Mid-term results of anatomical total shoulder arthroplasty for primary osteoarthritis using a short-stemmed cementless humeral component

Abstract

Total shoulder arthroplasty using a short-stem humeral component resulted in good clinical outcomes with no evidence of loosening. However, approximately 40% of the shoulders developed substantial bone loss in the proximal humerus at between four and seven years of follow-up. Cite this article: Bone Joint J 2018;100-B:603-9.

Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis

“…However, our quantitative analysis also demonstrated that severe forms (>50%) were quite rare (7.1%). This rate seemed to be lower than the rates reported with the first-generation stem (without a proximal mantle of porous titanium) 2 , 4 , 11 , 17 , 18 , 20 , 23 . In fact, the addition of a porous coating to the second-generation stem (Ascend Flex) allowed better bony ingrowth and metaphyseal fixation.…”

“…To date, 5 publications have focused on the second-generation Ascend Flex stem (with porous coating), 11 , 14 , 19 , 21 , 23 with reported rates of visible calcar osteolysis ranging from 3% to 42%. These osteolysis phenomena are usually described using a classic 5-zone system, without quantitative analysis (only qualitative) and without differentiation between the different types of adaptations 2 , 4 , 5 , 7 , 11 , 16, 17, 18, 19, 20, 21 , 23 . The authors classically reported the presence or absence of several types of bone remodeling (cortical narrowing, spot welds, condensation lines, and so on) in each of the 5 zones around the stem and then classified each patient as having “low adaptation” or “high adaptation.” In our study, we decided to describe these phenomena differently, by converting the 5-zone system into a 3-type system (MCN, MMT, and LMT), using ratios to evaluate bone narrowing.…”

Short-stem anatomical shoulder replacement—a systematic review

“…The studies by Romeo et al [21] and by Denard et al [9] are included in the analysis. One longitudinal study by Schnetzke et al [25] that reported on the outcome at two different time points (2.6 and 5.3 years) was included. The other studies included one final follow-up without a direct longitudinal comparison with the same cohorts at previous time points.…”

Cemented all-polyethylene glenoid with standard or individualized backside curvature

“…Owing to greater life expectancy combined with a high functional requirement, the number of primary and revision procedures will increase further in the future [25]. Various systems of stemless or short-stem prostheses have been successfully introduced onto the market in recent years to simplify revision procedures [31]. However, the weak link of anatomic shoulder replacement is not the stem but the glenoid component.…”

“…Revision of standardstem prostheses is challenging and frequently associated with relevant bone loss from the proximal humerus [1,4]. Developments in recent years have therefore focused primarily on the humeral portion of shoulder prostheses and have resulted in the introduction of the fourth generation of shoulder prostheses with stemless and short-stem prostheses with metaphyseal anchoring [13,[29][30][31].…”