Humeral-sided Radiographic Changes Following Reverse Total Shoulder Arthroplasty

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA

2 Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University Hospitals, Philadelphia, PA, USA

3 Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University Hospitals, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University Hospitals, Philadelphia, PA, USA

Abstract

Background: We sought to characterize humeral-sided radiographic changes at a minimum of 2 years after reverse
shoulder arthroplasty (RSA) to determine their association with specific implantation techniques.
Methods: The immediate and most recent postoperative anteroposterior radiographs of 120 shoulders with primary RSA
and a minimum of 2-years of radiographic follow-up were analyzed (mean follow-up 35.2 months). Stress shielding was
evaluated by measuring cortical thickness at 4 different locations. Three independent examiners evaluated radiographs
for humeral osteolysis, radiolucent lines, stress shielding, stem loosening, and scapular notching.
Results: The cortical diameter, marker of external stress shielding, significantly decreased from initial to most
recent measurement (p <0.001), but did not differ between cemented and uncemented groups. Cemented stems had
significantly more osteolysis and radiolucent lines; uncemented stems had significantly more internal stress shielding
(p <001). The presence of scapular notching was significantly correlated with the presence of humeral osteolysis
(p <0.001). Three (2.5%) stems were deemed “at risk” for loosening and 2 (1.7%) were loose.
Conclusion: Cemented humeral stems were associated with an increased rate of radiolucent lines and osteolysis,
whereas uncemented stems were associated with more internal stress shielding. Humeral cortical thickness significantly
decreased over time regardless of fixation. There was an association between scapular notching and increased
humeral osteolysis.
Level of evidence: III

