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Related Experiment Videos

Fixation for the millennium: the shoulder.

Gregory S Bauer1, Anand M Murthi, Louis U Bigliani

  • 1Shoulder Service, Department of Orthopaedic Surgery, Columbia-Presbyterian Medical Center, New York, New York 10032, USA. lubl@columbia.edu

The Journal of Arthroplasty
|June 18, 2002
PubMed
Summary

Shoulder arthroplasty fixation has evolved, with early designs facing issues like patient fatigability. Modern cemented and cementless glenoid components and humeral fixation offer improved outcomes, with fixation choice depending on patient factors and surgeon preference.

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Area of Science:

  • Orthopedic surgery
  • Biomaterials science
  • Prosthetic design

Background:

  • The original Charles Neer shoulder prosthesis (1951) used cast cobalt chrome alloy with press-fit fixation.
  • Early designs reported no significant loosening but caused patient fatigability, attributed to glenoid issues.
  • Introduction of cemented glenoid replacement in 1973 led to high lucency rates, questioning fixation stability.

Purpose of the Study:

  • To review the evolution of shoulder arthroplasty fixation techniques.
  • To compare the outcomes of cemented versus cementless glenoid components.
  • To assess the long-term fixation and loosening rates of humeral components.

Main Methods:

  • Historical review of shoulder prosthesis designs and fixation methods.

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  • Analysis of reported outcomes, including loosening rates and patient symptoms.
  • Comparison of cemented and cementless glenoid component performance.
  • Evaluation of humeral fixation strategies based on bone quality and patient factors.

    • Main Results:

    • Cementless glenoid components show fewer lucencies but necessitate metal backing and have higher failure rates than cemented designs.
    • Humeral fixation with cement or coated press-fit shows no symptomatic loosening.
    • Long-term studies indicate a low incidence of humeral loosening for both cemented and uncemented stems.

    Conclusions:

    • Humeral component fixation is generally reliable, with low loosening rates.
    • The choice of humeral fixation should consider bone quality, patient age, prosthetic design, and surgeon preference.
    • Glenoid fixation strategies continue to evolve, balancing lucency rates and failure risks between cemented and cementless options.