Vasiliadis Angelo V, Giovanoulis Vasileios, Lepidas Nikolaos, Bampis Ioannis, Servien Elvire, Lustig Sebastien, Gunst Stanislas
Department of Orthopaedic Surgery, St. Luke's Hospital, Panorama-Thessaloniki, 55236, Greece - Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, 69004, France.
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, 69004, France.
SICOT J. 2024;10:37. doi: 10.1051/sicotj/2024029. Epub 2024 Sep 20.
Reverse shoulder arthroplasty (RSA) is popular for the treatment of degenerative glenohumeral joint disease. Bone remodeling around the humeral stem related to stress shielding (SS) has been described. This review focuses on the specific radiological characteristics, risk factors, and clinical consequences of SS in RSA.
A meticulous review was conducted of articles published between 2013 and 2023. Data on the definition, risk factors, and clinical impact of stress shielding were recorded.
Twenty-eight studies describing 2691 patients who had undergone RSA were included. The mean age of patients ranged from 63 to 80 years with mean follow-up periods of 12 months to 9.6 years. The prevalence of SS reached up to 39% at a 2-year follow-up. Females and elderly are typically at higher risk due to osteopenia. SS was more frequent with the use of long stems(>100 mm) compared to short stems(<100 mm). Stem design, onlay or inlay, and neck-shaft-angle did not influence SS. Frontal misalignment and a high filling ratio are riskfactors for SS. Biological factors also contribute to SS, associated with scapular notching. No correlation was found between SS and clinical outcomes.
SS is common in patients with cementless implants after RSA, especially in female and elderly patients. It can be limited by implanting stems with a low diaphyseal filling-ratio, in correct coronal alignment. Risk factors for polyethylene debris, primarily scapular notching, should be avoided. The authors found no clinical consequences of stress shielding, but longer-term follow-up studies are required to confirm these findings.
反肩关节置换术（RSA）在治疗退行性盂肱关节疾病方面很受欢迎。已有关于肱骨干周围与应力遮挡（SS）相关的骨重塑的描述。本综述聚焦于RSA中SS的具体影像学特征、危险因素及临床后果。
对2013年至2023年发表的文章进行了细致回顾。记录了关于应力遮挡的定义、危险因素及临床影响的数据。
纳入了28项描述2691例行RSA患者的研究。患者平均年龄在63至80岁之间，平均随访期为12个月至9.6年。在2年随访时，SS的发生率高达39%。由于骨质减少，女性和老年人通常风险更高。与短柄（<100mm）相比，使用长柄（>100mm）时SS更常见。柄的设计、嵌体或贴体以及颈干角并不影响SS。额面失准和高填充率是SS的危险因素。生物学因素也导致SS，与肩胛切迹有关。未发现SS与临床结果之间存在相关性。
RSA后非骨水泥植入物患者中SS很常见，尤其是女性和老年患者。通过植入骨干填充率低、冠状位对线正确的柄可限制其发生。应避免主要导致肩胛切迹的聚乙烯碎屑的危险因素。作者未发现应力遮挡的临床后果，但需要长期随访研究来证实这些发现。
