthroplasty for OA of the shoulder were evaluated with a mean follow-up of 92 ± 14 months (range 69-116 months) by the Constant Score (CS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and active range of motion (ROM). Radiographic assessment for bone adaptations and humeral implant position was performed by plain radiographs. Comparison of the pre- and postoperative centers of rotation (CORs) was used to assess the restoration of the geometry of the humeral head. The appraisal of proper humeral component positioning was correlated with the functional outcomes. A Kaplan-Meier analysis was performed to investigate the influence of humeral implant position compared to survival time. Complications were noted. RESULTS The ROM (P < .001), CS (P < .001), and DASH scores (P < .001) showed significant improvements after surgery for the entire series. The COR restoration was anatomic in 75% (n = 60) of all implants and in 25% (n = 20) nonanatomic implants (pre- and postoperative COR deviation of 2.7 ± 1.8 mm vs. 5.1 ± 3.2 mm, P = .0380). The humeral component position did not affect the functional outcome whereas the 10-year unadjusted cumulative survival rate for the anatomic group was significantly higher in comparison with the nonanatomic group (96.7% vs. 75%, P = .002). The radiologic evaluation revealed minor periprosthetic bone adaptions in various forms without clinical significance or further intervention. No revision was necessary because of a failed fixation of the stemless humeral component. CONCLUSIONS Regarding the treatment of primary OA of the shoulder, STSA shows excellent long-term survival and clinical outcomes. In particular, STSA implants are able to restore the geometry of the humeral head. Nonanatomic reconstruction may influence the survival over the long term in different pathways. Further studies are necessary to elucidate the effect of humeral component position in STSA on function, pain, and implant survival rates.
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Affiliation(s)
| | - Christian Riediger
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Elisabeth Kopsch
- Department of Pediatrics, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
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Twomey-Kozak J, Adu-Kwarteng K, Lunn K, Briggs DV, Hurley E, Anakwenze OA, Klifto CS. Recent Advances in the Design and Application of Shoulder Arthroplasty Implant Systems and Their Impact on Clinical Outcomes: A Comprehensive Review. Orthop Res Rev 2024; 16:205-220. [PMID: 39081796 PMCID: PMC11288362 DOI: 10.2147/orr.s312870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose of Review This narrative review comprehensively aims to analyze recent advancements in shoulder arthroplasty, focusing on implant systems and their impact on patient outcomes. The purpose is to provide a nuanced understanding of the evolving landscape in shoulder arthroplasty, incorporating scientific, regulatory, and ethical dimensions. Recent Findings The review synthesizes recent literature on stemless implants, augmented glenoid components, inlay vs onlay configurations, convertible stems, and associated complications. Notable findings include improved patient-reported outcomes with stemless implants, variations in outcomes between inlay and onlay configurations, and the potential advantages of convertible stems. Additionally, the regulatory landscape, particularly the FDA's 510(k) pathway, is explored alongside ethical considerations, emphasizing the need for standardized international regulations. Summary Recent innovations in shoulder arthroplasty showcase promising advancements, with stemless implants demonstrating improved patient outcomes. The review underscores the necessity for ongoing research to address unresolved aspects and highlights the importance of a standardized regulatory framework to ensure patient safety globally. The synthesis of recent findings contributes to a comprehensive understanding of the current state of shoulder arthroplasty, guiding future research and clinical practices.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kwabena Adu-Kwarteng
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kiera Lunn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Damon Vernon Briggs
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Gosselin C, Lefebvre Y, Joudet T, Godeneche A, Barth J, Garret J, Audebert S, Charousset C, Bonnevialle N. Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years. J Shoulder Elbow Surg 2024:S1058-2746(24)00402-6. [PMID: 38851524 DOI: 10.1016/j.jse.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MATERIALS AND METHODS This retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with intuitive shoulder arthroplasty Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion, Constant score, and Subjective Shoulder Value. Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized computed tomography scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). RESULTS Fifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and Subjective Shoulder Value improved significantly from 38 ± 11 to 76 ± 11 (P < .001) and from 31% ± 16 to 88% ± 15 (P < .001) respectively at the last follow-up. Forward elevation, external rotation, and internal rotation range of motion increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. CONCLUSIONS At an average follow-up of 31 months, intuitive shoulder arthroplasty Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.
