Abstract
The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations. Contemporary humeral components aim to preserve the bone, but they are potentially subject to malalignment. Modern components are expected to favorably load the humerus and minimize adverse bone reactions. Although there will likely continue to be further refinements in humeral component design, the next frontiers in primary shoulder arthroplasty will revolve around designing an optimal plan, including adequate soft tissue tension and providing computer-assisted tools for the accurate execution of the preoperative plan in the operating room.
Highlights
The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations
Grammont revolutionized the field of shoulder arthroplasty with the development of the reverse prosthesis concept: a more constrained implant of reverse geometry that would increase the moment arm of the deltoid to compensate for the rotator cuff insufficiency [8]
In the field of reverse shoulder arthroplasty, preoperative planning software reveals that using a larger glenoid with a larger lateral offset and an inferior overhang is the most successful strategy to optimize the range of motion free of impingement, especially when combined with a more vertical polyethylene opening angle [22]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The original Neer prosthesis was a smooth monoblock hemiarthroplasty with a narrow stem and three sizes. Because the stem was narrow and designed for a cemented application, it could be “floated” in the canal in whichever location was best to position the prosthetic humeral head anatomically [2]. Early on the original Neer prosthesis was implanted without cement, in the absence of surface treatment, cementless implantation led to a high rate of radiographic loosening [3]. The development of technology to treat the stem with ingrowth-friendly surfaces led to the successful survival of cementless humeral components [4]. Modular anatomic humeral heads were introduced to allow a humeral head size selection independent of the stem size selection [5]. Most surgeons agree on trying to avoid the use of cement for humeral component fixation at the time of primary arthroplasty; If component revision becomes necessary, cement removal could substantially increase the difficulties associated with the revision procedure
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