Evidence map›Paper›PMID 38417733›Full record

ArticleJournal of shoulder and elbow surgery2024

Reverse total shoulder arthroplasty with proximal bone loss: a biomechanical comparison of partially vs. fully cemented humeral stems.

Carlos Maturana, Brandon Peterson, Brendan Shi, Bailey Mooney, Tyler Clites, Thomas J Kremen

Open access · greenAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of shoulder and elbow surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.6field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 1 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Carlos MaturanaAnatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Brandon PetersonAnatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA.
Brendan ShiDepartment of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Bailey MooneyAnatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Tyler ClitesAnatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Thomas J KremenDavid Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: tjkremen@mednet.ucla.edu.
University of California, Los Angeles · US

Funding

Regenerative Musculoskeletal Medicine Training ProgramT32AR059033 · NIAMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI John S Adams, Nicholas M. Bernthal · 2011 to 2026
$4.8M
Enhanced Soft Tissue-to-Bone Healing via Treatment with Novel Growth Factor NELL-1: Targeted Delivery and Biomimetic ScaffoldsIK2BX005199 · VA · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · PI THOMAS John KREMEN · 2020 to 2026
–
BLRD VA IK2 BX005199NIAMS NIH HHS T32 AR059033
6 · The paper itself

Abstract

backgroundThe appropriate amount of cementation at the time of reverse total shoulder arthroplasty with significant proximal bone loss or resection is unknown. Extensive cementation of a humeral prosthesis makes eventual revision arthroplasty more challenging, increasing the risk of periprosthetic fracture. We analyzed the degree of subsidence and torque tolerance of humeral components undergoing standard cementation technique vs. our reduced polymethyl methacrylate (PMMA) protocol. Reduced cementation may provide sufficient biomechanical stability to resist physiologically relevant loads, while still permitting a clinically attainable torque for debonding the prosthesis.

methodsA total of 12 cadaveric humeri (6 matched pairs) underwent resection of 5 cm of bone distal to the greater tuberosity. Each pair of humeri underwent standard humeral arthroplasty preparation followed by either cementation using a 1.5-cm PMMA sphere at a location 3 cm inferior to the porous coating or standard full stem cementation. A 6-degree-of-freedom robot was used to perform all testing. Each humeral sample underwent 200 cycles of abduction, adduction, and forward elevation while being subjected to a physiologic compression force. Next, the samples were fixed in place and subjected to an increasing torque until implant-cement separation or failure occurred. Paired t tests were used to compare mean implant subsidence vs. a predetermined 5-mm threshold, as well as removal torque in matched samples.

resultsFully and partially cemented implants subsided 0.49 mm (95% CI 0.23-0.76 mm) and 1.85 mm (95% CI 0.41-3.29 mm), respectively, which were significantly less than the predetermined 5-mm threshold (P < .001 and P < .01, respectively). Removal torque between fully cemented stems was 45.22 Nm (95% CI 21.86-68.57 Nm), vs. 9.26 Nm (95% CI 2.59-15.93 Nm) for partially cemented samples (P = .021). Every fully cemented humerus fractured during implant removal vs. only 1 in the reduced-cementation group. The mean donor age in our study was 76 years (range, 65-80 years). Only 1 matched pair of humeri belonged to a female donor with comorbid osteoporosis. The fractured humerus in the partially cemented group belonged to that donor.

conclusionPartially and fully cemented humeral prostheses had subsidence that was significantly less than 5 mm. Partially cemented stems required less removal torque for debonding of the component from the cement mantle. In all cases, removal of fully cemented stems resulted in humeral fracture. Reduced cementation of humeral prostheses may provide both sufficient biomechanical stability and ease of future component removal.

Indexed as

Arthroplasty, Replacement, ShoulderBone CementsCadaverHumerusProsthesis DesignShoulder ProsthesisAgedAged, 80 and overBiomechanical PhenomenaCementationFemaleHumansMalePolymethyl MethacrylateShoulder JointBone CementsPolymethyl Methacrylatebone cementhumeral stemsimplant subsidenceproximal humerus fractureReverse total shoulder arthroplastyshoulder biomechanics

Identifiers

PMID38417733
PMCPMC11330736
OpenAlexW4392195936

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.