title: Distinct Proximal Humeral Geometry in Chinese Population and Clinical Relevance.
abstract: BACKGROUND
  Replicating humeral anatomy during shoulder arthroplasty is important for good patient outcomes. The proximal humeral geometry of the Chinese population has been rarely reported. We analyzed the geometry of the proximal part of the humerus in Chinese subjects and compared it with that of Western populations and the dimensions of available prostheses.
  
  
  METHODS
  Eighty healthy Chinese subjects underwent computed tomography (CT)-arthrography. Three-dimensional (3D) digital humeral and glenoid models were reconstructed, and geometric parameters were measured. Humeral measurements included the radius of curvature, articular surface diameter and thickness, anterior-posterior/superior-inferior (AP/SI) articular surface diameter ratio, articular surface thickness/radius of curvature ratio, surface arc, inclination angle, retroversion angle, and medial and posterior offsets. Glenoid measurements included SI length, AP length, SI radius, and AP radius.
  
  
  RESULTS
  The average radius of curvature (and standard deviation) of the humeral head was 22.1 ± 1.9 mm, the articular surface diameter averaged 42.9 ± 3.6 mm, and the articular surface thickness averaged 16.9 ± 1.5 mm. There was strong linear correlation between the articular surface diameter and thickness (r = 0.696, p = 0.001), with a linear regression relationship of thickness = 0.357 × diameter + 1.615. The AP/SI articular surface diameter ratio averaged 0.93 ± 0.03; the articular surface thickness/radius of curvature ratio, 0.77 ± 0.05; the surface arc, 153° ± 5.6°; the inclination angle, 133° ± 3.1°; and the retroversion angle, 22.6° ± 10.2°. The medial and posterior offsets averaged 6.3 ± 0.9 mm and 0.4 ± 0.78 mm, respectively; the SI and AP lengths, 30.15 ± 3.70 mm and 20.35 ± 2.56 mm; and the SI and AP radii, 23.49 ± 2.48 mm and 25.54 ± 3.07 mm. Compared with the Western population, the Chinese cohort had a smaller radius of curvature (p < 0.001), smaller articular surface diameter (p = 0.009), larger articular surface thickness/radius of curvature ratio (p < 0.001), larger surface arc (p < 0.001), smaller inclination angle (p < 0.001), and smaller posterior offset (p < 0.001). Unlike the Western population, the Chinese population had higher glenohumeral conformity in the coronal plane than in the axial plane. Many manufacturers' shoulder prostheses do not adequately cover the range of humeral head dimensions in our Chinese cohort.
  
  
  CONCLUSIONS
  The geometric parameters of the humeri in the Chinese population differ from those in other populations. These differences have clinical relevance with regard to implant design and arthroplasty technique and likely affect clinical outcomes.
authors.affiliation: 1Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China 2University of Chicago Medical Center, Chicago, Illinois 3Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Illinois 4Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Shi
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Ravella
authors.forename: Jason L
authors.initials: JL
authors.lastname: Koh
authors.forename: Shaobai
authors.initials: S
authors.lastname: Wang
authors.forename: Cailong
authors.initials: C
authors.lastname: Liu
authors.forename: Guoan
authors.initials: G
authors.lastname: Li
authors.forename: Jianhua
authors.initials: J
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods*; D044466:Asian People; D002681:China; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging*; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D008953:Models, Anatomic; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult