{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:14:03Z","timestamp":1784895243041,"version":"3.55.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T00:00:00Z","timestamp":1651708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Short-stem implants in shoulder arthroplasty were recently developed and reported clinical outcomes are good. However, radiological analysis often reveals humeral stem misalignment in the frontal plane, along with high filling ratios that can lead to proximal bone remodeling under stress shielding. The aim of this cadaveric study was to test whether using compactors for standard-length (&gt; 100 mm) stems to implant short (&lt; 100 mm) stems reduces the risk of stem misalignment without compromising in terms of a higher filling ratio.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In a cadaveric study, twenty short stems were implanted using instrumentation for standard-length stems. Alignment and filling ratios were evaluated on anteroposterior radiographs for both the compactors and the stems. The angular deviations (<jats:italic>\u03b1<\/jats:italic>) from the humeral axis of the compactors and the short stems were measured. Misalignment was defined as |<jats:italic>\u03b1<\/jats:italic>| &gt; 5\u00b0. Metaphyseal and diaphyseal filling ratios were calculated and defined as either high (\u2265 0.7) or low (&lt; 0.7).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The median angular deviations of the compactors and the short stems were respectively 1.6\u00b0 (range, 0.03 to 5.9\u00b0) and 1.3\u00b0 (range, 0.3 to 9.6\u00b0). Nineteen of the 20 compactors (95%) and 17\/20 short stems (85%) were correctly aligned. The proportions of correctly aligned compactors and stems were not significantly different (95% CI, \u22120.33 to 0.11; Z-test of proportions <jats:italic>p<\/jats:italic> = .60), and the respective angular deviations were significantly correlated (Spearman \u03c1 = .60, <jats:italic>p<\/jats:italic> = 0.006). The diaphyseal and metaphyseal filling ratios of the compactors and the stems were all low.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this series of 20 implants in cadavers, the narrow short humeral stems implanted with compactors for standard-length stems were correctly aligned with the humeral axis. This approach may be a way to achieve both correct frontal alignment and low filling ratios.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0268075","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T17:44:21Z","timestamp":1651772661000},"page":"e0268075","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Using standard-length compactors to implant short humeral stems in total shoulder arthroplasty: A cadaver study of humeral stem alignment"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1038-105X","authenticated-orcid":true,"given":"Stanislas","family":"Gunst","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Nigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Vogels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvire","family":"Servien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Lustig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Nove-Josserand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Collotte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"pone.0268075.ref001","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1302\/0301-620X.101B5.BJJ-2018-1374.R1","article-title":"Mid-term radiological results of a cementless short humeral component in anatomical and reverse shoulder arthroplasty","volume":"101-B","author":"WR Aibinder","year":"2019","journal-title":"Bone Joint J"},{"key":"pone.0268075.ref002","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jse.2017.06.042","article-title":"Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty","volume":"27","author":"PJ Denard","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"key":"pone.0268075.ref003","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1302\/0301-620X.96B3.32702","article-title":"Short-stem uncemented primary reverse shoulder arthroplasty: clinical and radiological outcomes","volume":"96-B","author":"SA Giuseffi","year":"2014","journal-title":"Bone Joint J"},{"key":"pone.0268075.ref004","doi-asserted-by":"crossref","first-page":"2249","DOI":"10.2106\/JBJS.J.01994","article-title":"Increasing incidence of shoulder arthroplasty in the United States","volume":"93","author":"SH Kim","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0268075.ref005","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3109\/17453674.2015.1024565","article-title":"The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties","volume":"86","author":"MT Dillon","year":"2015","journal-title":"Acta Orthopaedica. 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