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Stemless reverse humeral component neck-shaft angle has an influence on initial fixation.

David E Cunningham1, Gregory W Spangenberg1, G Daniel G Langohr1

  • 1Department of Mechanical Engineering, The University of Western Ontario, London, ON, Canada; The Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.

Journal of Shoulder and Elbow Surgery
|July 28, 2023
PubMed
Summary

Optimizing the neck-shaft angle for stemless reverse shoulder implants is crucial for stability. Higher angles, like 140-150°, significantly reduce bone-implant distraction during daily activities, enhancing fixation.

Keywords:
Stemlessarthroplastycuff tear arthropathyfinite elementimplant designneck shaft anglereverse shoulder arthroplasty

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Implant design

Background:

  • Stemless anatomic humeral components are a viable alternative to stemmed implants in patients with good bone quality.
  • Limited research exists on factors influencing primary fixation of stemless reverse humeral implants.
  • This study investigates the impact of neck-shaft angle on stemless reverse humeral implant stability.

Purpose of the Study:

  • To assess the effect of surgical neck-shaft angle on the primary time-zero fixation of stemless reverse humeral implants.
  • To determine the optimal neck-shaft angle for maximizing implant stability.

Main Methods:

  • Finite element analysis of eight CT-derived humeral models.
  • Simulated implantation of a generic stemless humeral implant at neck-shaft angles of 130°, 135°, 140°, 145°, and 150°.
  • Analysis of four simulated daily living loading scenarios to measure bone-implant micromotion.

Main Results:

  • The greatest implant-bone distraction occurred at the 130° neck-shaft angle.
  • Increasing the neck-shaft angle significantly reduced micromotion (P=.0001).
  • Each 5° increase in neck-shaft angle resulted in an average 17% reduction in bone-implant distraction.

Conclusions:

  • Neck-shaft angle is a critical, modifiable factor for stemless reverse humeral component stability.
  • Varus neck-shaft angles (e.g., 130°) increase bone-implant distraction.
  • Humeral head osteotomies at higher neck-shaft angles may improve stemless implant stability.