The Journal of Bone and Joint Surgery 82:1594 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Three-Dimensional Analysis of the Proximal Part of the Humerus: Relevance to Arthroplasty*
Douglas D. Robertson, M.D., Ph.D. ,
Jie Yuan, Ph.D.,
Louis U. Bigliani, M.D. ,
Evan L. Flatow, M.D. and
Ken Yamaguchi, M.D.
Investigation performed at the Shoulder and Elbow Service,
Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington
University School of Medicine, St. Louis, Missouri
*One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. Funds were
received in total or partial support of the research or clinical
study presented in this article. The funding source was the Zimmer
Corporation.
Shoulder and Elbow Service, Department of Orthopaedic Surgery,
Washington University School of Medicine, 1 Barnes-Jewish Hospital
Plaza, Suite 11300, West Pavilion, St. Louis, Missouri 63110.
Department of Orthopaedic Surgery, Columbia University, New York,
N.Y. 10032.
§Department of Orthopaedic Surgery, Mt. Sinai University School
of Medicine, New York, N.Y. 10029.
Background: Recreation of normal anatomical
relationships may be important to optimize the outcome of proximal
humeral arthroplasty. With use of computerized tomographic data
and three-dimensional computer modeling, we concurrently studied
both extramedullary and intramedullary humeral morphology, including
canal shape, and related these findings to the design of proximal
humeral prostheses.
Methods: Sixty cadaveric humeri (thirty pairs:
fifteen from male donors and fifteen from female donors) were studied.
Three-dimensional computer models were built from canal and periosteal
contours extracted from computerized tomographic data and multiple
measured anatomical parameters, including humeral canal axis, humeral
head center, and hinge point offset; greater tuberosity and bicipital groove
offset; humeral head center, radius, thickness, retroversion, and
inclination; and size and torsion of sections of the canal.
Results: On the average, the humeral head center
was offset both medially (seven millimeters) and posteriorly (two
millimeters) from the humeral axis. The humeral head hinge point
did not line up with the axis but instead was laterally offset by
an average of seven millimeters. The average humeral head thickness
was nineteen millimeters. The humeral head thickness and length
were proportionately linked. There was marked variability in all
of these parameters. Humeral head inclination averaged 41 degrees
but was less variable than previously described, with 95 percent
of our sample within the range of 35 to 46 degrees. The proximal
section of the humeral canal was retroverted, and the retroversion
was found to be similar to that of the humeral head on statistical
analysis. Version of the middle and distal sections of the canal,
however, was dissimilar to that of the proximal section of the canal.
Proximal humeral retroversion was found to be extremely variable
and averaged 19 degrees. The accuracy, reliability, and repeatability
of the computer-based-model measurements were found to be excellent.
Conclusions: Measurements of external proximal
humeral morphology made with three-dimensional computer models of
cadaveric specimens derived from the Midwestern United States agreed,
in general, with those described for different populations evaluated with
different measuring techniques. Proximal humeral morphology was
extremely variable as highlighted by the large ranges of measurements
seen for all variables. Examination of the intramedullary morphology
showed that there is an internal version, with measurements dependent
on the canal distance distal to the anatomical neck.
Clinical Relevance: Because of the marked variabilities
seen in proximal humeral morphology, newer prosthetic designs are
now allowing surgeons to control multiple prosthetic variables.
An understanding of the normal values for proximal humeral morphology
can serve as an important guideline for component selection, especially
when the normal anatomy is distorted. Additionally, variations in intramedullary
version may have important consequences for future designs of press-fit
proximal humeral replacement.
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