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Affiliation(s)
- Cerise Gosselin
- CHU de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Yves Lefebvre
- Institut de l'épaule de Strasbourg (Strasbourg Shoulder Institute), Strasbourg, France
| | | | - Arnaud Godeneche
- Centre Orthopédique SANTY (SANTY Orthopedic Center), Ramsay Santé, Lyon, France
| | | | | | | | - Christophe Charousset
- Institut Ostéo Articulaire (Bone and Joint Institute) Paris Courcelles, Paris, France
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Chawla L, Kumar K, Barker S, Ismail A. Restoration of the joint geometry after stemless shoulder arthroplasty. Shoulder Elbow 2023; 15:321-327. [PMID: 37325383 PMCID: PMC10268137 DOI: 10.1177/17585732221088999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 09/20/2023]
Abstract
Aim This study aims to evaluate restoration of anatomy following Total Shoulder Arthroplasty (TSA) with the Mathys Affinis Short prosthesis. Background Over the last decade stemless shoulder arthroplasty has increased in popularity. One of the reported advantages of the stemless designs is the ability to restore anatomy following surgery. However, very few studies have evaluated restoration of anatomy following stemless shoulder arthroplasty. Methods The study included all patients who had undergone TSA using the Affinis Short (Mathys Ltd, Bettlach, Switzerland) prosthesis for primary osteoarthritis between 2010 and 2016. The mean follow up was 42.8 months (range 9.4 to 83.4 months). Pre and post-operative radiographs were assessed for Centre of Rotation (COR), Humeral Head Height (HHH), Humeral Head Diameter (HHD), Humeral Height (HH) and, Neck Shaft Angle (NSA) using the best fit circle method on PACS software. Measurements were scored and compared to assess the accuracy of the implant in restoring the native geometry, including the intraobserver variability. The same data was collected by another experienced observer to measure the interobserver variability. Results The deviation of COR of the prosthesis from the anatomical centre was less than 3 mm in 58 cases (85%). Humeral head height and humeral head diameter showed a variation of less than 3 mm in 66 cases (97%) and 43 cases (63%) respectively. Humeral height followed a similar trend, with 62 cases (91.2%) showing a difference of less than 5 mm. The neck shaft angle showed a variation of more than 8 degrees in 38 cases (55%), and 29 cases (42.6%) had a postoperative angle of less than 130 degrees. Conclusion Overall, stemless total shoulder arthroplasty with the Affinis Short prosthesis allows excellent restoration of anatomy confirmed by most of the measured radiographic parameters. The variability in neck shaft angle might be due to differing surgical techniques, with some surgeons preferring a slightly vertical neck cut to protect the rotator cuff insertion.
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Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and elliptical humeral head results in both improved early range of motion and radiographic center of rotation compared with standard total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:318-325. [PMID: 36049701 DOI: 10.1016/j.jse.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of the native glenohumeral anatomy is an important consideration in obtaining optimal range of motion (ROM) after anatomic total shoulder arthroplasty (TSA). Recently, a new stemless TSA system has been developed that uses both a multiplanar osteotomy (MPO), to improve the surgeon's ability to restore humeral center of rotation (COR), and an elliptical humeral head to improve ROM. The purpose of our study was to compare the difference in early postoperative ROM and restoration of radiographic COR, between this stemless TSA and standard stemmed TSAs. METHODS This was a retrospective review of 50 consecutive primary TSAs performed by a single surgeon for glenohumeral osteoarthritis. The initial cohort underwent TSA with a standard stemmed humeral component with a circular humeral head (n = 25), whereas the subsequent cohort underwent stemless TSA using an MPO and an elliptical humeral head (n = 25). Postoperative data collection included active shoulder ROM as measured by goniometer, complications or revision surgery, and measurements of radiographic COR. Patients were assessed at 6 weeks, 12 weeks, 6 months, and 12 months after surgery. Change in COR was determined on postoperative radiographs by 2 fellowship-trained surgeons on 2 separate occasions. Intra- and interrater reliability were computed using intraclass correlation coefficients. RESULTS For both mean forward flexion (FF) and external rotation (ER), there was greater ROM in the MPO-elliptical group at all time points, which was statistically significant. Mean change in FF favored the MPO group at 6 and 12 weeks and was statistically significant and above the minimal clinically important difference (MCID): 6 weeks, standard -15.8° vs. MPO 8.4° (P = .004); 12 weeks, standard 6.4° vs. MPO 29.2° (P = .001). Mean change in ER favored the MPO group at 6 weeks and was statistically significant: standard 5.4° vs. MPO 14.0° (P = .02). There were no revision surgeries in either group. Average change in COR was 2.7 mm in the standard group and 1.8 mm in the MPO-elliptical group, which was statistically significant (P < .001). Number of patients with >3 mm of difference in COR was 10 (40%) in the standard group and 1 (5%) in the MPO-elliptical group, which was statistically significant (P = .002). Average intraclass correlation coefficient was 0.75, indicating good reliability within and between surgeon measurements. CONCLUSION The use of a multiplanar osteotomy and elliptical humeral head was associated with improved early range of motion and better reproduction of the radiographic COR compared with standard stemmed TSA.
