These authors compared clinical outcomes of 288 anatomical total shoulders (aTSA) with and without radiolucencies around an uncemented grit-blasted metaphyseal-fit humeral stems at a minimum of 5-years after surgery.
The operations were performed by fellowship trained surgeons from 14 different centers across the world. Exclusion criteria included revision shoulder arthroplasty, rheumatoid arthritis, and post-traumatic arthritis. The article does not provide details of surgical technique, for example how the humerus was prepared, how the size of the implant was selected and whether impaction grafting was used.
Two-hundred forty-three humeral stems showed no radiolucent lines. Among the 37 humeral stems with lucent lines, lines were most common in zones 8, 4, 7, and 3.
Gross humeral loosening was noted in 4 of the 37 patients in the humeral lucent line group (11%). Other complications besides humeral loosening were more common in the humeral lucent line group.
Comment: This minimum 5 year follow up is informative. 13% of these stems had either gross humeral loosening or showed humeral radiolucent lines. These findings were associated with inferior clinical outcomes.
The association of humeral loosening or lucency with glenoid loosening brings up the possibility that a low grade infection might be at play in these cases. Alternatively, cement or polyethylene debris from glenoid failure might have contributed to the humeral changes.
The results of this study can be compared to those in a recent publication using a smooth humeral stem inserted with impaction autographing (see this link)
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The association of humeral loosening or lucency with glenoid loosening brings up the possibility that a low grade infection might be at play in these cases. Alternatively, cement or polyethylene debris from glenoid failure might have contributed to the humeral changes.
The results of this study can be compared to those in a recent publication using a smooth humeral stem inserted with impaction autographing (see this link)
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