This retrospective cohort introduces the Humeral Bone Loss (HUMBL) classification, a 5-pattern radiograph-based system for primary and revision shoulder arthroplasty. It asks whether more severe bone loss patterns predict worse outcomes. Outcomes measured were all-cause revision, instability, and humeral loosening across 1,083 shoulders.
When you read a preop shoulder arthroplasty radiograph, sort the humeral bone loss into one of 5 HUMBL patterns, because severity predicts what will fail.
The key new concept is ectatic bone loss: a pathologically widened endosteal canal that cannot hold a standard implant and lacks metaphyseal bone for a solid cement interface. Recognize it and plan for an APC or megaprosthesis, not a routine stem.
The most testable mental model mirrors the hip. Ectatic humeral loss is the shoulder analog of Paprosky type IV femoral deficiency, and it carries the worst prognosis at 46% five-year survival free of loosening. Also useful: isolated greater tuberosity compromise raises instability but not loosening, so an intact medial calcar keeps height restoration and fixation straightforward.
This is a Level III prognostic study from three high-volume revision surgeons, so the very low complication rates in intact bone may not generalize to lower-volume practice, and it stops short of giving a treatment algorithm.
This retrospective cohort introduces the Humeral Bone Loss (HUMBL) classification, a 5-pattern radiograph-based system for primary and revision shoulder arthroplasty. It asks whether more severe bone loss patterns predict worse outcomes. Outcomes measured were all-cause revision, instability, and humeral loosening across 1,083 shoulders.
When you read a preop shoulder arthroplasty radiograph, sort the humeral bone loss into one of 5 HUMBL patterns, because severity predicts what will fail.
The key new concept is ectatic bone loss: a pathologically widened endosteal canal that cannot hold a standard implant and lacks metaphyseal bone for a solid cement interface. Recognize it and plan for an APC or megaprosthesis, not a routine stem.
The most testable mental model mirrors the hip. Ectatic humeral loss is the shoulder analog of Paprosky type IV femoral deficiency, and it carries the worst prognosis at 46% five-year survival free of loosening. Also useful: isolated greater tuberosity compromise raises instability but not loosening, so an intact medial calcar keeps height restoration and fixation straightforward.
This is a Level III prognostic study from three high-volume revision surgeons, so the very low complication rates in intact bone may not generalize to lower-volume practice, and it stops short of giving a treatment algorithm.