Roya Khorram, Samer Al-Humadi, Kevin Kohut, Evan Lederman, Brian C Werner
{"title":"从短期到中期随访，Univers系统在肩关节置换术中的应力屏蔽作用是最小的，并且没有实质性的进展。","authors":"Roya Khorram, Samer Al-Humadi, Kevin Kohut, Evan Lederman, Brian C Werner","doi":"10.1016/j.jse.2025.05.032","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare short- to mid-term signs of stress shielding with an inlay press-fit reverse shoulder arthroplasty (rTSA) humeral component.</p><p><strong>Methods: </strong>A retrospective review was conducted on primary rTSAs with minimum 5-year follow-up that were implanted with a press-fit 135° inlay humeral component (Univers Revers and Revers Apex; Arthrex, Inc.; Naples, FL) designed to achieve metaphyseal fixation. Patient-reported outcomes (PROs), and range of motion (ROM) collected preoperatively and compared to 2 and 5 years postoperative. Radiographic signs of stress shielding, including cortical thinning, radiolucent lines, calcar osteolysis, and greater tuberosity (GT) resorption, were assessed and compared between 2 and 5 years postoperatively.</p><p><strong>Results: </strong>One hundred and thirteen patients with a mean age of 68 ± 6.6 years at the time of surgery met the study criteria. There were no differences in ROM or PROs between the 2- and 5-year postoperative time points (P >0.05). Partial calcar osteolysis was observed in 15% of patients at 2 years and 24% at 5 years, with no statistical difference (P = 0.093) between the time points. No cases of complete calcar osteolysis were observed at either time point. Partial GT resorption was observed in 5.4% of cases at 2 years, which increased to 9.8% at 5 years (P = 0.207). There was no case of complete GT resorption at either time point. Bony adaptive changes were classified as low in 91% of cases at final follow-up and no stems were considered as \"at risk for loosening\".</p><p><strong>Conclusion: </strong>Stress shielding appears to be minimal at mid-term follow-up after press-fit fixation of the Univers Revers, a 135° rTSA humeral component designed for metaphyseal fixation. Partial proximal bony resorption was uncommon at short-term follow-up and may progress slightly at mid-term follow-up, but complete resorption was not observed. Furthermore, ROM and PROs reached at short-term follow-up are maintained at mid-term follow-up, suggesting the impact of these bony changes is not clinically important.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stress Shielding of the Univers Revers System in Reverse Shoulder Arthroplasty is Minimal and Does Not Progress Substantially From Short- to Mid-Term Follow-up.\",\"authors\":\"Roya Khorram, Samer Al-Humadi, Kevin Kohut, Evan Lederman, Brian C Werner\",\"doi\":\"10.1016/j.jse.2025.05.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The purpose of this study was to compare short- to mid-term signs of stress shielding with an inlay press-fit reverse shoulder arthroplasty (rTSA) humeral component.</p><p><strong>Methods: </strong>A retrospective review was conducted on primary rTSAs with minimum 5-year follow-up that were implanted with a press-fit 135° inlay humeral component (Univers Revers and Revers Apex; Arthrex, Inc.; Naples, FL) designed to achieve metaphyseal fixation. Patient-reported outcomes (PROs), and range of motion (ROM) collected preoperatively and compared to 2 and 5 years postoperative. Radiographic signs of stress shielding, including cortical thinning, radiolucent lines, calcar osteolysis, and greater tuberosity (GT) resorption, were assessed and compared between 2 and 5 years postoperatively.</p><p><strong>Results: </strong>One hundred and thirteen patients with a mean age of 68 ± 6.6 years at the time of surgery met the study criteria. There were no differences in ROM or PROs between the 2- and 5-year postoperative time points (P >0.05). Partial calcar osteolysis was observed in 15% of patients at 2 years and 24% at 5 years, with no statistical difference (P = 0.093) between the time points. No cases of complete calcar osteolysis were observed at either time point. Partial GT resorption was observed in 5.4% of cases at 2 years, which increased to 9.8% at 5 years (P = 0.207). There was no case of complete GT resorption at either time point. Bony adaptive changes were classified as low in 91% of cases at final follow-up and no stems were considered as \\\"at risk for loosening\\\".</p><p><strong>Conclusion: </strong>Stress shielding appears to be minimal at mid-term follow-up after press-fit fixation of the Univers Revers, a 135° rTSA humeral component designed for metaphyseal fixation. Partial proximal bony resorption was uncommon at short-term follow-up and may progress slightly at mid-term follow-up, but complete resorption was not observed. Furthermore, ROM and PROs reached at short-term follow-up are maintained at mid-term follow-up, suggesting the impact of these bony changes is not clinically important.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Treatment Study.</p>\",\"PeriodicalId\":50051,\"journal\":{\"name\":\"Journal of Shoulder and Elbow Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Shoulder and Elbow Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jse.2025.05.032\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Shoulder and Elbow Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jse.2025.05.032","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Stress Shielding of the Univers Revers System in Reverse Shoulder Arthroplasty is Minimal and Does Not Progress Substantially From Short- to Mid-Term Follow-up.
Background: The purpose of this study was to compare short- to mid-term signs of stress shielding with an inlay press-fit reverse shoulder arthroplasty (rTSA) humeral component.
Methods: A retrospective review was conducted on primary rTSAs with minimum 5-year follow-up that were implanted with a press-fit 135° inlay humeral component (Univers Revers and Revers Apex; Arthrex, Inc.; Naples, FL) designed to achieve metaphyseal fixation. Patient-reported outcomes (PROs), and range of motion (ROM) collected preoperatively and compared to 2 and 5 years postoperative. Radiographic signs of stress shielding, including cortical thinning, radiolucent lines, calcar osteolysis, and greater tuberosity (GT) resorption, were assessed and compared between 2 and 5 years postoperatively.
Results: One hundred and thirteen patients with a mean age of 68 ± 6.6 years at the time of surgery met the study criteria. There were no differences in ROM or PROs between the 2- and 5-year postoperative time points (P >0.05). Partial calcar osteolysis was observed in 15% of patients at 2 years and 24% at 5 years, with no statistical difference (P = 0.093) between the time points. No cases of complete calcar osteolysis were observed at either time point. Partial GT resorption was observed in 5.4% of cases at 2 years, which increased to 9.8% at 5 years (P = 0.207). There was no case of complete GT resorption at either time point. Bony adaptive changes were classified as low in 91% of cases at final follow-up and no stems were considered as "at risk for loosening".
Conclusion: Stress shielding appears to be minimal at mid-term follow-up after press-fit fixation of the Univers Revers, a 135° rTSA humeral component designed for metaphyseal fixation. Partial proximal bony resorption was uncommon at short-term follow-up and may progress slightly at mid-term follow-up, but complete resorption was not observed. Furthermore, ROM and PROs reached at short-term follow-up are maintained at mid-term follow-up, suggesting the impact of these bony changes is not clinically important.
Level of evidence: Level IV; Case Series; Treatment Study.
期刊介绍：
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
