Wednesday, October 15, 2014

The humeral component - importance of body shape

In this day of discussion of 'platform' prostheses, stems that encourage bony ingrowth, trabecular metal and advocates for humeral component cementing, it is appropriate to point out that the combination of a tapered body and impaction grafting enables safe cementless fixation of the humeral component. This approach has the additional advantage of facilitating stem removal, should it become necessary.

The shape of the body is important. The two images on the left show that a press fit cannot be obtained with a cylindrical body. However, as is shown on the two images on the right, a tapered body allows a snug metaphyseal fit, especially if coupled with impaction grafting.

Here are five examples from our OR yesterday. Each of these prosthesis fit tightly within the impaction grafted humeral canal without wedging in the diaphysis (wedging can predispose to fracture at the tip of the prosthesis). Note the conservative broaching and the filling in of the space between the prosthesis and the endosteal cortex with graft harvested from the humeral head.


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