ArticleArchives of orthopaedic and trauma surgery2024
The effects of length and width of the stem on proximal humerus stress shielding in uncemented primary reverse total shoulder arthroplasty.
Article in Archives of orthopaedic and trauma surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Radiographic bone resorption after reverse total shoulder arthroplasty using a single onlay platform: risk factors and distribution patterns in a Japanese cohort.Journal of shoulder and elbow arthroplasty · 2026Article
- Volumetric 3-dimensional computed tomography analysis of proximal humeral bone resorption after reverse total shoulder arthroplasty.Journal of orthopaedic surgery and research · 2026Article
- Clinical relevance, classification, and risk factors for stress shielding in total shoulder arthroplasty: a systematic review and meta-analysis of clinical outcomes.EFORT open reviews · 2026Review
- Uncemented vs. cemented reverse total shoulder arthroplasty with latissimus dorsi and teres major transfer.JSES international · 2025Article
- Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study.Journal of imaging · 2024Article
- Humeral Stem Design in Reverse Total Shoulder Arthroplasty.Current reviews in musculoskeletal medicine · 2024Review
- Outcomes of a cementless onlay short stem reverse shoulder arthroplasty in elderly patients: a comprehensive analysis of clinical and radiological findings.Archives of orthopaedic and trauma surgery · 2024Article
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7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionTo preserve humeral bone during RTSA, stems have been made shorter and cement avoided whenever possible. However, with the increased use of uncemented RTSA, a phenomenon comparable to the stress shielding of the hip has been described for the proximal humerus. The aim of this study was to investigate the influence of stem length and width on proximal humeral bone resorption after primary uncemented RTSA. MATERIALS AND
methodsThe prospective shoulder arthroplasty database of our institution was reviewed for all primary uncemented RTSAs from 2017 to 2020 in osteoarthritis and cuff tear arthropathy cases with > 2-year follow-up. We compared the clinical and the radiographic 2-year outcome of the short and standard length stems of the same prosthesis design. This allowed us to assess the effects of stem length and width with regard to stress shielding. Furthermore, we defined a cut-off value for the filling ratios to prevent stress shielding.
resultsFifty patients were included in the analysis, nineteen were in the short stem group (SHORT) and thirty-one in the standard stem group (STANDARD). After 2 years, SHORT showed a relative Constant Score of 91.8% and STANDARD of 98.3% (p = 0.256). Stress shielding was found in 4 patients (21%) in SHORT and in 16 patients (52%) in STANDARD (p = 0.03); it occurred more frequently in patients with higher humeral filling ratios (p < 0.05). The calculated cut-off to prevent stress shielding was 0.7 (± 0.03) for the metaphyseal and distal filling ratio.
conclusionWhile short and standard stems for RTSA have good results after 2 years, we found a significant negative effect of higher length and width of the stem with regard to stress shielding. Even though the clinical effects of stress shielding have to be assessed, short stems should be chosen with a filling ratio at the metaphyseal and distal position below 0.7. LEVEL OF EVIDENCE (A RETROSPECTIVE CASE-CONTROL STUDY): III.
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