These authors evaluated humeral stress shielding after shoulder arthroplasty performed with a smooth, standard-length humeral stem fixed with impaction autografting.
Prior to placement of the final component, cancellous autograft harvested from the humeral head was placed in the humeral canal and pressed into place using a humeral impactor with the same stem geometry as the implant. Autograft was progressively inserted until the impactor fit tightly within the humerus. The final uncoated, smooth, stemmed, fixed-angle humeral component with the desired head geometry was then driven into the prepared canal.
At two years after surgery, the radiographic appearances were evaluated by an independent experienced shoulder surgeon from another institution not involved in the care of these patients. The metaphysical and diaphysial filling ratios were measured as shown below.
The filling ratios were small, showing a substantial preservation of bone stock.
The Simple Shoulder Test score improved from 3.9±2.5 to 9.9±2.4.
Humeral component subsidence or component shift was observed in 3 ream-and-run procedures (6%) and in 8 TSAs (10%). These radiographic findings were not significantly associated with patient demographic characteristics, canal-filling ratios, or clinical outcomes.
The authors concluded that this independent assessment of the 2-year radiographic and clinical outcomes of a conventional smooth humeral stem inserted with impaction autografting demonstrates the clinical utility of this bone-preserving approach to humeral component fixation with minimal complications; good clinical outcomes; and low rates of bone loss, component subsidence, and shift in position.
Comment: After three decades of use, impaction autografting of a smooth standard-length stem remains our preferred method for bone-preserving humeral component fixation.
Impaction allografting remains our preferred method for addressing failed prior humeral component fixation.
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