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Nourissat G, Harris HW, Kamel A, Bonnelance M, Authom T, Beaudouin E, Poilbout N, Wahab H, Azar M, Bouche PA. Short term Results of anatomic stemless shoulder replacement with peripheral neck fixation. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
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Marigi EM, Elahi MA, Cancio-Bello AM, Duquin TR, Sperling JW. Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:442-450. [PMID: 37588463 PMCID: PMC10426651 DOI: 10.1016/j.xrrt.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally, key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ali Elahi
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Thomas R. Duquin
- Department of Orthopaedics, State University of New York, Buffalo, NY, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Strony JT, LaBelle M, McMellen CJ, Golden ML, Chalmers P, Tashjian RZ, Gillespie RJ. Restoration of the native humeral anatomy during stemless anatomic total shoulder arthroplasty: a radiographic comparison of intramedullary versus freehand resection. J Shoulder Elbow Surg 2022; 31:2225-2232. [PMID: 35569754 DOI: 10.1016/j.jse.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND During anatomic total shoulder arthroplasty (aTSA), the humeral head can be resected with or without the use of an intramedullary cutting guide, the former referred to as intramedullary (IM) resection and the latter referred to as freehand (FH) resection. Outcomes following aTSA are predicated upon the restoration of the native humeral anatomy, which can be more challenging with stemless implants. To date, no studies have determined which method of humeral head resection is superior in restoring native anatomy. Our purpose was to determine whether FH or IM resection was superior in restoring native anatomy during aTSA with stemless implants. METHODS A review of all patients who underwent aTSA using the stemless Tornier Simpliciti Shoulder System at two academic institutions by two separate surgeons between January 2017 and June 2020 was performed. One surgeon at one institution performed stemless aTSA using the IM resection technique, while the second surgeon utilized the FH resection technique. Patients were excluded if they underwent surgery for an indication other than glenohumeral osteoarthritis, if they received a short-stem or standard-stem implant, or if they lacked adequate preoperative and postoperative Grashey radiographs. One hundred eleven patients across both institutions (51 IM, 60 FH) were included for the final radiographic assessment. The humeral head height (HH) and neck-shaft angle (NSA) were measured on preoperative and postoperative Grashey radiographs. The centers of rotation (CORs) were measured on postoperative Grashey radiographs. Patients were classified as having acceptable restoration of their native anatomy if the change (Δ) in COR or HH was ≤3 mm and ≤ 5 mm, respectively, or if the postoperative NSA was ≥130°. RESULTS IM resection had the greatest acceptable restoration of COR (90.2% IM versus 70% FH, P = .009), HH (96.1% IM vs. 63.3% FH, P < .001), and NSA (96.1% IM vs. 78.3% FH, P = .006) relative to FH resection. The mean postoperative NSAs for the IM and FH cohorts were 134.4° (±2.1°) and 133.8° (±5.4°), respectively (P = .208). The mean ΔCORs for the IM and FH groups were 1.2 (±1.5) and 2.3 (±1.2) mm, respectively (P < .001). Finally, the mean ΔHHs for the IM and FH cohorts were 1.7 (±1.4) and 4.4 (±2.9) mm, respectively (P < .001). CONCLUSIONS Restoration of the native humeral anatomy following stemless aTSA occurred at a significantly higher rate when using IM vs. FH resection.
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Affiliation(s)
- John T Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Mark LaBelle
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher J McMellen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael L Golden
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Rojas JT, Jost B, Hertel R, Zipeto C, Van Rooij F, Zumstein MA. Patient-specific instrumentation reduces deviations between planned and postosteotomy humeral retrotorsion and height in shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1929-1937. [PMID: 35346846 DOI: 10.1016/j.jse.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) may potentially improve humeral osteotomy in shoulder arthroplasty. The purpose of this study was to compare the deviation between planned and postosteotomy humeral inclination, retrotorsion, and height in shoulder arthroplasty, using PSI vs. standard cutting guides (SCG). METHODS Twenty fresh-frozen cadaveric specimens were allocated to undergo humeral osteotomy using either PSI or SCG, such that the 2 groups have similar age, gender, and side. Preosteotomy computed tomography (CT) scan was performed and used for the 3-dimensional (3D) planning. The osteotomy procedure was performed using a PSI designed for each specimen or an SCG depending on the group. A postosteotomy CT scan was performed. The preosteotomy and postosteotomy 3D CT scan reconstructions were superimposed to calculate the deviation between planned and postosteotomy inclination, retrotorsion, and height. Outliers were defined as cases with 1 or more of the following deviations: >5° inclination, >10° retrotorsion, and >3 mm height. The deviation and outliers in inclination, retrotorsion, and height were compared between the 2 groups. RESULTS The deviations between planned and postosteotomy parameters were similar among the PSI and SCG groups for inclination (P = .260), whereas they were significantly greater in the SCG group for retrotorsion (P < .001) and height (P = .003). There were 8 outliers in the SCG group, compared with only 1 outlier in the PSI group (P = .005). Most outliers in the SCG group were due to deviation >10° in retrotorsion. CONCLUSION After 3D planning, PSI had less deviation between planned and postosteotomy humeral retrotorsion and height, relative to SCG.
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Affiliation(s)
- J Tomás Rojas
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital, St.Gallen, Switzerland
| | - Ralph Hertel
- Department of Orthopaedics and Trauma Surgery, Lindenhofspital, Bern, Switzerland
| | - Claudio Zipeto
- Shoulder R & D Department, Medacta International SA, Castel San Pietro, Switzerland
| | | | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland; Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland; Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
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Innovations in Shoulder Arthroplasty. J Clin Med 2022; 11:jcm11102799. [PMID: 35628933 PMCID: PMC9144112 DOI: 10.3390/jcm11102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.
