Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study
Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus. Methods: Forty cadaveric shoulder specimens were a...
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MDPI AG
2024-12-01
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| Series: | Journal of Imaging |
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| Online Access: | https://www.mdpi.com/2313-433X/10/12/334 |
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| author | Daniel Ritter Patric Raiss Patrick J. Denard Brian C. Werner Peter E. Müller Matthias Woiczinski Coen A. Wijdicks Samuel Bachmaier |
| author_facet | Daniel Ritter Patric Raiss Patrick J. Denard Brian C. Werner Peter E. Müller Matthias Woiczinski Coen A. Wijdicks Samuel Bachmaier |
| author_sort | Daniel Ritter |
| collection | DOAJ |
| description | Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus. Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.72): Standard stem with low (<i>n</i> = 10) and high (<i>n</i> = 10) filling ratios, a short stem with low (<i>n</i> = 10) and high filling ratios (<i>n</i> = 10). Biomechanical testing included cyclic loading of the native bone and the implanted humeral component. Optical recording allowed for spatial implant tracking and the quantification of cortical bone deformations in the proximal humerus. Results: Planned filling ratios based on 3D volumetric measures had a good-to-excellent correlation (ICC = 0.835; <i>p</i> < 0.001) with implanted filling ratios. Lower canal fill ratios resulted in significantly higher variability between short and standard stems regarding implant tilt (820 N: <i>p</i> = 0.030) and subsidence (220 N: <i>p</i> = 0.046, 520 N: <i>p</i> = 0.007 and 820 N: <i>p</i> = 0.005). Higher filling ratios resulted in significantly lower bone deformations in the medial calcar area compared to the native bone, while the bone deformations in lower filling ratios did not differ significantly (<i>p</i> > 0.177). Conclusions: Lower canal filling ratios maintain dynamic bone loading in the medial calcar of the humerus similar to the native situation in this biomechanical loading setup. Short stems implanted with a low filling ratio have an increased risk for implant tilt and subsidence compared to high filling ratios or standard stems. |
| format | Article |
| id | doaj-art-7fe7eda861454891acf2ced83e46dc56 |
| institution | OA Journals |
| issn | 2313-433X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Imaging |
| spelling | doaj-art-7fe7eda861454891acf2ced83e46dc562025-08-20T02:00:34ZengMDPI AGJournal of Imaging2313-433X2024-12-01101233410.3390/jimaging10120334Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational StudyDaniel Ritter0Patric Raiss1Patrick J. Denard2Brian C. Werner3Peter E. Müller4Matthias Woiczinski5Coen A. Wijdicks6Samuel Bachmaier7Department of Orthopedic Research, Arthrex, 81249 Munich, GermanyOCM Clinic, 81369 Munich, GermanySouthern Oregon Orthopedics, Medford, OR 97504, USADepartment of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, GermanyDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, GermanyDepartment of Orthopedic Research, Arthrex, 81249 Munich, GermanyDepartment of Orthopedic Research, Arthrex, 81249 Munich, GermanyObjective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus. Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.72): Standard stem with low (<i>n</i> = 10) and high (<i>n</i> = 10) filling ratios, a short stem with low (<i>n</i> = 10) and high filling ratios (<i>n</i> = 10). Biomechanical testing included cyclic loading of the native bone and the implanted humeral component. Optical recording allowed for spatial implant tracking and the quantification of cortical bone deformations in the proximal humerus. Results: Planned filling ratios based on 3D volumetric measures had a good-to-excellent correlation (ICC = 0.835; <i>p</i> < 0.001) with implanted filling ratios. Lower canal fill ratios resulted in significantly higher variability between short and standard stems regarding implant tilt (820 N: <i>p</i> = 0.030) and subsidence (220 N: <i>p</i> = 0.046, 520 N: <i>p</i> = 0.007 and 820 N: <i>p</i> = 0.005). Higher filling ratios resulted in significantly lower bone deformations in the medial calcar area compared to the native bone, while the bone deformations in lower filling ratios did not differ significantly (<i>p</i> > 0.177). Conclusions: Lower canal filling ratios maintain dynamic bone loading in the medial calcar of the humerus similar to the native situation in this biomechanical loading setup. Short stems implanted with a low filling ratio have an increased risk for implant tilt and subsidence compared to high filling ratios or standard stems.https://www.mdpi.com/2313-433X/10/12/334reverse shoulder arthroplastyshort stemstandard stemCT imagingcanal fillstress shielding |
| spellingShingle | Daniel Ritter Patric Raiss Patrick J. Denard Brian C. Werner Peter E. Müller Matthias Woiczinski Coen A. Wijdicks Samuel Bachmaier Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study Journal of Imaging reverse shoulder arthroplasty short stem standard stem CT imaging canal fill stress shielding |
| title | Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study |
| title_full | Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study |
| title_fullStr | Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study |
| title_full_unstemmed | Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study |
| title_short | Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study |
| title_sort | volumetric humeral canal fill ratio effects primary stability and cortical bone loading in short and standard stem reverse shoulder arthroplasty a biomechanical and computational study |
| topic | reverse shoulder arthroplasty short stem standard stem CT imaging canal fill stress shielding |
| url | https://www.mdpi.com/2313-433X/10/12/334 |
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