Stemless anatomic total shoulder arthroplasty: a systematic review and meta-analysis

Liu, Eva Y.; Kord, Dorsa; Horner, Nolan S.; Leroux, Timothy; Alolabi, Bashar; Khan, Moin

doi:10.1016/j.jse.2019.12.022

Cited by 63 publications

(61 citation statements)

References 34 publications

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“…Shoulder arthroplasty was introduced by Neer et al [ 5 ]; from that date prosthesis design has evolved during time to better reproduce and accommodate the individual shoulder anatomy and variability[ 3 , 6 ]. During this evolution, implants have transitioned to shorter humeral stem lengths or even stemless components.…”

Section: Introductionmentioning

confidence: 99%

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Chillemi¹,

Paglialunga

Giorgi

et al. 2021

WJO

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BACKGROUND Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world’s population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components. AIM To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis. METHODS This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR. RESULTS In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case. CONCLUSION HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.

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Section: Introductionmentioning

confidence: 99%

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Chillemi¹,

Paglialunga

Giorgi

et al. 2021

WJO

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“…These range of motion improvements are clinically comparable to findings seen at 2 years of follow-up with other modern stemless and stemmed shoulder arthroplasty systems. 6,13,15,35,55 However, without a direct comparison group, we cannot comment on if the elliptical humeral head component used in this patient cohort afforded any clinical benefit compared with other prosthetic designs.…”

Section: Discussionmentioning

confidence: 94%

Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages

Goldberg

Baranek

Korbel

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Stem-free shoulder arthroplasty has recently been shown to have comparable results to stemmed arthroplasty, though stemless designs are typically used in a younger patient population. Additionally, although the native humeral head is elliptical in shape, clinical results with ellipsoid implants in shoulder arthroplasty have not been reported on previously. This case series reports on the outcomes of a recently introduced anatomic total shoulder arthroplasty with an ellipsoid-shaped articular surface and unique multiplanar platform type of stemless fixation. Methods: This retrospective case series examines the initial cohort of patients who received an anatomic total shoulder arthroplasty using an ellipsoid stem-free humeral prosthesis and an all-polyethylene glenoid component from the Catalyst CSR Total Shoulder System (Catalyst OrthoScience) over a 1-year period. Inclusion criteria were patients with a diagnosis of advanced glenohumeral joint arthritis with an intact rotator cuff, regardless of patient age. Clinical outcomes including shoulder range of motion and patientreported outcome measures, as well as radiographs, were evaluated at multiple time points postoperatively, with minimum 2-year follow-up. Results: Sixty-three shoulders in 57 patients with a mean age of 73.0 years (range 60-85 years) were included in the study with a mean follow-up period of 30.5 months (range 24-41 months). Forward elevation improved from 121 to 150 (P < .0001), external rotation improved from 28 to 48 (P < .0001), and internal rotation improved from L3 to L1 (P < .001). There were statistically significant improvements exceeding the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score (37 to 94, P <.001), Single Assessment Numeric Evaluation (SANE) (40 to 93, P <.001), visual analog scale (6.3 to 0.4, P < .001), and Patient-Reported Outcomes Measurement Information System physical domain T score (44 to 57, P < .001). The improvement in the ASES score also exceeded the threshold for the substantial clinical benefit. Age, sex, and preoperative glenoid morphology did not appear to have an effect on the clinical outcome scores. There were no implant failures or evidence of radiographic loosening of the humerus component in any patients. Conclusion: At 2-year minimum follow-up, this stem-free ellipsoid humerus total shoulder arthroplasty provides very good results with high patient satisfaction, clinical improvement in all outcome measures studied, and no signs of loosening.This study was reviewed by the Western Institutional Review Board IRB Affairs Department (IRB no. 1-1231172-1) and it was found that this research met the requirements for a waiver of consent under 45 CFR x 46.104(d)(4).

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“…No early humeral component failure was reported in the anatomical stemless TSA systematic review. 21 Several factors could account for this difference including the constrained nature of the reversed stemless implant, increased forces on the humeral component, and the potential for bony impingement. Nevertheless, these are early results from a limited number of studies and more information is needed on the performance of stemless implants in poor bone quality cases.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a previous meta-analysis on stemless anatomical TSA found operative times and blood loss to be significantly shorter and lower in the stemless group. 21…”

Section: Discussionmentioning

confidence: 99%

Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results

et al. 2021

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Introduction Stemless reverse total shoulder arthroplasty is used to treat rotator cuff deficient arthropathies, rheumatoid arthritis, and osteoarthritis. It has several advantages over the stemmed implant including preservation of bone stock, reduced surgical time, and easier revision. Methods A systematic search was conducted in MEDLINE, EMBASE, PubMed, and CENTRAL to retrieve all relevant studies evaluating stemless reverse total shoulder arthroplasty. Results The literature search identified 1993 studies out of which 7 studies were included in this review; 324 patients underwent stemless reverse total shoulder arthroplasty with a weighted mean age of 74.1 (SD = 8.6, range = 38 to 93) years and a weighted mean follow-up time of 44 (SD = 6.6, range = 3 to 95) months. The included studies reported significant improvements in range of motion and functional scores comparable to stemmed reverse total shoulder arthroplasty. The weight mean flexion and abduction was (135 ± 12)° and (131 ± 12)° post-operatively, respectively. The weighted mean constant score increased from (26.7 ± 5.2) Patients (pts) to (63.0 ± 8.0) pts post-operatively. Overall complication and revision rate were 12.3% and 5.2%. Conclusion Early and mid-term results indicate stemless reverse total shoulder arthroplasty has similar clinical outcomes to stemmed reverse total shoulder arthroplasty. There was no radiological evidence of humeral loosening at the latest follow-up.

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Stemless anatomic total shoulder arthroplasty: a systematic review and meta-analysis

Cited by 63 publications

References 34 publications

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages

Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results

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