Humeral Anatomy Study: A Comparison Of Male And Female Shoulders With

Similar Average Age And Bmi

Amanda Jacobson, B.S.BME1, Matthew A. Hamilton, Ph.D.1, Alex Greene1, Pierre-Henri Flurin, M.D.2, Thomas Wright, M.D.3,
Joseph Zuckerman, M.D.4, Christopher P. Roche, MSBME1.
1
Exactech, Inc., Gainesville, FL, USA, 2Bordeaux-Merignac Clinic, Bordeaux, France, 3University of Florida Dept of Ortho Surgery,
Gainesville, FL, USA, 4NYU Hospital for Joint Diseases, New York, NY, USA.

Disclosures:
A. Jacobson: 3A; Exactech. M.A. Hamilton: 3A; Exactech. A. Greene: 3A; Exactech. P. Flurin: 1; Exactech. 3B; Exactech. T.
Wright: 1; Exactech. 3B; Exactech. J. Zuckerman: 1; Exactech. 3B; Exactech. C.P. Roche: 3A; Exactech. 4; Exactech.

Introduction: An anatomic study was conducted on 75 3-D CT reconstructions of the shoulder to better understand the normal
morphological variability of the glenohumeral joint when gender and BMI effects are accounted for.
Methods: 75 cadaveric shoulder CT scans, 38 males (76.4 ± 8.7 yrs; BMI = 23.6 ± 6.3) and 37 females (78.1 ± 10.9 yrs; BMI = 21.3
±5.8) were reconstructed using Mimics (Materialize NV) to create 3-D models of the humerus. After 3-D reconstruction, each
bone model was analyzed in Rapidform (3D Systems) to quantify variations in morphology between males and females and
between patients with low and high BMI. Measurement reproducibility was determined to be ±1.0 mm for linear parameters
and ±1.0° for angular parameters. The humeral shaft outer diameter (OD) and humeral intramedullary (IM) canal diameter were
measured using a best fit circle at 4 different heights (75mm, 150mm, and 225mm from the humeral head and at the deltoid
tuberosity). The humeral head diameter was measured with a best fit sphere, the humeral head thickness was measured from a
plane defining the anatomic neck, and the articular surface area was calculated using this sphere diameter and associated
thickness. The medial, posterior, and total offset of the humeral head center were measured relative to the IM axis; the anterior
and posterior distances from the humeral head center were also measured for the lesser and greater tuberosities, respectively.
The humeral head neck angle was measured relative to the IM axis and the humeral head retroversion was measured relative to
the epicondylar axis. A Student’s two-tailed, unpaired t-test was used to identify differences between male and female
measurements and between BMI<24 and BMI>24 measurements, where p<0.05 denoted a significant difference.
Results: As described in Figure 1, male humeri were associated with significantly larger/thicker humeral heads that were more
offset (particularly in the posterior direction) than female humeri. Male humeri were associated with significantly more anterior
shift of the lesser tuberosity and significantly more posterior shift of the greater tuberosity. The male humeri were also observed
to be significantly longer, with larger OD and IM diameters at all four resection heights. A non-significant trend was observed for
male proximal humeri to be more medially offset (p = 0.0768) and less retroverted (p = 0.1089) than female proximal humeri. As
described in Figure 2, humeri in patients with BMI >24 were associated with significantly larger humeral heads having a larger
articular surface area than humeri from patients with a BMI <24. Humeri from patients with a BMI > 24 were also associated
with significantly more anterior shift of the lesser tuberosity. Finally, humeri from patients with a BMI >24 were also observed to
be significantly longer, with larger OD at the 3 most proximal resections.
Discussion: The results of this study demonstrate that humeral anatomy (particularly the proximal humerus) is highly variable;
significant differences were observed between male and female humeri and between humeri with low and high BMI. A
comparison of these pooled results with that of previously published anatomical studies 1-3 of the humerus (Figure 3) validates
our results but also demonstrates (relative to Figures 1 and 2) that mean results may be misleading as several parameters are
binomial (particularly due to gender). Future work should evaluate if this observed anatomic variability can be accommodated
by contemporary “fourth generation” shoulder arthroplasty prostheses.
Significance: Given that joint stability is best achieved and maintained after shoulder arthroplasty by restoring the native soft
tissue tensioning; and native soft tissue tensioning is best restored by implanting a prosthesis that restores the patient’s humeral
anatomy. This anatomical data of male and female humeri with similar average age and BMI is relevant for biomechanical
computer modeling and has implications on shoulder arthroplasty design, particularly related to balancing soft tissue tensioning
and improving implant fixation.
Acknowledgments:
References: 1. Boileau, P and Walch, G. 3-D Geometry of the Proximal Humerus. JBJS-B. 1997.
2. Hertel, R. et al. Geometry of the Proximal Humerus and Implications for Prosthetic Design. JSES. 2002.
3. Robertson, D. et al. 3-D Analysis of the Proximal Part of the Humerus: Relevance to Arthroplasty. JBJS.
2000.
ORS 2014 Annual Meeting
Poster No: 0997