title: Ipsilateral shoulder and elbow replacements: on the risk of periprosthetic fracture.
abstract: BACKGROUND
  Ipsilateral shoulder and elbow replacements may leave only a short segment of bone bridging the two implants in the humerus. The potential for high stress concentrations as a result of this geometry has been a concern with regard to periprosthetic fracture, especially with osteoporotic bone. The study aims to determine the optimum length of the bone-bridge between shoulder and elbow humeral implants, and to assess the effect of filling the canal with cement.
  
  
  METHODS
  A three-dimensional finite element model was used to compare the stresses between a humerus with a solitary prosthesis and a humerus with both proximal and distal cemented prostheses. The length of the bone-bridge and the effect of filling the canal with cement were studied under bending and torsion.
  
  
  RESULTS
  Gradual load transfer from prosthesis to bone was observed for all cases, and no stress concentration was evident. The length of the bone-bridge had no deleterious effect on stresses in the humerus, and filling the canal with cement did not appreciably decrease the loads carried by the humerus.
  
  
  CONCLUSIONS
  The length of the bone-bridge between stem tips has little effect on the resultant stresses in the humerus. Filling the canal with cement adds little benefit to the structural integrity of the humerus. Ipsilateral shoulder and elbow prostheses may be considered independent of one another in terms of risk of periprosthetic fracture.
authors.affiliation: Department of Orthopaedics, University of British Columbia, 910 West 10th Ave., Vancouver, BC, Canada V5Z 4E3. d_plausinis@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Plausinis
authors.forename: C
authors.initials: C
authors.lastname: Greaves
authors.forename: W D
authors.initials: WD
authors.lastname: Regan
authors.forename: T R
authors.initials: TR
authors.lastname: Oxland
mesh_terms: D003198:Computer Simulation; D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000503:physiopathology*; D007595:Joint Prosthesis / Q000009:adverse effects*; D008954:Models, Biological; D011475:Prosthesis Failure; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012784:Shoulder Fractures / Q000209:etiology / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D014954:Wrist Injuries / Q000209:etiology / Q000503:physiopathology