{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:47:13Z","timestamp":1786978033296,"version":"build-2736575974"},"reference-count":47,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HI21C0196"],"award-info":[{"award-number":["HI21C0196"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["2710006392"],"award-info":[{"award-number":["2710006392"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Short\u2010stem humeral implants in reverse total shoulder arthroplasty (rTSA) are increasingly adopted because they preserve bone stock and reduce stress shielding. However, their shorter length raises the risk of malalignment, and outcomes may be further affected by osteoporosis, which is common in rTSA patients. This study investigated how humeral stem alignment (neutral, varus, valgus) and bone mineral density simultaneously influence stress distribution in the proximal humerus using finite element (FE) analysis. FE models were developed from computed tomography scans of one normal and one osteoporotic humerus. A curved short stem was virtually implanted in three alignments, and physiological loading was applied. Von Mises stress was examined in cortical and trabecular bone, subdivided into medial\/lateral and proximal\/distal regions. Varus alignment produced the largest stress reduction in the proximal\u2010lateral region, particularly in osteoporotic bone (up to \u221255.5%). Valgus alignment reduced stress primarily in the proximal\u2010medial region (up to \u221255.9%) but also affected the proximal\u2010lateral region. These results confirm that malalignment induces stress shielding patterns consistent with clinically observed bone resorption. Specifically, varus alignment was associated with shielding in the proximal\u2010lateral region, whereas valgus alignment contributed to reductions in both proximal\u2010medial and lateral regions. In osteoporotic bone, malalignment exacerbated stress shielding, with varus demonstrating the most detrimental effect.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Clinical Significance:<\/jats:bold>\n                    These findings highlight the importance of stem alignment to minimize proximal stress shielding, especially in osteoporotic patients. Careful intraoperative positioning may reduce adverse mechanical outcomes, though further clinical studies are required to establish definitive surgical guidelines.\n                  <\/jats:p>","DOI":"10.1002\/jor.70140","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T06:00:23Z","timestamp":1768543223000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Stress Shielding Effects of Short Stem Alignment and Bone Density in Reverse Shoulder Arthroplasty"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-9969","authenticated-orcid":false,"given":"Wonhee","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering Korea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-4947","authenticated-orcid":false,"given":"Yong\u2010Jin","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering Korea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea"},{"name":"School of Mechanical &amp; Aerospace Engineering Nanyang Technological University Nanyang Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeyoung","family":"Kwon","sequence":"additional","affiliation":[{"name":"Anymedi Inc. Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guk Bae","family":"Kim","sequence":"additional","affiliation":[{"name":"Anymedi Inc. Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8752-3987","authenticated-orcid":false,"given":"Tae Kang","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Nowon Eulji Medical Center Eulji University School of Medicine Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6181-9621","authenticated-orcid":false,"given":"Kyoung Hwan","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, Asan Medical Center University of Ulsan Ulsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"G.WalchandP.Boileau1999. Shoulder Arthroplasty. Berlin Heidelberg: Springer Berlin Heidelberg. 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