Equinoxe® Humeral Reconstruction Prosthesis Marks 10 Years of Advancing Solutions for Complex Proximal Humeral Bone Loss

September 22, 2025

We're proud to announce the 10-year anniversary of the Equinoxe^® Humeral Reconstruction Prosthesis (HRP). Since its release in September 2015, the HRP has been the solution of choice for orthopedic surgeons when treating shoulder arthroplasty patients with a wide range of proximal humeral bone loss.

The Equinoxe HRP was developed to help shoulder specialists treat their most difficult cases, featuring a hyper-modular adaptable design that can be used to address proximal humeral bone loss, accommodating indications such as revision arthroplasty, fracture mal-/non-unions, tumors and resection arthroplasty. These challenging indications have long frustrated shoulder surgeons and patients due to high complication rates and instability associated with previous clinical solutions. Over the past decade, the HRP has set the standard for performance, flexibility, and fixation in these most difficult clinical situations.

"The HRP is the solution I trust for my shoulder arthroplasty patients with significant proximal humeral bone loss," said Stephen Parada, MD, orthopedic surgeon and clinical researcher. "In my experience, its modularity and novel diaphyseal collar design make it uniquely capable of restoring stability and function in even the most complex revision and bone loss cases, while largely eliminating the complication of humeral loosening, which has plagued other clinical solutions, including allograft-prosthetic composites and other endoprostheses."

A Legacy of Evidence-Based Innovation

The HRP design rationale was informed by a CT-based anatomic study and reflects the company's dedication to surgeon-focused, data-driven product development. This anatomic study reported significant variation in humeral anatomy and highlighted the importance of accommodating different proximal and diaphyseal dimensions, which directly influenced the modular sizing and dual-offset design of the HRP with the goal of ensuring fixation and stability. The prosthesis key features include:

• Hyper-modularity to accommodate humeral resection lengths from 50mm to 212.5mm for aTSA procedures and 60mm to 22.5mm for rTSA procedures
• Multiple sizes of anatomically shaped proximal bodies designed to restore rotator cuff insertions and increase deltoid wrapping
• Offset distal stems and diaphyseal collars provided in multiple sizes designed to enhance humeral fixation and ensure a uniform cement mantle thickness
• Numerous suture holes and plasma-coated surfaces to facilitate soft tissue attachment
• Compatibility with hemiarthroplasty, anatomic TSA, and reverse TSA in one unified platform

In short, the HRP was designed not for one type of surgery, but for many types of shoulder reconstruction involving major proximal humeral bone loss.

"Our goal was to create a new type of endoprosthesis that could adapt to virtually any humeral bone loss situation, while setting a new standard for humeral fixation and joint stability," said Chris Roche, Senior Vice President of Extremities. "I am proud of the special product that our surgeon design team and internal team developed. We considered complications that could occur in these challenging bone loss and revision cases, and conceived numerous first-to-world, novel features designed to reduce the occurrence of each complication. Ten years later, surgeons have chosen HRP for over 3,000 patients worldwide with the goal of regaining function, stability, and quality of life."

Largest Study of Its Kind: Clinical Validation

The success of HRP is not anecdotal, it's evidential. Published in the Journal of Shoulder and Elbow Surgery, a multi-center retrospective study of HRP patients remains the largest of its kind and showed for the patients studied:

• Significant improvements in pain and range of motion (ROM)
• Marked improvements in patient-reported outcome measures (PROMs)
• Zero cases of humeral component loosening over a two-year minimum follow-up

"This remarkable device has given us new confidence in treating patients with severe proximal humeral bone loss," said Joseph King, MD, shoulder surgeon and study author. "It's a unique and valuable solution that, in our study, eliminated the complication of aseptic humeral loosening and reduced the occurrence of instability in this challenging patient cohort."

Built on the Shoulders of Innovation

The HRP is part of the wider Equinoxe Shoulder System, which just celebrated its 20th anniversary and is considered one of the most researched shoulder systems in the world, with over 300 peer-reviewed papers and 22,000+ patients enrolled in its registry. The HRP embodies the same design principles and commitment to real-world clinical outcomes.

"We've always believed that innovation means nothing without clinical validation," said Jake Deister, MD, orthopedic surgeon and longtime Exactech collaborator. "The HRP is an example of how we transform clinical need into surgical reality-and then prove it with data. The HRP has no doubt helped my patients, and many others over the past decade restore strength, movement, and life."