Online citations, reference lists, and bibliographies.

Comparison Of Proximal Humeral Bone Stresses Between Stemless, Short Stem, And Standard Stem Length: A Finite Element Analysis.

Najmeh Razfar, J. Reeves, Daniel G Langohr, R. Willing, G. Athwal, J. Johnson
Published 2016 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
BACKGROUND The stem lengths of humeral components used in shoulder arthroplasty vary; however, the literature on these devices is limited. This finite element study investigates the effect of humeral component length on stresses in the proximal humerus. METHODS Intact and 3 reconstructed (standard length, short, and stemless implants) finite element models were created from shoulder computed tomography scan data (N = 5). Loading was simulated at varying abduction angles (15°, 45°, and 75°). The average bone stress (represented as a percentage of intact values) was reported at 8 transverse slices. In addition, the overall average change in cortical and trabecular bone stresses was quantified. RESULTS Cortical bone stresses in the most proximal slice for the standard (58% ± 12%) and short (78% ± 10%) stem models were significantly reduced compared with the intact (100%) and stemless (101% ± 6%) models (P = .005). These reductions persisted in the second cortical slice for the standard stem compared with the intact, stemless, and short models (P = .025). Interestingly, stresses in the trabecular bone within these proximal slices were significantly elevated when stemless implants were used compared with all other implants (P < .001), regardless of abduction angle. CONCLUSION Reducing stem length produced humeral stresses that more closely matched the intact stress distribution in proximal cortical bone. Opposing trends presented in the proximal trabecular bone, probably because of differences in load transfer when shorter stems are used. Accordingly, the results suggest that implant stem length is 1 variable that can be modified in an attempt to better mimic intact bone stresses during humeral component insertion, provided stem fixation is adequate.
This paper references
10.1037/e623932009-001
Anthropometric reference data for children and adults: United States, 2003–2006.
M. McDowell (2008)
10.1007/s00132-012-2020-x
[Options and limits of stemless shoulder prostheses].
T. Ambacher (2013)
10.1016/0021-9290(93)90042-D
Young's modulus of trabecular and cortical bone material: ultrasonic and microtensile measurements.
J. Rho (1993)
10.1016/j.clinbiomech.2011.08.004
Primary stability and strain distribution of cementless hip stems as a function of implant design.
R. Bieger (2012)
10.1007/978-3-642-71031-5
The Law of Bone Remodelling
J. Wolff (1986)
10.1007/s002640050355
Stem length and canal filling in uncemented custom-made total hip arthroplasty
T. Sakai (1999)
10.1002/jbm.820140204
The influence of design parameters on calcar stresses following femoral head arthroplasty.
S. Cook (1980)
Basic orthopaedic biomechanics and mechano-biology
V. Mow (2005)
10.1016/0021-9290(83)90072-6
A survey of finite element analysis in orthopedic biomechanics: the first decade.
R. Huiskes (1983)
10.1002/jor.21360
Bone stresses before and after insertion of two commercially available distal ulnar implants using finite element analysis.
Rebecca L. Austman (2011)
10.1016/J.JBIOMECH.2007.02.010
Subject-specific finite element models can accurately predict strain levels in long bones.
E. Schileo (2007)
10.1016/0141-5425(87)90104-X
Effects of stem design and material properties on stresses in hip endoprostheses.
A. Rohlmann (1987)
10.1016/J.JBIOMECH.2006.10.037
In vivo glenohumeral contact forces--measurements in the first patient 7 months postoperatively.
G. Bergmann (2007)
10.1097/00003086-199201000-00010
Producing and avoiding stress shielding. Laboratory and clinical observations of noncemented total hip arthroplasty.
J. Bobyn (1992)
10.2106/00004623-197759070-00021
The compressive behavior of bone as a two-phase porous structure.
D. Carter (1977)
10.1007/s10195-012-0216-9
Stemless shoulder prosthesis versus conventional anatomic shoulder prosthesis in patients with osteoarthritis
A. Berth (2012)
10.1016/j.jse.2012.12.005
Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening.
