Impaction autografting: bone-preserving, secure fixation of a standard humeral component

Background When fixed with bone ingrowth, a tight diaphyseal press fit, or cement, the humeral component of a shoulder arthroplasty may present problems of malposition, stress shielding, or periprosthetic fracture or difficulty with removal at revision arthroplasty. We have avoided the need for thes...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2016-11, Vol.25 (11), p.1787-1794
Main Authors: Lucas, Robert M., MD, Hsu, Jason E., MD, Gee, Albert O., MD, Neradilek, Moni B., MS, Matsen, Frederick A., MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
allograft
Arthroplasty, Replacement, Shoulder
Autografts
Bone Transplantation - methods
Female
fixation
Humans
humeral component
Humerus - transplantation
impaction grafting
lucent lines
Male
Middle Aged
Orthopedics
Prosthesis Design
Shoulder arthroplasty
Shoulder Joint - surgery
Shoulder Prosthesis
subsidence
Young Adult
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Summary:Background When fixed with bone ingrowth, a tight diaphyseal press fit, or cement, the humeral component of a shoulder arthroplasty may present problems of malposition, stress shielding, or periprosthetic fracture or difficulty with removal at revision arthroplasty. We have avoided the need for these fixation methods by using impaction cancellous autografting of the humeral stem, minimizing contact between the prosthetic stem and the humeral cortex. This study presents the radiographic survivorship of impaction-autografted humeral implants using component subsidence as the primary endpoint. Methods We reviewed 286 primary anatomic shoulder arthroplasties having an average follow-up of 4.9 ± 2.7 years. Initial postoperative radiographs and minimum 2-year follow-up radiographs were evaluated by 3 observers to assess subsidence. Results Two different implants (Humeral Replacement Prosthesis [HRP] and Global Advantage prosthesis) were used. Of 286 stems, 267 (93.4%) had not subsided. The Global Advantage prosthesis had a subsidence-free survival rate of 98.5% at 5 years. The stiffer-stemmed HRP used early during the study had a higher rate of subsidence compared with the currently used Global Advantage stem (hazard ratio, 5.6; P  = .001). Radiolucent lines of 2 mm or greater were less common for the Global Advantage prosthesis than for the HRP in each of 7 zones ( P  
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2016.03.008