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Humeral Fixation by Press-Fitting of a Tapered Metaphyseal Stem

A Prospective Radiographic Study

Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington; the Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio; and the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas

Frederick A. Matsen III, MD
Department of Orthopaedics and Sports Medicine, University of Washington, Box 356500, 1959 N.E. Pacific Street, Seattle, WA 98195-6500. E-mail address: matsen{at}u.washington.edu

Joseph P. Iannotti, MD, PhD
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195

Charles A. Rockwood Jr., MD
Department of Orthopaedics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The technique of shoulder arthroplasty requires a method for securely and durably fixing the humeral component in the medullary canal of the proximal part of the humerus. As an alternative to fixation by cementing or tissue ingrowth, we explored the effectiveness of using a prosthesis with a metaphyseal taper from the anatomic neck to the diaphysis. This component is designed to obtain press-fit fixation in the cancellous bone of the metaphysis rather than in the cortical bone of the diaphysis. We tested the hypothesis that this press-fit humeral stem, designed to respect the taper of the proximal part of the humeral canal, would be associated with a low rate of loosening in patients managed with primary shoulder arthroplasty for osteoarthritis.

Methods: A prospective study was conducted to evaluate the prevalence of radiolucent lines around press-fit humeral prostheses. One hundred and thirty-one patients with glenohumeral osteoarthritis were followed for a minimum of two years. A zonal method of evaluating radiolucent lines was established. Shift in position and subsidence were judged qualitatively.

Results: No component showed subsidence or a shift in position. Fifty shoulders (39%) had no radiolucency. Two shoulders had radiolucency around the proximal part of the prosthesis, and seventy-five had radiolucency at the distal tip. Eleven radiolucencies were 1 mm in width. A neutral stem orientation was significantly less likely to be associated with radiolucency (p = 0.026). The prevalence of radiolucent lines did not differ between patients managed with hemiarthroplasty and those managed with total shoulder arthroplasty, and it did not increase with longer periods of follow-up.

Conclusions: In patients managed with shoulder arthroplasty, the fixation of a press-fit humeral component that has a tapered metaphyseal segment is comparable with that reported for cemented components and superior to that reported for press-fit cylindrical components.

Clinical Relevance: This type of fixation may provide an alternative to cementing of the humeral stem in individuals with glenohumeral osteoarthritis.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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