Five-year radiographic evaluation of stress shielding with a press-fit standard length humeral stem

Elliott W Cole; Samuel G Moulton; Reuben Gobezie; Anthony A Romeo; J Brock Walker; Evan Lederman; Patrick J Denard

doi:10.1016/j.jses.2019.11.002

Five-year radiographic evaluation of stress shielding with a press-fit standard length humeral stem

JSES Int. 2020 Jan 2;4(1):109-113. doi: 10.1016/j.jses.2019.11.002. eCollection 2020 Mar.

Authors

Elliott W Cole¹, Samuel G Moulton¹, Reuben Gobezie², Anthony A Romeo³, J Brock Walker⁴, Evan Lederman^{4

5}, Patrick J Denard^{1

6}

Affiliations

¹ Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
² The Cleveland Shoulder Institute, Beachwood, OH, USA.
³ Rothman Institute, New York, NY, USA.
⁴ University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
⁵ The Orthopedic Clinic Association, Phoenix, AZ, USA.
⁶ Southern Oregon Orthopedics, Medford, OR, USA.

Abstract

Background: Stress shielding of the humeral stem is a known complication in press-fit total shoulder arthroplasty (TSA), but there remain limited data on its prevalence and clinical impact in midterm follow-up. The purpose of this study was to determine the prevalence of humeral stem stress shielding and its impact on functional outcomes at minimum 5-year follow-up in standard length press-fit TSA. The hypothesis was that the presence of stress shielding at minimum 5-year follow-up would not affect functional outcome scores or range of motion (ROM).

Methods: A multicenter retrospective review of primary TSAs performed with a press-fit standard length humeral stem. Functional outcome scores, ROM, and radiographs were reviewed at minimum 5-year follow-up. Prevalence of stress shielding was determined by presence of medial calcar osteolysis and adaptive changes. Function was assessed with the visual analog scale (VAS) pain score, Simple Shoulder Test (SST) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and Single Assessment Numeric Evaluation (SANE) score, and ROM.

Results: Forty-seven patients with 47 TSAs were available for follow-up at a mean of 79 months postoperation. Overall, 15 of 47 humeral stems had high adaptive change scores (31.9%), and 20 demonstrated medial calcar osteolysis (42.6%). Stems with evidence of stress shielding showed no significant change in SST, VAS, ASES, or SANE scores and minimal change in ROM measurements at minimum 5-year follow-up.

Conclusion: Stress shielding is common at midterm follow-up in press-fit TSA but does not appear to affect functional outcomes.

Keywords: Total shoulder arthroplasty; humeral stem; midterm; press-fit; standard length; stress shielding.