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Does computerized CT-based 3D planning of the humeral head cut help to restore the anatomy of the proximal humerus after stemless total shoulder arthroplasty? J Shoulder Elbow Surg 2021; 30:e309-e316. [PMID: 32950671 DOI: 10.1016/j.jse.2020.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of proximal humeral anatomy (RPHA) after total shoulder arthroplasty (TSA) has been shown to result in better clinical outcomes than is the case in nonanatomic humeral reconstruction. Preoperative virtual planning has mainly focused on glenoid component placement. Such planning also has the potential to improve anatomic positioning of the humeral head by more accurately guiding the humeral head cut and aid in the selection of anatomic humeral component sizing. It was hypothesized that the use of preoperative 3-dimensional (3D) planning helps to reliably achieve RPHA after stemless TSA. METHODS One hundred consecutive stemless TSA (67 males, 51 right shoulder, mean age of 62 ±9.4 years) were radiographically assessed using pre- and postoperative standardized anteroposterior radiographs. The RPHA was measured with the so-called circle method described by Youderian et al. We measured deviation from the premorbid center of rotation (COR), and more than 3 mm was considered as minimal clinically important difference. Additionally, pre- and postoperative humeral head diameter (HHD), head-neck angle (HNA), and humeral head height (HHH) were measured to assess additional geometrical risk factors for poor RPHA. RESULTS The mean distance from of the premorbid to the implanted head COR was 4.3 ± 3.1 mm. Thirty-five shoulders (35%) showed a deviation of less than 3 mm (mean 1.9 ±1.1) and 65 shoulders (65%) a deviation of ≥3 mm (mean 8.0 ± 3.7). Overstuffing was the main reason for poor RPHA (88%). The level of the humeral head cut was responsible for overstuffing in 46 of the 57 overstuffed cases. The preoperative HHD, HHH, and HNA were significantly larger, higher, and more in valgus angulation in the group with accurate RPHA compared with the group with poor RPHA (HHD of 61.1 mm ± 4.4 vs. 55.9 ± 6.6, P < .001; HHH 8.6±2.2 vs. 7.6±2.6, P = .026; and varus angulation of 134.7° ±6.4° vs. 131.0° ±7.91, P = .010). CONCLUSION Restoration of proximal humeral anatomy after stemless TSA using computed tomography (CT)-based 3D planning was not precise. A poorly performed humeral head cut was the main reason for overstuffing, which was seen in 88% of the cases with inaccurate RPHA. Preoperative small HHD, low HHH, and varus-angulated HNA are risk factors for poor RPHA after stemless TSA.
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Wodarek J, Shields E. Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results. J Shoulder Elb Arthroplast 2021; 5:24715492211008408. [PMID: 34993377 PMCID: PMC8492026 DOI: 10.1177/24715492211008408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.
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Affiliation(s)
- Jeremy Wodarek
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Edward Shields
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
- Orthopedic Associates of Muskegon, Muskegon, Michigan
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Koch M, Frankewycz B, Voss A, Kaeaeb M, Herrmann S, Alt V, Greiner S. 3D-Analysis of the Proximal Humeral Anatomy Before and After Stemless Shoulder Arthroplasty-A Prospective Case Series Study. J Clin Med 2021; 10:jcm10020259. [PMID: 33445617 PMCID: PMC7826806 DOI: 10.3390/jcm10020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stemless shoulder arthroplasty (SSA) is used to anatomically reconstruct proximal humerus geometry and preserve proximal humerus bone stock. The current literature lacks 3D-analysis of pre- and postoperative proximal humeral anatomy after SSA. The aim of this study was to prospectively analyze the humeral head anatomy using a computer-assisted topography mapping technique after SSA in relation to the preoperative status and the contralateral (not affected) side. METHODS Twenty-nine patients (mean age: 63.5 ± 11.7 years) affected by primary shoulder osteoarthritis and treated with SSA were included. Preoperative and postoperative CT scans of the affected and contralateral sites were analyzed regarding joint geometry. Clinical outcome was assessed by Constant and Disabilities of the Arm, Shoulder and Hand (DASH) score shortly before and one year after surgery. RESULTS Clinical outcome improved significantly. No correlation between clinical outcome and the evaluated anatomical parameters was found. There was a significant decrease of the humeral head height (p < 0.01) and radius (p = 0.03) in the preoperative versus the postoperative joint geometry. The comparison to the contralateral site showed also a significant decrease of the humeral head height (p < 0.01). All other parameters showed no significant differences. CONCLUSION Proximal humeral anatomy can be almost anatomically reconstructed by SSA. Solely the humeral head height differs significantly to the preoperative as well as contralateral morphology.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Borys Frankewycz
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
| | - Max Kaeaeb
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
| | | | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
| | - Stefan Greiner
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (B.F.); (A.V.); (M.K.); (V.A.)
