Influence of uncemented humeral stem proximal geometry on stress distributions and torsional stability following total shoulder arthroplasty

Journal of Experimental Orthopaedics
Johannes BarthArnaud Godenèche

Abstract

While surgeons tend to implant larger stems to improve torsional stability, numerous studies demonstrated that increasing humeral stem diameter could exacerbate stress-shielding and lead to bone resorption. We aimed to determine the influence of humeral stem proximal geometry on stress distributions and torsional stability following total shoulder arthroplasty. Preoperative computed tomography scans were acquired from 5 patients and processed to form 3-dimensional models of the proximal humerus. Computer models of 3 generic implants were created based on three designs: predominantly oval, semi-angular, and predominantly angular. All stems shared identical head geometry and differed only in the proximal metaphyseal area. Finite element analyses were performed, with the humerus rigidly constrained distally, and loaded to simulate the joint reaction force. Implant torsional stability and proximal bone stress distributions were assessed for the three different stem designs with three sizes: oversized (stem making contact with the cortical diaphysis), normosized (one increment smaller) and undersized (two increments smaller). Considering the normosized stems, the angular design increased the physiologic bone stresses at the proximal...Continue Reading

References

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Citations

May 22, 2021·Journal of Shoulder and Elbow Surgery·Benjamin ZmistowskiJay D Keener

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Methods Mentioned

BETA
total shoulder arthroplasty

Software Mentioned

SolidWorks
ADAMS

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