R. Ballas (2013)
10.1097/00003086-199201000-00014
The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials.
R. Huiskes (1992)
10.1007/s10195-006-0141-x
Proximal load transfer with a stemless uncemented femoral implant
N. Santori (2006)
10.1002/cnm.2530
Accounting for patient variability in finite element analysis of the intact and implanted hip and knee: a review.
Mark Taylor (2013)
10.1016/j.jse.2009.12.009
Results of a new stemless shoulder prosthesis: radiologic proof of maintained fixation and stability after a minimum of three years' follow-up.
D. Huguet (2010)
10.1016/J.ARTH.2005.06.015
Comparison of two hydroxyapatite-coated femoral stems: clinical, functional, and bone densitometry evaluation of patients randomized to a regular or modified hydroxyapatite-coated stem aimed at proximal fixation.
J. Sluimer (2006)
10.1080/10255842.2012.662677
The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis
Mikael Reimeringer (2013)
10.1016/1350-4533(95)90854-5
Is stem length important in uncemented endoprostheses?
K. Tanner (1995)
10.1054/ARTH.2000.16498
Early failure of modern cemented stems.
R. Barrack (2000)
10.1016/j.clinbiomech.2012.03.006
Evaluation of femoral strains with cementless proximal-fill femoral implants of varied stem length.
Sally Arno (2012)
10.1054/ARTH.2001.28369
Load transfer and stress shielding of the hydroxyapatite-ABG hip: a study of stem length and proximal fixation.
B. van Rietbergen (2001)
10.1016/S0021-9290(03)00071-X
Trabecular bone modulus-density relationships depend on anatomic site.
E. Morgan (2003)
10.1016/S0021-9290(03)00257-4
Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue.
Harun H. Bayraktar (2004)
10.1016/J.JBIOMECH.2006.04.007
Artificial composite bone as a model of human trabecular bone: the implant-bone interface.
J. Grant (2007)
10.2106/JBJS.H.01610
Glenohumeral contact kinematics in patients after total shoulder arthroplasty.
Daniel Frank Massimini (2010)
10.1302/0301-620X.79B1.6645
Total Shoulder Replacement In Rheumatoid Disease: 7- To 13-year Follow-up Of 37 Joints
M. Stewart (1997)
10.1016/S1058-2746(97)90081-1
Total shoulder arthroplasty with the Neer prosthesis: long-term results.
M. Torchia (1995)
10.1067/MSE.2003.22
Stress shielding and bone resorption in shoulder arthroplasty.
J. Nagels (2003)
10.1243/09544119JEIM553
Development of a customized density—modulus relationship for use in subject-specific finite element models of the ulna
Rebecca L. Austman (2009)
10.1007/s00132-012-2020-x
Möglichkeiten und Grenzen der schaftfreien Oberarmkopfprothese
Thomas Ambacher (2012)
10.1243/09544119JEIM618
Effects of bone density alterations on strain patterns in the pelvis: Application of a finite element model
A. Leung (2009)
10.1016/J.JBIOMECH.2005.07.018
Subject-specific finite element models of long bones: An in vitro evaluation of the overall accuracy.
F. Taddei (2006)
10.1016/S0883-5403(97)90192-3
Effect of a stemless femoral implant for total hip arthroplasty on the bone mineral density of the proximal femur. A prospective longitudinal study.
E. Munting (1997)
10.1002/jor.1100140108
Friction and stem stiffness affect dynamic interface motion in total hip replacement.
J. Kuiper (1996)



This paper is referenced by
10.1016/j.jse.2018.06.002
The effect of stemless humeral component fixation feature design on bone stress and strain response: a finite element analysis.
Jacob M. Reeves (2018)
10.1016/j.jses.2019.09.011
Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis
Lisa Peduzzi (2019)
10.5435/JAAOS-D-17-00088
Stemless Prosthesis for Total Shoulder Arthroplasty
Mark D. Lazarus (2017)
10.1016/j.jse.2017.10.038
Does prosthetic humeral articular surface positioning associate with outcome after total shoulder arthroplasty?
P. Chalmers (2018)
10.1016/j.jse.2017.08.010
Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty.