Keywords

Main Subjects

References

1. Werner CML, Steinmann PA, Gilbart M, Gerber
C. Treatment of painful pseudoparesis due to
irreparable rotator cuff dysfunction with the delta III
reverse-ball-and-socket total shoulder prosthesis. J
Bone Joint Surg Am. 2005; 87(7):1476-86.
2. Cuff DJ, Pupello DR, Santoni BG, Clark RE, Frankle 
MA. Reverse shoulder arthroplasty for the treatment
of rotator cuff deficiency: a concise follow-up, at a
minimum of 10 years, of previous reports. J Bone
Joint Surg. 2017; 99(22):1895-9.
3. Day JS, MacDonald DW, Olsen M, Getz C, Williams GR,
Kurtz SM. Polyethylene wear in retrieved reverse 
total shoulder components. J Shoulder Elbow Surg.
2012; 21(5):667-74.
4. Rosas S, Law TY, Kurowicki J, Formaini N, Kalandiak
SP, Levy JC. Trends in surgical management of
proximal humeral fractures in the Medicare
population: a nationwide study of records from 2009
to 2012. J Shoulder Elbow Surg. 2016; 25(4):608-13.
5. Brolin TJ, Throckmorton TW. Emerging indications
for reverse total shoulder arthroplasty. In: Dines
D, Dines J, Edwards TB, editors. Reverse shoulder
arthroplasty: a practical approach. New York:
Thieme Medical Publishers Inc; 2018. P. 34-9.
6. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé
D. Grammont inverted total shoulder arthroplasty in
the treatment of glenohumeral osteoarthritis with
massive rupture of the cuff: results of a multicenter
study of 80 shoulders. J Bone Joint Surg Br. 2004;
86(3):388-95.
7. Fox TJ, Foruria AM, Klika BJ, Sperling JW, Schleck
CD, Cofield RH. Radiographic survival in total
shoulder arthroplasty. J Shoulder Elbow Surg. 2013;
22(9):1221-7.
8. Nagels J, Stokdijk M, Rozing PM. Stress shielding and
bone resorption in shoulder arthroplasty. J Shoulder
Elbow Surg. 2003; 12(1):35-9.
9. Raiss P, Edwards TB, Deutsch A, Shah A, Bruckner T,
Loew M, et al. Radiographic changes around humeral
components in shoulder arthroplasty. J Bone Joint
Surg Am. 2014; 96(7):e54.
10. Sanchez-Sotelo J, O’Driscoll SW, Torchia ME,
Cofield RH, Rowland CM. Radiographic assessment
of cemented humeral components in shoulder
arthroplasty. J Shoulder Elbow Surg. 2001; 10(6):
526-31.
11. Schnetzke M, Coda S, Raiss P, Walch G, Loew M.
Radiologic bone adaptations on a cementless shortstem
shoulder prosthesis. J Shoulder Elbow Surg.
2016; 25(4):650-7.
12. Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME,
Rowland CM. Radiographic assessment of ingrowth
total shoulder arthroplasty. J Shoulder Elbow Surg.
2000; 9(6):507-13.
13. Sperling JW, Cofield RH, Rowland CM. Minimum
fifteen-year follow-up of Neer hemiarthroplasty
and total shoulder arthroplasty in patients aged
fifty years or younger. J Shoulder Elbow Surg. 2004;
13(6):604-13.
14. Szerlip BW, Morris BJ, Laughlin MS, Kilian CM,
Edwards TB. Clinical and radiographic outcomes
after total shoulder arthroplasty with an anatomic
press-fit short stem. J Shoulder Elbow Surg. 2018;
27(1):10-6.
15. Harmsen SM, Norris TR. Radiographic changes and
clinical outcomes associated with an adjustable
diaphyseal press-fit humeral stem in primary reverse
shoulder arthroplasty. J Shoulder Elbow Surg. 2017;
26(9):1589-97.
16. Melis B, DeFranco M, Lädermann A, Molé D, Davard
L, Nérot C, et al. An evaluation of the radiological 
changes around the Grammont reverse geometry
shoulder arthroplasty after eight to 12 years. J Bone
Joint Surg Br. 2011; 93(9):1240-6.
17. Wiater BP, Baker EA, Salisbury MR, Koueiter DM,
Baker BM, Nolan BM, et al. Elucidating trends
in revision reverse total shoulder arthroplasty
procedures: a retrieval study evaluating clinical,
radiographic, and functional outcomes data. J
Shoulder Elbow Surg. 2015; 24(12):1915-25.
18. Terrier A, Merlini F, Pioletti DP, Farron A. Comparison
of polyethylene wear in anatomical and reversed
shoulder prostheses. J Bone Joint Surg Br. 2009;
91(7):977-82.
19. Wang ML, Sharkey PF, Tuan RS. Particle bioreactivity
and wear-mediated osteolysis. J Arthroplasty. 2004;
19(8):1028-38.
20. Day JS, Paxton ES, Lau E, Gordon VA, Abboud
JA, Williams GR. Use of reverse total shoulder
arthroplasty in the Medicare population. J Shoulder
Elbow Surg. 2015; 24(5):766-72.
21. Nam D, Kepler CK, Nho SJ, Craig EV, Warren RF,
Wright TM. Observations on retrieved humeral
polyethylene components from reverse total
shoulder arthroplasty. J Shoulder Elbow Surg. 2010;
19(7):1003-12.
22. Wiater JM, Moravek JE, Budge MD, Koueiter DM,
Marcantonio D, Wiater BP. Clinical and radiographic
results of cementless reverse total shoulder
arthroplasty: a comparative study with 2 to 5 years of
follow-up. J Shoulder Elbow Surg. 2014; 23(8):1208-14.
23. Gruen TA, McNeice GM, Amstutz HC. “Modes of
failure” of cemented stem-type femoral components:
a radiographic analysis of loosening. Clin Orthop
Relat Res. 1979; 141(1):17-27.
24. Byrt T, Bishop J, Carlin JB. Bias, prevalence and
Kappa. J Clin Epidemiol. 1993; 46(5):423-9.
25. Light RJ. Measures of response agreement for
qualitative data: some generalizations and alternatives.
Psychol Bull. 1971; 76(5):365-77.
26. Cicchetti DV. Guidelines, criteria, and rules of thumb
for evaluating normed and standardized assessment
instruments in psychology. Psychol Assess. 1994;
6(4):284-90.
27. Ascione F, Domos P, Guarrella V, Chelli M, Boileau
P, Walch G. Long-term humeral complications after
Grammont-style reverse shoulder arthroplasty. J
Shoulder Elbow Surg. 2018; 27(6):1065-71.
28. Gilot G, Alvarez-Pinzon AM, Wright TW, Flurin
PH, Krill M, Routman HD, et al. The incidence of
radiographic aseptic loosening of the humeral
component in reverse total shoulder arthroplasty. J
Shoulder Elbow Surg. 2015; 24(10):1555-9.
29. Zumstein MA, Pinedo M, Old J, Boileau P. Problems,
complications, reoperations, and revisions in reverse
total shoulder arthroplasty: a systematic review. J
Shoulder Elbow Surg. 2011; 20(1):146-57.
30. Sinha RK, Dungy DS, Yeon HB. Primary total hip
arthroplasty with a proximally porous-coated femoral
stem. J Bone Joint Surg Am. 2004; 86(6):1254-61.
The Archives of Bone and Joint Surgery
Volume 8, Issue 1
January 2020
Pages 50-57

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History

  • Receive Date: 13 November 2018
  • Accept Date: 21 January 2019

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