title: Stem abutment affects alignment of the humeral component in computer-assisted elbow arthroplasty.
abstract: OBJECTIVE
  The humeral component in total elbow arthroplasty has limited geometric modularity, and the extent to which this affects accurate positioning is unknown. The objectives of this study were to (1) validate the accuracy of a computer-assisted implant alignment technique, and (2) identify variations in distal humeral morphology that affected computer-assisted implant alignment. This was achieved by implanting both an unmodified humeral component and an implant with a reduced stem using computer assistance. We hypothesized that implantation of a humeral component with a reduced stem length would be more accurate than implantation of the standard length stem. In addition, we hypothesized that the variation in flexion-extension (FE) varus-valgus angulation would significantly affect computer-assisted implant alignment.
  
  
  METHODS
  Computer-assisted alignment of the implant articulating axis with the humeral FE axis was performed on 13 cadaveric humeri for both the regular and modified humeral component. Navigation was based on alignment of the prosthesis with a preoperative plan and registration of this plan to the humerus.
  
  
  RESULTS
  Implant alignment was significantly improved for the reduced stem. Alignment error of the reduced stem averaged 1.3 ± 0.5 mm in translation and 1.2° ± 0.4° in rotation, compared with 1.9 ± 1.1 mm and 3.6° ± 2.1° for the regular stem. Humeral varus-valgus angulation significantly affected alignment of the unmodified stem.
  
  
  CONCLUSIONS
  A humeral component with a fixed valgus angulation cannot be accurately positioned in a consistent fashion without sacrificing alignment of the FE axis. Improved accuracy of implant placement can be achieved by introducing a family of humeral components, with 3 valgus angulations of 0°, 4° and 8°.
authors.affiliation: Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada. colin.p.mcdonald@gmail.com
authors.forename: Colin P
authors.initials: CP
authors.lastname: McDonald
authors.forename: Terry M
authors.initials: TM
authors.lastname: Peters
authors.forename: James A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D002102:Cadaver; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D006811:Humerus; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D025321:Surgery, Computer-Assisted