ArticleJournal of shoulder and elbow arthroplasty2026
Incidence of radiographic humeral bone remodeling after reverse total shoulder arthroplasty and its impact on clinical outcome.
Article in Journal of shoulder and elbow arthroplasty, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reverse total shoulder arthroplasty (rTSA) has proven to be a reliable surgical treatment option for a wide variety of shoulder pathologies. Bony remodeling around the humeral component occurs frequently but its impact on clinical outcome remains unclear. Methods: We retrospectively reviewed 102 patients who underwent primary rTSA between 2008 and 2020. At final follow-up (FU), patients underwent standardized radiographs and clinical examination, including patient-reported outcome measures and the adjusted Constant Murley score (aCMS). Serial radiographs (pre-operative, 6 weeks and ≥2 years post-operative) were evaluated for: bone remodeling (cortical thickness, pedestal formation, spot welds, reactive lines, osteolysis, radiolucent lines) and implant stem parameters (subsidence, size, alignment and filling ratio). Stress shielding was quantitatively defined as a decrease in combined cortical thickness measured at four sites (2 medial [M1 and M2], 2 lateral [L1 and L2]). Subgroup analysis was conducted to determine correlations between the radiographic findings and clinical outcome. The relationship between stress shielding severity and functional outcome was investigated by using percent-based thresholds to explore potential cutoff values. Results: In 102 patients (mean age 70 years, 71% female, mean FU 65 months), the mean aCMS was 80. Stress shielding occurred in 74%, with combined cortical thickness decreasing from 3.0 to 2.2 mm at final FU; proximal lateral thinning (L1) was most pronounced. A ≥10% cortical thinning threshold at L1 is associated with a lower aCMS (77 vs. 86, Discussion: This study assessed the long-term radiographic evaluations of humeral bone remodeling after rTSA. The quantitative assessment of cortical thickness showed that the proximal lateral humerus is most affected by stress shielding. A >10% cortical thinning at this site showed a tendency toward inferior clinical outcome, contrasting with prior reports suggesting no functional impact. Other radiographic bone remodeling was common but did not impair function. Our findings support the standardize assessment of cortical resorption with special attention to the region of the proximal lateral humerus during patient FU.
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