P. Denard (2018)
10.1302/0301-620X.101B9.BJJ-2018-1369.R1
Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty.
Marian Uy (2019)
10.1016/j.jse.2019.03.007
Bone adaptation impact of stemless shoulder implants: a computational analysis.
Manuel Rosado Nunes Comenda (2019)
10.1115/1.4042172
The Effect of Inhomogeneous Trabecular Stiffness Relationship Selection on Finite Element Outcomes for Shoulder Arthroplasty.
Jacob M. Reeves (2019)
10.1016/j.jses.2019.11.002
Five-year radiographic evaluation of stress shielding with a press-fit standard length humeral stem
Elliott W. Cole (2020)
10.1007/s11678-019-0514-4
Short-stem anatomical shoulder replacement—a systematic review
Marc Schnetzke (2019)
10.1177/1758573219866431
Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis – A prospective multicentre study:
Rw Jordan (2019)
10.17392/1141-20
Strut graft vs. traditional plating in the management of periprosthetic humeral fractures: a multicentric cohort study.
G. Rollo (2020)
Influence of the geometry of stemless implants on the bone adaptation process of the humerus: a computational analysis
M. Comenda (2018)
10.1053/J.SART.2017.12.003
Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty—Opposes
Samuel M Harmsen (2017)
10.1016/j.otsr.2019.12.010
Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties?
A. Lädermann (2020)
An In-Silico Assessment of Stemless Shoulder Arthroplasty: from CT to Predicted Bone Response
Jacob M. Reeves (2018)
10.23750/abm.v90i1-S.8064
Cementless metaphyseal reverse shoulder arthroplasty: our preliminary experience.
Gian Mario Micheloni (2019)
10.1016/j.jse.2019.08.018
The effect of short-stem humeral component sizing on humeral bone stress.
G. Daniel G. Langohr (2019)
10.1053/J.SART.2017.05.006
Short-stemmed arthroplasty with glenoid preoperative planning
Eric L. Giang (2017)
10.1016/B978-0-12-809831-8.00016-7
Modeling the Spine and Upper and Lower Extremities for Impact Scenarios
King H. Yang (2018)
10.1016/j.jse.2017.06.042
Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty.
P. Denard (2018)
Bone remodeling analysis of the humerus after resurfacing and stemless shoulder arthroplasties
B. F. Santos (2017)
10.1016/j.jse.2017.04.012
Humeral bone resorption after anatomic shoulder arthroplasty using an uncemented stem.
K. Inoue (2017)
10.1186/s40634-019-0178-4
Influence of uncemented humeral stem proximal geometry on stress distributions and torsional stability following total shoulder arthroplasty
J. Barth (2019)
10.1016/j.rcot.2020.01.021
Les tiges courtes influencent-elles l’angle cervico-diaphysaire et le remplissage médullaire des prothèses totales inversées d’épaule ?
Alexandre Lädermann (2020)
10.1115/1.4040122
Methods for Post Hoc Quantitative Computed Tomography Bone Density Calibration: Phantom-Only and Regression.
Jacob M. Reeves (2018)
10.1016/j.jse.2017.10.029
An analysis of proximal humerus morphology with special interest in stemless shoulder arthroplasty.
Jacob M. Reeves (2018)
Finite Element Analysis of Hollow-stemmed Shoulder Implants in Different Bone Qualities Derived from a Statistical Shape and Density Model
Pendar Soltanmohammadi (2019)
10.1115/1.4045907
Finite Element-Predicted Effects of Screw Configuration in Proximal Humerus Fracture Fixation.
Maryam Tilton (2020)
10.1016/j.jse.2017.09.019
An assessment of proximal humerus density with reference to stemless implants.
Jacob M. Reeves (2018)
10.1016/j.jse.2019.09.032
Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component.
Simon N. Bell (2019)
10.1055/a-1079-6549
Long-Term Radiographic Changes in Stemless Press-Fit Total Shoulder Arthroplasty.
Sascha Beck (2020)
See more
Semantic Scholar Logo Some data provided by SemanticScholar