Bone adaptation impact of stemless shoulder implants: a computational analysis

• Published in: Journal of shoulder and elbow surgery 2019-10, Vol.28 (10), p.1886-1896
• Main Authors: Comenda, Manuel, Quental, Carlos, Folgado, João, Sarmento, Marco, Monteiro, Jacinto
• Format: Article
• Language: English
• Subjects: Adaptation, Physiological; Arthroplasty, Replacement, Shoulder - instrumentation; bone adaptation; Bone Density; Bone Remodeling; Bone Resorption; Computer Simulation; Finite Element Analysis; finite element method; Humans; Humerus - physiopathology; Humerus - surgery; Male; Models, Anatomic; Prosthesis Design - adverse effects; shoulder arthroplasty; Shoulder joint; Shoulder Prosthesis - adverse effects; stemless implants; stress shielding
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.03.007

Despite stemless implants showing promising functional and radiologic clinical outcomes, concerning signs of complications, such as bone resorption, have been reported. The aim of this study was to investigate the influence of 5 stemless designs on the bone adaptation process of the humerus. Three-dimensional finite element models of shoulder arthroplasties were developed considering stemless designs based on the Eclipse, Global Icon, SMR, Simpliciti, and Sidus stemless systems. For the designs not possessing a collar that covers the entire resected surface of the humerus, conditions of contact and no contact were simulated between the humeral head components and the bone surface. By use of a bone remodeling model, computational simulations were performed considering 6 load cases of standard shoulder movements. The bone adaptation process was evaluated by comparing differences in bone density between the implanted models and the intact model of the humerus. Overall, the design of the stemless implants had a relevant impact on the bone adaptation process of the humerus. The Eclipse-based design caused the largest bone mass loss, whereas the SMR-based design caused the least. When contact was simulated between the humeral head components of the SMR-, Simpliciti-, and Sidus-based designs and the resected bone surface, bone resorption increased. Considering only the bone adaptation process, the results suggest that the SMR-based implant presents the best performance and that contact between the humeral head component and the resected bone surface should be avoided. However, because other factors must be considered, further investigation is necessary to allow definite recommendations.