Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study.

IF 2.7 Q3 IMAGING SCIENCE & PHOTOGRAPHIC TECHNOLOGY

Journal of Imaging Pub Date : 2024-12-23 DOI:10.3390/jimaging10120334

Daniel Ritter, Patric Raiss, Patrick J Denard, Brian C Werner, Peter E Müller, Matthias Woiczinski, Coen A Wijdicks, Samuel Bachmaier

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Abstract

Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus.

Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.72): Standard stem with low (n = 10) and high (n = 10) filling ratios, a short stem with low (n = 10) and high filling ratios (n = 10). Biomechanical testing included cyclic loading of the native bone and the implanted humeral component. Optical recording allowed for spatial implant tracking and the quantification of cortical bone deformations in the proximal humerus.

Results: Planned filling ratios based on 3D volumetric measures had a good-to-excellent correlation (ICC = 0.835; p < 0.001) with implanted filling ratios. Lower canal fill ratios resulted in significantly higher variability between short and standard stems regarding implant tilt (820 N: p = 0.030) and subsidence (220 N: p = 0.046, 520 N: p = 0.007 and 820 N: p = 0.005). Higher filling ratios resulted in significantly lower bone deformations in the medial calcar area compared to the native bone, while the bone deformations in lower filling ratios did not differ significantly (p > 0.177).

Conclusions: Lower canal filling ratios maintain dynamic bone loading in the medial calcar of the humerus similar to the native situation in this biomechanical loading setup. Short stems implanted with a low filling ratio have an increased risk for implant tilt and subsidence compared to high filling ratios or standard stems.

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肱骨管填充率对短柄和标准柄肩关节置换术初始稳定性和皮质骨负荷的影响：生物力学和计算研究。

目的：本研究评估短柄和标准柄反向肩关节置换术中三维（3D）体积肱骨管填充率（VFR）对肱骨近端生物力学稳定性和骨变形的影响。方法：在临床计算机断层扫描（CT）扫描仪上分析40具尸体肩部标本，允许对肱骨管进行分割以计算体积测量，并在术后通过x线平片验证。虚拟种植体定位允许分组分配（VFR < 0.72）：低（n = 10）和高（n = 10）填充率的标准茎，低（n = 10）和高填充率（n = 10）的短茎。生物力学测试包括原生骨和植入肱骨构件的循环载荷。光学记录允许空间植入物跟踪和肱骨近端皮质骨变形的量化。结果：基于三维体积测量的计划填充率具有良好到极好的相关性(ICC = 0.835；P < 0.001)。较低的根管填充率导致短根和标准根在种植体倾斜（820 N: p = 0.030）和下沉（220 N: p = 0.046, 520 N: p = 0.007和820 N: p = 0.005）方面的差异显著增加。较高的填充率导致跟骨内侧区的骨变形明显低于天然骨，而较低填充率的骨变形无显著差异（p > 0.177）。结论：在这种生物力学加载设置下，较低的椎管填充率维持了肱骨内侧跟的动态骨负荷，类似于本地情况。与高填充率或标准柄相比，低填充率的短柄植入物倾斜和下沉的风险增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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