Friday, October 24, 2014

Get Shorty? Are short stemmed humeral components an advantage?

There has been recent interest in shorter stemmed humeral components - sometimes called 'mini' or even 'micro' stems. While the suggested advantages are (1) preservation of more humeral bone and (2) easier fit in the humeral canal, what is sacrificed is the ability of the longer stem to assure proper orientation of the humeral head with respect to the humerus. This problem is shown on the x-rays below of a case recently presenting to us. While the prosthesis appears properly oriented

The axillary view shows the stem in substantial anterior inclination, with lack of coverage of the posterior proximal humerus and a tendency for anterior subluxation. A revision was required.

The goals of bone conservation and ease of fit can be obtained without the risk of malposition with the use of a traditional length stem selected after minimal canal reaming with impaction grafting as shown in this link.

Here are the x-rays of a man we saw back this week who is one year out from a ream and run procedure with our standard approach to humeral component selection and fixation - no cement, no ingrowth, no loss of endosteal bone through reaming, no valgus, no varus, no angulation, no loosening, no plastic glenoid and 12/12 on the Simple Shoulder Test.

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