Anatomic shoulder arthroplasty with metal head linked with proximal humeral osteolysis
After anatomic shoulder arthroplasty with the same glenoid component, patients who received stemless ceramic-head implants had fewer radiolucent lines and less osteolysis than patients who received long-stem metal-head humeral implants.
Researchers retrospectively studied 59 patients who underwent anatomic total shoulder replacement (TSR) during a 6-year period and received two types of modular humeral implants. Either the press-fit Affinis prosthesis (Mathis) – which was implanted uncemented and had a tapered, long titanium humeral stem – and a cobalt chromium head was used (group A; 39 TSRs in 36 patients) or the uncemented Affinis short humeral stem and a ceramic head was used, which is classified as stemless in the Australian Orthopaedic Association National Joint Replacement Registry (group B; 23 TSAs in 23 patients).
Regarding surface finish, the stem in group A was two-thirds grit blasted with the distal one-third polished, whereas the stem in group B was coated with osteoconductive calcium phosphate.
Prospective analysis of both groups was done at 2-year clinical follow-up, and 5.5-year radiographic follow-up showed the extent of glenoid osteolysis was greater in group A than group B based on the Lazarus score and cement/bone radiolucent lines assessment.
“No glenoid in group B (ceramic-head group) had more than a partial radiolucent line (none higher than Lazarus grade 1),” the authors wrote.
Proximal humerus osteolysis was seen in 56% of all patients, specifically 72% of group A and 30% of group B.
Researchers also found clinical outcomes were similar in patients at 2-year follow-up regardless of the presence of humeral osteolysis or radiolucent lines in the glenoid regions. “The study showed that there was more glenoid and humeral osteolysis with a long-stem metal-head construct than with a stemless ceramic-head construct,” they wrote.