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Updated: Oct 19, 2025

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

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Determining the ideal osteotomy for stemless total shoulder replacement: a cadaveric study.

Damian McClelland¹, John R Blackwell¹, Sarah O'Beirne²

¹Royal Stoke University Hospital, Stoke on Trent, UK.

Journal of Shoulder and Elbow Surgery

|September 24, 2021

Summary

The optimal osteotomy angle for a circular humeral cut surface is 23° from the vertical. This finding is crucial for precise surgical procedures involving the humerus, improving outcomes in orthopedic surgery.

Keywords:

Humeral replacement humeral osteotomy stemless replacement

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Area of Science:

Orthopedic Surgery
Anatomy
Biomechanical Engineering

Background:

Humeral head osteotomy is a critical step in various shoulder surgeries.
Achieving a perfectly circular cut surface is essential for optimal implant fit and joint function.
Current osteotomy angles may not consistently produce the desired circularity.

Purpose of the Study:

To determine the precise osteotomy angle that yields a circular humeral cut surface.
To establish a reliable method for achieving optimal bone preparation in shoulder arthroplasty.
To compare the effectiveness of different osteotomy angles in creating a circular bone cut.

Main Methods:

Cadaveric shoulder specimens (n=49) were used for sequential humeral head osteotomy.
Osteotomies were performed at 10° increments from a vertical starting point (180°).
Anteroposterior (AP) and superoinferior (SI) distances were measured to assess cut surface roundness.

Main Results:

The optimal osteotomy angle for a circular humeral cut surface was determined to be 23° from the vertical.
At 23°, the average roundness error was 1%, with a 95% confidence limit below 1%.
The range of angles producing a circular cut (within 10% error) is 18°-27°, significantly narrower than traditional 45° angles.

Conclusions:

Humeral head shape transitions from oval to circular and back to oval as the osteotomy angle increases.
An osteotomy angle of 23° from the vertical is recommended for achieving a circular humeral cut surface.
The identified optimal angle range offers a more precise approach compared to traditional methods, potentially improving surgical outcomes.