Humeral bone loss is common in revision shoulder arthroplasty, but no reliability-tested system existed to describe it. This study built the PHAROS classification from plain radiographs and tested its reliability. It also asked whether the bone loss type predicts the reconstruction a surgeon will need.
When you plan a revision shoulder arthroplasty, the amount and location of humeral bone loss dictates your reconstruction. PHAROS gives you a shared language for that from plain films alone.
Use the deltoid attachment as your mental landmark. Loss above it (Type 1 or 2) usually still allows a standard or longer stem with possible tuberosity repair. Loss extending below it (Type 3) signals you may need proximal or total humeral replacement.
When both the calcar and greater tuberosity are gone (Type 2A or worse), you have lost your height landmarks. Get bilateral full-length humeral radiographs to set prosthesis height and avoid undertensioning and instability.
Type 1G (irreparable greater tuberosity) rules out anatomic TSA, so plan for a reverse. The system is reliable enough to use but was built by high-volume surgeons at a single center and is not yet validated in general practice or with CT.
Humeral bone loss is common in revision shoulder arthroplasty, but no reliability-tested system existed to describe it. This study built the PHAROS classification from plain radiographs and tested its reliability. It also asked whether the bone loss type predicts the reconstruction a surgeon will need.
When you plan a revision shoulder arthroplasty, the amount and location of humeral bone loss dictates your reconstruction. PHAROS gives you a shared language for that from plain films alone.
Use the deltoid attachment as your mental landmark. Loss above it (Type 1 or 2) usually still allows a standard or longer stem with possible tuberosity repair. Loss extending below it (Type 3) signals you may need proximal or total humeral replacement.
When both the calcar and greater tuberosity are gone (Type 2A or worse), you have lost your height landmarks. Get bilateral full-length humeral radiographs to set prosthesis height and avoid undertensioning and instability.
Type 1G (irreparable greater tuberosity) rules out anatomic TSA, so plan for a reverse. The system is reliable enough to use but was built by high-volume surgeons at a single center and is not yet validated in general practice or with CT.