Stemless reverse shoulder arthroplasty neck shaft angle influences humeral component time-zero fixation and survivorship: a cadaveric biomechanical assessment.

Background: Stemless humeral components are being clinically investigated for reverse shoulder arthroplasty (RSA) procedures. There is, however, a paucity of basic science literature on the surgical parameters that influence the success of these procedures. Therefore, this cadaveric biomechanical study evaluated the neck shaft angle (NSA) of implantation on the survivability and performance of stemless RSA humeral components during cyclical loading. Methods: Twelve paired cadaveric humeri were implanted with stemless RSA humeral components at NSAs of 135° and 145°. Implant-bone motion at the periphery of the implant was measured with 3 optical machine vision USB3 cameras outfitted with c-mount premium lenses and quantified with ProAnalyst software. A custom 3-dimensional loading apparatus was used to cyclically apply 3 loading directions representative of physiological states at 5 progressively increasing loading magnitudes. Stemless 135° and 145° implants were compared based on the maximum implant-bone relative distraction detected, as well as the survivorship of the implants throughout the loading protocol. Results: Primary fixation and implant biomechanical survivorship were substantially better in the 145° NSA implants. The 135° NSA implants elicited significantly higher implant-bone distractions during cyclical loading (P = .001), and implant survivorship was considerably lower in the 135° NSA specimens when compared to the 145° NSA specimens (135° NSA: 0%, 145° NSA: 50%) (P < .001). Conclusion: NSA is a modifiable parameter that influences time-zero implant stability, as well as the early survivorship of the stemless RSA humeral components tested in this study. NSA resections of 145° appear to promote better stability than those utilizing 135° NSAs during early postoperative eccentric loads. Further studies are required to assess if other stemless reversed humeral implant designs have improved time-zero fixation at higher NSAs.

Are we closing the gaps in the management of osteoporosis following fragility fractures of the femur?

OBJECTIVE: The objective of this study was to identify deficiencies in initiating anti-osteoporotic treatment following a fragility femoral fracture. METHODS: All patients ≥55 years of age treated for a fragility femoral fracture between June 2012 and May 2017 were enrolled. Medications at discharge and at 90 days and 1 year of follow up were analyzed. Patients were classified into 4 groups: Group I did not receive any treatment for osteoporosis; Group II received only calcium and vitamin D3; Group III received an anabolic agent, calcium, and vitamin D3; and Group IV received bisphosphonates, calcium, and vitamin D3. RESULTS: A total of 167 patients with an average age of 65.81±12.55 years were included. There were 88 (52.7%) males and 79 (47.3%) females. At discharge, 107 patients (64.1%) were not prescribed optimal treatment for osteoporosis, and this reduced to 55 (32.9%) at the 90-day follow up. At 1 year, the number of patients receiving suboptimal treatment was further reduced to 25.74%. CONCLUSIONS: Although the number of patients with fragility fractures receiving insufficient treatment was lower in the present study than in previous reports, increased efforts and coordinated treatment plans initiated by a fracture liaison service should be of high priority.