Spatial mapping of humeral head bone density
File(s)
Accepted version
Published version
Author(s)
Alidousti, H
Giles, J
Emery, R
Jeffers, J
Type
Journal Article
Abstract
Background:
Short stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus.
Methods:
Eight CT scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head.
The proximal humeral head was divided into twelve slices
parallel to the humeral anatomical neck. Each slice was then divided into four concentric circles. The slices below the anatomical neck, where short stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated and regions of interest were compared using a repeated measures ANOVA with significance set at p<0.05.
Results:
Average apparent bone density was found to decrease from proximal to distal regions with the majority of higher bone density proximal to the anatomical neck of the humerus (p<0.05). Below the anatomical neck, bone density increases from central to peripheral regions where cortical bone eventually occupies the space (p<0.05). In distal slices below the anatomical neck, a higher bone density distribution in the medial calcar region was also observed.
Conclusion:
This study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomical neck and epiphyseal plate, and to use the denser bone at the periphery.
Short stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus.
Methods:
Eight CT scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head.
The proximal humeral head was divided into twelve slices
parallel to the humeral anatomical neck. Each slice was then divided into four concentric circles. The slices below the anatomical neck, where short stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated and regions of interest were compared using a repeated measures ANOVA with significance set at p<0.05.
Results:
Average apparent bone density was found to decrease from proximal to distal regions with the majority of higher bone density proximal to the anatomical neck of the humerus (p<0.05). Below the anatomical neck, bone density increases from central to peripheral regions where cortical bone eventually occupies the space (p<0.05). In distal slices below the anatomical neck, a higher bone density distribution in the medial calcar region was also observed.
Conclusion:
This study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomical neck and epiphyseal plate, and to use the denser bone at the periphery.
Date Issued
2017-05-08
Date Acceptance
2017-03-01
Citation
Journal of Shoulder and Elbow Surgery, 2017, 26 (9), pp.1653-1661
ISSN
1532-6500
Publisher
Elsevier
Start Page
1653
End Page
1661
Journal / Book Title
Journal of Shoulder and Elbow Surgery
Volume
26
Issue
9
Copyright Statement
© 2017 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
License URL
Sponsor
Wellcome Trust
Engineering & Physical Science Research Council (EPSRC)
Grant Number
WT 098269/Z/12/Z
EP/K027549/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Shoulder arthroplasty
humeral bone density
short-stem devices
implant fixation
humeral component
implant design
implant loosening
MINERAL DENSITY
IMPLANT
FRACTURES
STABILITY
TISSUE
1103 Clinical Sciences
Publication Status
Published