Humeral Bone Loss (HUMBL) is commonly encountered in primary and revision shoulder arthroplasty and can lead to complications including humeral loosening or instability. The HUMBL classification categorizes bone loss into 5 major patterns of increasing severity: 1) Intact/No substantial bone loss (including bone compromised by prior implants/hardware or abnormal bone quality) 2) isolated greater tuberosity loss or compromise (including acute fracture, nonunion and malunion) 3) segmental bone loss (bone loss distal to the surgical neck) 4) ectatic bone loss (expansion of the cortex compared to an intact segment) and 5) humeral discontinuity (separation of the humeral shaft from a prior implant or where a new implant would be placed). The purpose of this study was to describe patterns of bone loss in primary and revision shoulder arthroplasty and stratify outcomes based on bone loss pattern.
The HUMBL classification demonstrates that certain patterns of bone loss are associated with increased rates of reoperation, instability, and humeral loosening. The presence of ectatic bone loss, not previously described in shoulder arthroplasty, led to high rates of revision, instability, and humeral loosening.
Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study. Copyright remains with the authors and publisher.
Humeral Bone Loss (HUMBL) is commonly encountered in primary and revision shoulder arthroplasty and can lead to complications including humeral loosening or instability. The HUMBL classification categorizes bone loss into 5 major patterns of increasing severity: 1) Intact/No substantial bone loss (including bone compromised by prior implants/hardware or abnormal bone quality) 2) isolated greater tuberosity loss or compromise (including acute fracture, nonunion and malunion) 3) segmental bone loss (bone loss distal to the surgical neck) 4) ectatic bone loss (expansion of the cortex compared to an intact segment) and 5) humeral discontinuity (separation of the humeral shaft from a prior implant or where a new implant would be placed). The purpose of this study was to describe patterns of bone loss in primary and revision shoulder arthroplasty and stratify outcomes based on bone loss pattern.
The HUMBL classification demonstrates that certain patterns of bone loss are associated with increased rates of reoperation, instability, and humeral loosening. The presence of ectatic bone loss, not previously described in shoulder arthroplasty, led to high rates of revision, instability, and humeral loosening.
Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study. Copyright remains with the authors and publisher.