Humeral Component Fixation

Cement fixation, press-fit, and bone ingrowth/ongrowth have all been utilized successfully for humeral component fixation. Although press-fit fixation is appealing for use in a young person requiring a prosthetic replacement with concerns about future revision, its use has not been universally predictable and has sometimes resulted in need for early revision due to implant loosening. Most textured surfaces with or without hydroxyapetite coating for purposes of bone ingrowth/ongrowth have proven to show little improvement over standard press fit implants except in cup arthroplasty surface replacement. Newer technologies of tantlum weave (trabecular metal) segments on humeral implants have suggested the ability to have bone growth through the prosthesis and literally heal to the prosthesis. This technology presents advantages especially in fracture cases where tuberosities have notoriously had a high rate of nonunion, but its track record is still limited. Careful canal preparation, use of a cement restrictor, modern cement preparation techniques, and careful injection under gentle pressure with use of an appropriate-sized prosthesis remains the mainstay of fixation for humeral implants in 2007.