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The Evolution Of Innovation In Humeral Implant Options: Two Surgeons’ Case Reviews

Rick Papandrea, MD

Orthopaedic Associates of Wisconsin

Stephanie Muh, MD

Henry Ford Hospital West Bloomfield

Throughout the field of orthopaedics, there is a trend moving toward preserving as much of the patient’s natural anatomy as possible. Likewise, having access to a wide range of bone conserving implants affords the surgeon the opportunity to treat each patient with respect to anatomical preservation.

In shoulder arthroplasty, understanding the benefits of innovative, canal-sparing humeral implant options brings new considerations in treatment including patient demographic, surgical time and returning patients to post-operative lifestyle in concert with their expectations. Incorporating innovative implants that surgeons believe will improve patient outcomes requires thoughtful consideration and a respect for the required learning curve.

Rick Papandrea, MD, and Stephanie Muh, MD, two fellowship-trained surgeons, share their newly-acquired knowledge—choosing bone-conserving, canal-sparing humeral implants. In the following case reports, they juxtapose patient selection with surgical experiences and outcomes.

“With the advent of shorter stems, I have come to analyze my longer-term follow-up with more scrutiny, and thusly now select shorter stems more frequently, bone quality permitting, due to concerns of proximal stress shielding of the tuberosities. Though I am not sure what length of the shorter style stem is the best choice, I believe the stemless [implants] will be incorporated far more frequently whenever the bone is good enough. I have been able to continue to use an LTO (lesser tuberosity osteotomy) on these cases.  Lately, I have only used the standard length stem with significant osteopenia proximally.”

Patient 1: Primary anatomic total shoulder arthroplasty using Equinoxe Preserve short stem and caged glenoid.Patient 1: Primary anatomic total shoulder arthroplasty using Equinoxe Preserve short stem and caged glenoid.

  • Active male in his 60s, retired reporter with surprisingly good preop motion
  • This patient is a good candidate for either a stemless anatomic or a short stem anatomic
  • Six (6) weeks postop his external rotation (ER) has returned to preop baseline of 45 degrees and his forward flexion (FF) has improved from 90 to 145 degrees.

Patient 2: Primary anatomic total shoulder arthroplasty using a stemless implant.Patient 2: Primary anatomic total shoulder arthroplasty using a stemless implant.

  • Active male in his 60s, retired radiologist
  • Typical pain and significant range of motion limitations

Patient 3: Revision of a failed anatomic total shoulder with loose humeral stem to reverse total shoulder arthroplastyPatient 3:  Revision of a failed anatomic total shoulder with loose humeral stem to reverse total shoulder arthroplasty

  • The humeral stem was loose, so it was replaced with the short stem for the aggressive proximal geometry, which fit nicely and improved the proximal press-fit
  • Revised an anatomic to a reverse, replacing stem from another company
  • Significant glenoid wear led to augmented baseplate choice – superior posterior augment
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