Thursday, May 1, 2014

Managing a humeral shaft deformity with a stemmed humeral component

We have found that a stemmed humeral component provides the most flexible and most secure approach to the humeral side of shoulder arthroplasty.
Even in the presence of a humeral shaft deformity, the combination of a relatively small diameter humeral stem and impaction grafting can enable the secure and properly oriented placement of the humeral articular surface.

As an example, here is the preoperative film of a man with a very tight shoulder and a prior history of fibrous dysplasia. We desired a thin broad humeral component ideally positioned with respect to his glenoid.

After soft tissue releases and resection of the osteophytes, impaction grafting was used to secure the thin-stemmed, short-necked humeral prosthesis in the desired position.

Thus fixing of the component in the humerus requires either removing bone from the inside of the bone by broaching until a reasonable fit is achieved, cementing the prosthesis, obtaining a tight press fit in the diaphysis, bone ingrowth or impaction grafting. The latter is our preferred method because it adds, rather than removes bone, avoids the risk of fracture from a tight cortical press fit, avoids the use of cement, and avoids the difficulties associated with revision of an ingrowth prosthesis. As the prior post shows, impaction allografting can be used in revision of a prior failed arthroplasty.


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