- Sporthopaedicum Regensburg/Straubing, 93053 Regensburg, Germany
- Correspondence:
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Cox RM, Sholder D, Stoll L, Abboud JA, Williams GR, Ramsey ML, Lazarus MD, Horneff JG. Radiographic humeral head restoration after total shoulder arthroplasty: does the stem make a difference? J Shoulder Elbow Surg 2021; 30:51-56. [PMID: 32713669 DOI: 10.1016/j.jse.2020.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral stem designs for total shoulder arthroplasty have varied over the years, with a recent trend toward shorter stems. The purpose of this study was to examine the impact of humeral component stem length on the ability to restore the native humeral head anatomy. METHODS We performed a retrospective review including patients who underwent total shoulder arthroplasty for primary osteoarthritis between 2007 and 2017 with complete operative reports and adequate radiographs. Surgical data including stem design were collected. Preoperative and postoperative radiographic measurements of the center of rotation (COR), humeral head height (HH), and neck-shaft angle were performed. Restoration of the native humeral anatomy was deemed "acceptable" based on postoperative differences in the COR ≤ 3 mm, HH ≤ 5 mm, and neck-shaft angle > 130°. Deviations between preoperative and postoperative measurements were compared across stem types. All available 2-year stemless implant radiographs were also analyzed. RESULTS In total, 261 patients were included, with 31 stemless, 43 short-stem, and 187 standard-stem implants. There was no significant difference in COR restoration in the x-axis direction (P = .060) or y-axis direction (P = .579). There was no significant difference in restoration of acceptable HH by stem type (P = .339). Stemless arthroplasty implants were more likely to be placed in varus (22.6%) compared with short-stem (7.0%) and standard-stem (3.7%) designs (P < .001). CONCLUSION Restoration of humeral anatomic parameters occurred significantly less with stemless implants than with short- and standard-stem implants. The stem of a shoulder arthroplasty implant aids surgeons in accurately restoring patient-specific anatomy.
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Affiliation(s)
- Ryan M Cox
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Sholder
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura Stoll
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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15
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Rasmussen JV, Harjula J, Arverud ED, Hole R, Jensen SL, Brorson S, Fenstad AM, Salomonsson B, Äärimaa V. The short-term survival of total stemless shoulder arthroplasty for osteoarthritis is comparable to that of total stemmed shoulder arthroplasty: a Nordic Arthroplasty Register Association study. J Shoulder Elbow Surg 2019; 28:1578-1586. [PMID: 31043348 DOI: 10.1016/j.jse.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the short-term survival rate of total stemless, metaphyseal fixated, shoulder arthroplasty with that of total stemmed shoulder arthroplasty in the treatment of osteoarthritis. METHODS Data were collected by the national arthroplasty registries in Denmark, Finland, Norway, and Sweden and merged into 1 dataset under the umbrella of the Nordic Arthroplasty Register Association. For the present study, we included all patients with osteoarthritis treated with either stemless (n = 761) or stemmed (n = 4398) shoulder arthroplasty from 2011 to 2016. RESULTS A total of 21 (2.8%) stemless and 116 (2.6%) stemmed shoulder arthroplasties were revised. The 6-year unadjusted cumulative survival rates were 0.953 for stemless shoulder arthroplasty and 0.958 for stemmed shoulder arthroplasty, P = .77. The most common indication for revision of both arthroplasty types was infection. Five (0.7%) stemless and 16 (0.4%) stemmed shoulder arthroplasties were revised because of loosening of either the glenoid or the humeral component. In the multivariate cox regression model, which included age, category, gender, year of surgery, previous surgery, and arthroplasty type, the hazard ratio (HR) for revision of the stemless shoulder arthroplasty was 1.00 (95% confidence interval [CI], 0.63-1.61), P = .99, with the stemmed shoulder arthroplasty as reference. Male gender (HR = 1.50 [95% CI, 1.06-2.13], P = .02) and previous surgery (HR = 2.70 [95% CI, 1.82-4.01], P < .001) were associated with increased risk of revision. CONCLUSION The short-term survival of total stemless shoulder arthroplasty appears comparable with total stemmed shoulder arthroplasty, but longer observation time is needed to confirm whether they continue to perform equally.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jenni Harjula
- Department of Orthopaedics and Traumatology, Turku University and University Hospital, Turku, Finland
| | - Erica D Arverud
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden
| | - Randi Hole
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Steen L Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Stig Brorson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Björn Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University and University Hospital, Turku, Finland
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Pinto MC, Archie AT, Mosher ZA, Ransom EF, McGwin G, Fehringer EV, Brabston EW, Ponce BA. Radiographic restoration of native anatomy: a comparison between stemmed and stemless shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1595-1600. [PMID: 30982698 DOI: 10.1016/j.jse.2019.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder arthroplasty is a reliable procedure for patients with degenerative glenohumeral disease, and reproduction of native shoulder anatomy leads to superior outcomes. The aim of this study was to compare the ability of stemmed and stemless implants to radiographically restore native glenohumeral anatomy. METHODS Shoulder arthroplasties were performed in 79 patients, with 58 receiving a stemless implant and 21 receiving a stemmed implant. Preoperative and postoperative radiographs were assessed for humeral head height, humeral head centering, humeral head medial offset, humeral head diameter, humeral neck angle, and lateral humeral offset by 2 independent viewers. Measurements were scored and summed to identify the anatomic reconstruction index (ARI). Radiographic measurements were compared using the Student t test, and significance was set at P < .05 for all statistical analyses. Interobserver agreement of radiographic analyses was assessed using the intraclass correlation coefficient, finding excellent reliability (intraclass correlation coefficient, 0.92). RESULTS Five of six radiographic measurements along with the calculated ARI demonstrated no differences between stemmed and stemless shoulder implants (humeral head diameter, P = .651; humeral head height, P = .813; humeral head medial offset, P = .592; lateral humeral offset, P = .311; humeral head centering, P = .414; and ARI, P = .862). Stemless implants showed improved restoration of the native humeral neck angle (0° for stemless vs. -3° for stemmed, P = .017). CONCLUSION Radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants.
