Fixation of humeral prostheses and axial micromotion

Surgeons often avoid cementing a proximal humeral prosthesis. Occasionally bony augmentation is needed. This study was undertaken to compare proximal cementation in combination with distal press with total cementation or press fit alone. In phase 1 axial micromotion with axial loading was measured in 15 pairs of humeri: 5 fully cemented versus proximally cemented, 5 fully cemented versus press fit, and 5 proximally cemented versus press fit. X-ray films of the specimens were obtained to assess canal fill. In phase 2 axial micromotion was measured in 5 pairs of high mineral density and 5 pairs of low mineral density to compare proximal cementation with press fit. The 3M modular prosthesis was used in both phases. No difference was found in phase 1 among the 3 fixation techniques. A strong reverse statistical correlation (P =.007) (r =.55) was seen between axial micromotion and fill of the canal with the prosthesis. In the second phase no statistically significant difference was found between the techniques of fixation or between the 2 bone densities. Fill of the canal at the distal end of the prosthesis was the only variable found that affected axial micromotion, but it accounted for only approximately 30% of the variance. Bone quality and augmentation of the proximal bone with cement did not affect axial micromotion in this experiment but warrant further study. (J Shoulder Elbow Surg 1998;7:414-8)