Design of Humeral Stems

  • Emmet John Griffiths
  • Ian A. Trail
  • Gilles Walch


The first attempt at prosthetic replacement of the humeral head was performed in 1893 by Pean to treat a shoulder infected with tuberculosis. Modern total shoulder arthroplasty, however, really began in the 1950s with the cemented Neer prosthesis [1] (Fig. 14.1) which gave reasonable short and long term results in terms of pain relief, function and movement and a low incidence of humeral loosening [2]. Since then there has been significant evolution both in terms of materials but also in design of the humeral prostheses. Initially humeral components were monoblocks available in limited sizes. These evolved into second generation implants which allowed a degree of modularity in terms of variable head sizes to better match the resected head (Fig. 14.2). This purported to allow better soft tissue tensioning and hence a better outcome although clinical studies have not yet bourne this out [3, 4]. They also facilitated revision surgery by allowing separate head removal which exposes the bone-cement interface proximally as well as the glenoid. The third-generation implants added further modularity in terms of eccentricity of the head compared to the stem, head thickness and diameter as well as head-neck angulation (in some systems) (Fig. 14.3). These are commonly referred to as an anatomic replacement [5]. More recently the introduction of platform systems has added further complexity to the design of humeral stems as the ability to change from an anatomic stem to a reverse polarity stem requires further modularity of the body of the stem. Finally there has also been the development of both resurfacing systems (Fig. 14.4) and short stem, (or metaphyseal fit/stemless) prostheses (Fig. 14.5). At this time again there is little clinical evidence to support one over the other. However, there is no doubt that the use of resurfacing and stemless prosthesis again makes revision simpler.


Cemented stem Uncemented stem Anatomic head Offset Inclination Stemless 


  1. 1.
    Neer CS, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg [Am]. 1982;64(3):319–37.CrossRefGoogle Scholar
  2. 2.
    Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the neer prosthesis: long term results. J Shoulder Elb Surg. 1997;6(6):495–505.CrossRefGoogle Scholar
  3. 3.
    Trail IA, Nuttall D. The results of shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg (Br). 2002;84:1121–4.CrossRefGoogle Scholar
  4. 4.
    Haines JF, Trail IA, Nuttall D, Birch A, Barrow A. Results of arthroplasty in osteoarthritis of the shoulder. J Bone Joint Surg (Br). 2006;88:496–501.CrossRefGoogle Scholar
  5. 5.
    Walch G, Boileau P. Prosthetic adaptability: a new concept for shoulder arthroplasty. J Shoulder Elb Surg. 1999;8(5):443–51.CrossRefGoogle Scholar
  6. 6.
    Hertel R, Knothe U, Ballmer FT. Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elb Surg. 2002;11(4):331–8.CrossRefGoogle Scholar
  7. 7.
    Harryman DT, Sidles JA, Harris SL, Lippitt SB, Matsen FA. The effect of articular conformity and the size of the humeral head component on laxity and motion after glenohumeral arthroplasty. J Bone Joint Surg [Am]. 1995;77(4):555–63.CrossRefGoogle Scholar
  8. 8.
    Jobe CM, Iannotti JP. Limits imposed on glenohumeral motion by joint geometry. J Shoulder Elb Surg. 1995;4(4):281–5.CrossRefGoogle Scholar
  9. 9.
    Weber-Spickschen TS, Alfke D, Agneskirchner JD. The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty. Bone Joint J. 2015;97-B:1662–7.CrossRefGoogle Scholar
  10. 10.
    Nuttall D, Haines JF, Trail IA. The effect of the off-set humeral head on the micromovement of pegged glenoid components; a comparative study using radiostereometric analysis. J Bone Joint Surg (Br). 2009;91(6):757–61.CrossRefGoogle Scholar
  11. 11.
    Teeter MG, Carroll MJ, Walch G, Athwal GS. Tribocorrosion in shoulder arthroplasty humeral component retrievals. J Shoulder Elb Surg. 2016;25:311–5.CrossRefGoogle Scholar
  12. 12.
    Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH. Radiographic stability of ingrowth humeral stems in total shoulder arthroplasty. Clin Orthop Relat Res. 2010;468:2122–8.CrossRefGoogle Scholar
  13. 13.
    Raiss P, Bradley Edwards T, Deutsch A, Shah A, Bruckner T, Loew M, Boileau P, Walch G. Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014;96(7):e54.CrossRefGoogle Scholar
  14. 14.
    Schnetzke M, Coda S, Raiss P, Walch G, Loew M. Radiologic bone adaptations on a cementless short-stem shoulder prosthesis. J Shoulder Elb Surg. 2016;25:650–7.CrossRefGoogle Scholar
  15. 15.
    Razfar N, Reeves JM, Langohr DG, Willing R, Athwal GS, Johnson JA. Comparison of proximal humeral bone stresses between stemless, short stem, and standard stem length: a finite element analysis. J Shoulder Elb Surg. 2016;25:1076–83.CrossRefGoogle Scholar
  16. 16.
    Lädermann A, Denard PJ, Boileau P, Farron A, Deransart P, Terrier A, Ston J, Walch G. Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Inter Orthop (SICOT). 2015;39:2205–13.CrossRefGoogle Scholar
  17. 17.
    Berhouet J, Kontaxis A, Gulotta LW, Craig E, Warren R, Dines J, Dines D. Effects of the humeral tray component positioning for onlay reverse shoulder arthroplasty design: a biomechanical analysis. J Shoulder Elb Surg. 2015;24:569–77.CrossRefGoogle Scholar
  18. 18.
    Nuttall D, Birch A, Haines JF, Trail IA. Radiostereographic analysis of a shoulder surface replacement: does hydroxyapatite have a place? Bone Joint J. 2014;96-B(8):1077–81.CrossRefGoogle Scholar
  19. 19.
    Uschok S, Magosch P, Moe M, Lichtenberg S, Habermeyer P. Is the stemless humeral head replacement clinically and radiographically a secure equivalent to standard stem humeral head replacement in the long-term follow up? A prospective randomized trial. J Shoulder Elb Surg. 2017;26:225–32.CrossRefGoogle Scholar
  20. 20.
    Ballas R, Béguin L. Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening. J Shoulder Elb Surg. 2013;22(9):e1–6.CrossRefGoogle Scholar
  21. 21.
    Huguet D, DeClercq G, Rio B, Teissier J, Zipoli B. Results of a new stemless shoulder prosthesis: radiologic proof of maintained fixation and stability after a minimum of three years’ follow-up. J Shoulder Elb Surg. 2010;19(6):847–52.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Emmet John Griffiths
    • 1
  • Ian A. Trail
    • 2
  • Gilles Walch
    • 3
  1. 1.Norfolk & Norwich University HospitalNorwichUK
  2. 2.Wrightington HospitalWiganUK
  3. 3.Centre Orthopédique Santy-Ramsay Generale de SantéLyonFrance

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