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Affiliation(s)
- Martim C Pinto
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam T Archie
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary A Mosher
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin F Ransom
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Geral McGwin
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward V Fehringer
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W Brabston
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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17
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Reeves JM, Athwal GS, Johnson JA, Langohr GDG. The Effect of Inhomogeneous Trabecular Stiffness Relationship Selection on Finite Element Outcomes for Shoulder Arthroplasty. J Biomech Eng 2019; 141:2718204. [DOI: 10.1115/1.4042172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 11/08/2022]
Abstract
An important feature of humeral orthopedic finite element (FE) models is the trabecular stiffness relationship. These relationships depend on the anatomic site from which they are derived; but have not been developed for the humerus. As a consequence, humeral FE modeling relies on relationships for other anatomic sites. The variation in humeral FE outcomes due to the trabecular stiffness relationship is assessed. Stemless arthroplasty FE models were constructed from CT scans of eight humeri. Models were loaded corresponding to 45 deg and 75 deg abduction. Each bone was modeled five times with the only variable being the trabecular stiffness relationship: four derived from different anatomic-sites and one pooled across sites. The FE outcome measures assessed were implant-bone contact percentage, von Mises of the change in stress, and bone response potential. The variance attributed to the selection of the trabecular stiffness relationship was quantified as the standard deviation existing between models of different trabecular stiffness. Overall, variability due to changing the trabecular stiffness relationship was low for all humeral FE outcome measures assessed. The variability was highest within the stress and bone formation potential outcome measures of the trabecular region. Variability only exceeded 10% in the trabecular stress change within two of the eight slices evaluated. In conclusion, the low variations attributable to the selection of a trabecular stiffness relationship based on anatomic-site suggest that FE models constructed for shoulder arthroplasty can utilize an inhomogeneous site-pooled trabecular relationship without inducing marked variability in the assessed outcome measures.
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Affiliation(s)
- Jacob M. Reeves
- Department of Mechanical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
| | - George S. Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, 268 Grosvenor StreetE-p, London, ON N6A4V2, Canada e-mail:
| | - James A. Johnson
- Department of Mechanical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
| | - G. Daniel G. Langohr
- Department of Mechanical Engineering, Western University Canada, 1151 Richmond Street, London, ON N6A3K7, Canada e-mail:
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18
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Reeves JM, Langohr GDG, Athwal GS, Johnson JA. The effect of stemless humeral component fixation feature design on bone stress and strain response: a finite element analysis. J Shoulder Elbow Surg 2018; 27:2232-2241. [PMID: 30104100 DOI: 10.1016/j.jse.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/26/2018] [Accepted: 06/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since the advent of stemless implants, several different fixation feature designs have been used to improve primary implant stability. These stemless designs are diverse, and the rationale for their selection and design has not been thoroughly studied. Accordingly, this investigation assessed the effect of stemless implant geometry on the simulated stress and strain response of the proximal humerus. METHODS Five humeral finite element models were used to examine 10 generic stemless implants with variable fixation features (2 central, 4 peripheral, and 4 boundary crossing). Loads representing 45° and 75° of shoulder abduction were simulated. Implants were compared based on the percentage of implant-bone surface area that remained in contact, the change in bone stress relative to the intact state, and the simulated potential for bone to resorb, remodel, or remain unchanged after reconstruction. RESULTS The implant-bone contact area was greatest for peripheral, followed by central and boundary-crossing designs. All implants elicited similar bone stress variations, which were greatest 0 to 5 mm beneath the resection and laterally. The simulated potential cortical response was also similar for all implants, with the greatest simulated resorbing potential 0 to 15 mm beneath the resection, and very little expected remodeling. Differences between implants were most prominent within the simulated potential trabecular response, with the central implants having the least bone volume percentage expected to resorb. CONCLUSIONS Simulated humeral bone response after stemless anatomic shoulder replacement depends on fixation feature geometry. Trade-offs exist between implant types. Centrally pegged implants produced the lowest simulated resorbing potential, whereas peripheral implants had the greatest percentages of implant-bone contact area.
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Affiliation(s)
- Jacob M Reeves
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - G Daniel G Langohr
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - George S Athwal
- The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, The University of Western Ontario, London, ON, Canada; Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada.
