Abstract
Background
Stress shielding and osteolysis around the humeral stem after reverse shoulder arthroplasty
causes loosening and periprosthetic fractures and reduces bone stock during revision
surgery. In Japanese patients, who have relatively small bodies, different characteristics
may exist regarding the occurrence of these changes compared with the characteristics
of Westerners, who have relatively larger frames. The purpose of this multicenter
study was to investigate the incidence and clarify the predictors of stress shielding
and osteolysis in Japanese individuals who underwent reverse shoulder arthroplasty.
Methods
The occurrence of stress shielding and osteolysis was investigated in 135 shoulders
that had undergone reverse shoulder arthroplasty at least 2 years prior in five Japanese
hospitals. During post-surgical follow-up, which was conducted every 3 months, the
locations of the stress shielding occurrences, such as cortical thinning and osteopenia
(which primarily occurred in zones 1, 2, and 7, where 1 is the greater tuberosity
and 7 is the calcar part), spot weld, and condensation lines, were recorded. Cases
without any abnormal findings on radiographs obtained up to ≥2 years after surgery
were regarded as having no abnormalities. Finally, the predictors of cortical thinning
and proximal humeral osteolysis were assessed using univariate and multivariate regression
analyses.
Results
Cortical thinning and osteopenia occurred in 68 shoulders, a condensation line occurred
in 37 shoulders, and spot weld occurred in 23 shoulders. In particular, greater tuberosity
and calcar osteolysis occurred in 40 and 47 shoulders, respectively. Long stem, cementless
stem, and a larger proximal filling ratio were independent predictors of cortical
thinning and osteopenia, whereas a cementless stem, larger metaphysis diameter, and
a larger proximal filling ratio were associated with proximal humeral osteolysis.
Conclusions
The predictors of stress shielding and osteolysis included the use of long stems,
cementless stems, larger proximal filling ratios, and larger metaphysis diameters.
Level of evidence
retrospective comparative study (Level III).
Keywords
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Article info
Publication history
Published online: January 27, 2023
Accepted:
January 5,
2023
Received in revised form:
December 11,
2022
Received:
July 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
