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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Reverse Total Shoulder Arthroplasty
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Humeral bone resorption after reverse shoulder arthroplasty using uncemented stem.

Kazuya Inoue1, Naoki Suenaga2, Naomi Oizumi2

  • 1Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan.

JSES International
|March 21, 2020
PubMed
Summary

Humeral bone resorption is common after reverse shoulder arthroplasty (RSA), particularly in certain zones. Female sex and onlay-type stems are identified risk factors for severe bone resorption, impacting shoulder revision surgery outcomes.

Keywords:
Humeral bonebone resorptionreverse shoulder arthroplastyrisk factorstress shieldinguncemented humeral stem

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Radiology

Background:

  • Humeral stem loosening is a key cause of revision surgery in reverse shoulder arthroplasty (RSA).
  • Humeral bone loss complicates revision surgery due to stress shielding.
  • Limited detailed reports exist on humeral bone resorption following RSA.

Purpose of the Study:

  • To determine the prevalence of humeral bone resorption after RSA.
  • To identify risk factors associated with humeral bone resorption.

Main Methods:

  • Retrospective analysis of 48 shoulders undergoing RSA with uncemented humeral stems (July 2014 - May 2017).
  • Follow-up duration exceeded 1 year.
  • Statistical analyses included logistic, multiple logistic, and multivariate logistic regression.

Main Results:

  • Bone resorption was frequently observed, with advanced grades (3 and 4) occurring in 48% of cases.
  • High occurrences were noted in humeral zones 1, 2, and 7.
  • Female sex and onlay-type stems were significant independent risk factors for grade 4 bone resorption.

Conclusions:

  • Bone resorption is a frequent complication after RSA, particularly in the greater tuberosity, lateral diaphysis, and calcar regions.
  • Female patients and those receiving onlay-type stems face higher risks of significant bone resorption.
  • Findings highlight the need to consider patient sex and stem type in RSA planning to mitigate bone resorption.