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19
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Tashjian RZ, Chalmers PN. Future Frontiers in Shoulder Arthroplasty and the Management of Shoulder Osteoarthritis. Clin Sports Med 2018; 37:609-630. [DOI: 10.1016/j.csm.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Erickson BJ, Cordasco FA. Why short-stemmed implants are the implant of choice in a 60-year-old with shoulder osteoarthritis. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.sart.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chalmers PN, Granger EK, Orvets ND, Patterson BM, Chamberlain AM, Keener JD, Tashjian RZ. Does prosthetic humeral articular surface positioning associate with outcome after total shoulder arthroplasty? J Shoulder Elbow Surg 2018; 27:863-870. [PMID: 29289492 DOI: 10.1016/j.jse.2017.10.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the effect of humeral articular component positioning on changes in patient-reported outcomes after anatomic total shoulder arthroplasty. METHODS This was a retrospective series of consecutive patients at 2 high-volume referral centers. The study included patients with (1) a preoperative and postoperative radiograph demonstrating a perfect or nearly perfect profile of the humerus and implant and (2) Simple Shoulder Test, visual analog scale for pain, and American Society of Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment scores preoperatively and at greater than 2 years postoperatively. Head height, head diameter, tuberosity-to-head height distance, inclination, and medial offset of the center of rotation (COR) were measured preoperatively and postoperatively. Distance and direction from the ideal COR to the reconstructed center of rotation was measured. Measurements were correlated with improvement in functional outcomes. RESULTS The study included 95 patients, aged 66 ± 9 years, with a mean follow-up of 4.3 ± 1.7 years. An a priori power analysis suggested that a sample size of 95 patients provided 80% power to detect correlations of R2 = 0.07. The COR shift was >2 mm in 62% of patients and >4 mm 15%. Thirty-two percent had a change of ASES of <21 points. On multivariate analysis, there were no significant associations between any change in measured prosthetic radiographic parameters and changes in the visual analog scale, Simple Shoulder Test, or ASES scores (P > .05). CONCLUSION In this retrospective analysis of total shoulder arthroplasty in which most components were well positioned, humeral component positioning did not associate with change in postoperative outcomes. These findings should be prospectively confirmed.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Erin K Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan D Orvets
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Brendan M Patterson
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, St. Louis, MO, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Abstract
The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems. Many of these humeral component design changes may be beneficial; however, long-term studies are necessary to determine if the results of anatomic shoulder arthroplasty with the use of newer humeral components can match those of anatomic shoulder arthroplasty with the use of older humeral components.
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von Engelhardt LV, Manzke M, Breil-Wirth A, Filler TJ, Jerosch J. Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty. World J Orthop 2017; 8:790-797. [PMID: 29094010 PMCID: PMC5656495 DOI: 10.5312/wjo.v8.i10.790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/14/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.
METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.
RESULTS Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.
CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.
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Affiliation(s)
- Lars V von Engelhardt
- Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Michael Manzke
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Andreas Breil-Wirth
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Timm J Filler
- Department of Anatomy, Heinrich-Heine University of Duesseldorf, Duesseldorf 40225, Germany
| | - Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
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Hawi N, Magosch P, Tauber M, Lichtenberg S, Habermeyer P. Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results. J Shoulder Elbow Surg 2017; 26:1609-1615. [PMID: 28410956 DOI: 10.1016/j.jse.2017.02.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several stemless shoulder implants are available on the market, but only a few studies have presented results with sufficient mid- to long-term follow-up. The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement. METHODS This is a prospective cohort study evaluating the stemless shoulder prosthesis since 2005. Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders; 17 underwent total shoulder replacement, and 32 underwent hemiarthroplasty. Forty-three patients were clinically and radiologically monitored after a mean of 9 years (range, 90-127 months; follow-up rate, 88%). The indications for shoulder replacement were primary osteoarthritis in 7 shoulders, post-traumatic in 24, instability in 7, cuff tear arthropathy in 2, postinfectious arthritis in 1, and revision arthroplasty in 2. RESULTS The Constant-Murley Score improved significantly from 52% to 79% (P < .0001). The active range of motion also increased significantly for flexion from 101° to 118° (P = .022), for abduction from 79° to 105° (P = .02), and for external rotation from 21° to 43° (P < .0001). Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention. No revision caused by loosening or countersinking of the humeral implant was observed. CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation standard shoulder arthroplasty.
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Affiliation(s)
- Nael Hawi
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Trauma Department, Hannover Medical School, Hannover, Germany.
