Functional midterm follow-up comparison of stemless total shoulder prostheses versus conventional stemmed anatomic shoulder prostheses using a 3D-motion-analysis

Abstract

BackgroundThe aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with standard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion (ROM) and Constant score (CS).MethodsSeventeen patients underwent total shoulder arthroplasty (TSA) in 25 shoulder joints. Stemless TSA was performed in 12 shoulder joints (group STEMLESS), third-generation stemmed TSA in 13 shoulder joints (group STEMMED). Functional results were documented using the CS. 3D-motion-analysis using the Heidelberg upper extremity model (HUX) was conducted to measure active maximum (ROM).ResultsThe group STEMLESS achieved a CS of 67.9 (SD 12.0) points and the group STEMMED of 70.2 (SD 5.8 points) without significant difference between the groups (p = 0.925). The maximum ROM of the group STEMLESS, ascertained by 3-D-motion-analysis, was in forward flexion 125.5° (SD 17.2°), in extension 49.4° (SD 13.8°), in abduction 126.2° (SD 28.5°) and in external rotation 40.3° (SD 13.9°). The maximum ROM of the group STEMMED, also ascertained by 3-D-motion analysis, was in forward flexion 135.0° (SD 16.8°), in extension 47.2° (SD 11.5°), in abduction 136.3° (SD 24.2°) and in external rotation 40.1° (SD 12.2°). The maximum ROM of the STEMLESS group was lower in forward flexion and abduction, higher in extension and almost identical in external rotation. But there was no significant difference (forward flexion p = 0.174, extension p = 0.470, abduction p = 0.345, external rotation p = 0.978).ConclusionBoth types of shoulder prostheses achieve a similar and good active ROM and similar results in CS.Trial registration DRKS00013166, retrospectively registered, 11.10.2017

The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis

“…Eight studies with a total of 347 shoulders (investigative group, 172 prostheses; control group, 175 prostheses) were presented in this meta-analysis. Four studies [3, 11, 13, 15] were performed in Germany, and the remaining 4 studies were from Switzerland [14], Austria [12], Italy [10], and Canada [16]. The publication years were from 2013 to 2017.…”

“…Four studies [3, 11, 13, 15], including 171 shoulders (slTSA, 85 shoulders; sTSA, 86 shoulders), reported pain scores for these two shoulder prostheses. A fixed-effects model was used for synthesis of results because there was no statistical heterogeneity ( P = 0.726 and I 2 = 0%).…”

“…Six studies [3, 11–13, 15, 16] reported the results for strength of the slTSA and sTSA groups, comprising 254 shoulders (slTSA, 126 shoulders; sTSA, 128 shoulders), and the test for heterogeneity was not significant ( P = 0.118; I 2 = 43.1%). Thus, a fixed-effects model was used.…”

“…Regarding the activities of daily living, four studies [3, 11, 13, 15] analyzed their improvement after TSA using two different prostheses. We did not detect statistical heterogeneity ( P = 0.750 and I 2 = 0).…”

Patient reported outcome after stemmed versus stemless total shoulder arthroplasty for glenohumeral osteoarthritis: a patient-blinded randomized clinical trial

“…Stemless TSA has several theoretical advantages over stemmed TSA: restoring patients' anatomy (humeral shaft angle, humeral head diameter, and lateralization); preserving humeral bone stock, and few complications in component removal should the need of a revision arthroplasty arise [7][8][9]. A recent review of 3,360 anatomical total shoulder arthroplasties found an overall complication rate of 10.3% [9].…”