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Compaction Bone-Grafting in Prosthetic Shoulder Arthroplasty
Michael A. Wirth, MD1; Moon-Sup Lim, MD2; Carleton Southworth, MS3; Rebecca Loredo, MD1; T. Kenneth Kaar, MB, MD, FRCSI, FRCS(Orth)4; Charles A. RockwoodJr., MD1
1 University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7774. E-mail address for M.A. Wirth: wirth@uthscsa.edu
2 Wallace Memorial Baptist Hospital, 374-75, Namsan-dong, Keumjeonggu, Pusan 609-340, Republic of Korea
3 DePuy Orthopaedics, 700 Orthopaedic Drive, Warsaw, IN 46581-0988
4 Private Rooms, Ground Floor, Hospital Block, Merlin Park Regional Hospital, Galway, Ireland
View Disclosures and Other Information
Disclosure: The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. M.A. Wirth and C.A. Rockwood Jr. received honoraria/royalties from DePuy, Johnson and Johnson. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Note: The authors thank Andrea Hicks for her assistance in the preparation of this work.
Investigation performed at the University of Texas Health Science Center at San Antonio, San Antonio, Texas

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jan 01;89(1):49-57. doi: 10.2106/JBJS.E.01069
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Background: Compaction bone-grafting has been suggested as a means of improving the stability of the humeral component in shoulder arthroplasty, but the clinical and radiographic results of the procedure have not been reported in the literature, to our knowledge. To address this deficit, we report on a series of shoulder arthroplasties performed with compaction bone-grafting to secure humeral component fixation. These prostheses were implanted in shoulders demonstrating a suboptimal interference fit of the humeral component.

Methods: Fifty-eight shoulders in fifty-three patients were treated with prosthetic shoulder arthroplasty that included compaction bone-grafting. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort and function, and overall quality of life, and with use of patient self-assessments including the American Shoulder and Elbow Surgeons Score and the validated Simple Shoulder Test. A detailed radiographic analysis was performed by three raters to determine whether radiolucent lines were present immediately postoperatively and at a later follow-up interval. The humeral tilt angle was determined by measuring the angle between the humeral axis and the component. Subsidence was also evaluated. The mean of the raters' measurements was used in the analysis.

Results: The mean duration of follow-up was sixty-nine months (range, twenty-six to 148 months). No loose stems were observed, and no humeral component was revised. At the time of follow-up, there was significant improvement in the Simple Shoulder Test scores and all visual analog scores (p < 0.0001 in each instance). Thirty-four stems had no radiolucent line at the time of follow-up, and the mean maximum thickness of the lucent lines was 0.21 mm in the entire group of fifty-eight shoulders. Most lucent lines occurred near the distal stem tip. The mean tilt of the valgus and varus humeral components was 2.2° and 2.6°, respectively, on the immediate postoperative radiographs. No humeral component shifted from varus to valgus or vice versa. The duration of follow-up was not correlated with the maximum thickness of the humeral component lucency, and the presence or absence of a prosthetic glenoid was also unrelated to the maximum thickness of the lucency.

Conclusions: Compaction bone-grafting in shoulder arthroplasty can yield stable and durable fixation of the humeral component, as seen clinically and radiographically, without use of cement. Our findings provide evidence that compaction bone-grafting in shoulder arthroplasty is an option to ensure intermediate-term fixation (at a mean of five years) of humeral components that have a suboptimal fit.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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