| | - Petra Magosch
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Sven Lichtenberg
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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25
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Brolin TJ, Cox RM, Abboud JA, Namdari S. Stemless Shoulder Arthroplasty: Review of Early Clinical and Radiographic Results. JBJS Rev 2017; 5:e3. [DOI: 10.2106/jbjs.rvw.16.00096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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26
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Radiological and functional 24-month outcomes of resurfacing versus stemmed anatomic total shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2016; 41:375-384. [PMID: 27761628 DOI: 10.1007/s00264-016-3310-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This study compared clinical and radiographic outcomes of patients undergoing resurfacing total shoulder arthroplasty (TSA) with those treated with a stemmed TSA. METHODS Patients with primary osteoarthritis who underwent humeral resurfacing (RES) or stemmed (STA) TSA were identified in our shoulder arthroplasty register for retrospective analysis. Standard radiographs and clinical/patient-rated assessments were made up to 24 months post-surgery. Implant revisions were assessed. Patients were frequency-matched in a 1:1 (RES:STA) ratio based on gender and age, and compared with regard to operation time and shoulder function (Constant, SPADI and Quick DASH scores). Mixed models with statistical adjustments were applied. RESULTS From 2006 to 2014, 44 RES and 137 STA operations were performed in 157 patients; one and two revisions were recorded in the RES and STA group, respectively. The final matched cohort included a total of 69 patients and 37 operations per treatment group. Resurfacing TSA was 17 min shorter (95%CI: 5-28) compared to the stemmed procedure (p = 0.005). RES and STA patients showed significant functional improvement six months post-implantation, yet all measured scores did not differ between the groups at 2 years (p ≥ 0.131). The status of static centering of the humeral head, acromiohumeral distance, and a lack of signs of implant loosening were also similar between treatments. CONCLUSION Similar 24-month post-operative radiological and functional outcome is achieved by RES and STA patients, even with a shorter RES surgery time. Larger cohorts and longer follow-up are required to better assess implant survival.
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Kadum B, Wahlström P, Khoschnau S, Sjödén G, Sayed-Noor A. Association of lateral humeral offset with functional outcome and geometric restoration in stemless total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:e285-94. [PMID: 27083578 DOI: 10.1016/j.jse.2016.02.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of shoulder geometry is desirable in total shoulder arthroplasty (TSA) and thought to influence the postoperative clinical outcome. We aimed to study the association of postoperative lateral humeral offset (LHO) changes and clinical outcome, as well as to investigate the ability of stemless anatomic TSA to restore shoulder geometry. METHODS In patients with primary shoulder osteoarthritis who underwent stemless anatomic TSA, the preoperative and postoperative clinical outcome was measured. Shoulder geometry was measured on preoperative computed tomography for the osteoarthritic shoulder and contralateral healthy shoulder and on postoperative computed tomography for the operated shoulder. RESULTS Forty-four patients with a minimum follow-up of 12 months (range, 12-50 months) were available for the study. Postoperatively, the clinical outcome measures improved. The postoperative difference in LHO between the operated shoulder and contralateral healthy shoulder was 1.3 ± 4.6 mm and was correlated with scores on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire at 3 months (Pearson correlation = 0.36, P = .01) and visual analog scale for pain at rest (Pearson correlation = 0.30, P = .03) and with exertion (Pearson correlation = 0.34, P = .01) at 3 months. Lengthening of LHO was associated with worsening shoulder function at 3 months but not at 12 months. The postoperative shoulder geometric parameters were restored postoperatively to acceptable ranges. CONCLUSION The stemless anatomic TSA could restore shoulder geometry in an acceptable manner. At 3 months but not at 12 months, increased LHO had a negative effect on shoulder function and resulted in more shoulder pain at rest and with exertion but did not affect quality of life, health status, or range of motion.
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Affiliation(s)
- Bakir Kadum
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden.
| | - Per Wahlström
- Department of Hand Surgery, Umeå University, Umeå, Sweden
| | - Shwan Khoschnau
- Department of Orthopaedics, Elisabethsjukhuset, Uppsala, Sweden
| | - Göran Sjödén
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden
| | - Arkan Sayed-Noor
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden
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Hawi N, Tauber M, Messina MJ, Habermeyer P, Martetschläger F. Anatomic stemless shoulder arthroplasty and related outcomes: a systematic review. BMC Musculoskelet Disord 2016; 17:376. [PMID: 27577859 PMCID: PMC5006279 DOI: 10.1186/s12891-016-1235-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral center of rotation independently from the shaft, and to avoid stem-related complications. The stemless prosthesis design has also recently been introduced for use in reverse arthroplasty systems. METHODS We systematically reviewed the literature for studies of currently available canal-sparing respectively stemless shoulder arthroplasty systems. From the identified series, we recorded the indications, outcome measures, and humeral-sided complications. RESULTS We identified 11 studies of canal-sparing respectively stemless anatomic shoulder arthroplasty implants, published between 2010 and 2016. These studies included 929 cases, and had a mean follow-up of 26 months (range, 6 to 72 months). The rates of humeral component-related complications ranged between 0 and 7.9 %. The studies reported only a few isolated cases of complications of the humeral component. Some arthroplasty systems are associated with radiological changes, but without any clinical relevance. CONCLUSIONS All of the published studies of canal-sparing respectively stemless shoulder arthroplasty reported promising clinical and radiological outcomes in short to midterm follow-up. Long-term studies are needed to demonstrate the long-term value of these kind of implants.
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Affiliation(s)
- Nael Hawi
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925 München, Germany
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925 München, Germany
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Michael Joseph Messina
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925 München, Germany
- Boston Shoulder Institute/Harvard Medical School, Boston, MA USA
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925 München, Germany
| | - Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925 München, Germany
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Munich, Germany
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Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy. INTERNATIONAL ORTHOPAEDICS 2016; 40:1473-9. [DOI: 10.1007/s00264-016-3138-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
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