Stemless shoulder arthroplasty: review of short and medium-term results

Abstract

BackgroundThe number of anatomic total shoulder (TSA), hemiarthroplasty (HA), and reverse total shoulder arthroplasties (RTSA) is rapidly increasing in the United States. Stemless shoulder arthroplasty has numerous theoretical advantages, including preserved bone stock, decreased operating time, reduced rate of intraoperative humerus fracture, and flexibility of anatomic reconstruction. Only recently studies with more than 5 years of mean follow-up have become available.MethodsThe MEDLINE database was systematically queried to identify all studies reporting outcomes regarding anatomic or reverse stemless shoulder arthroplasty. Studies were categorized according to mean reported follow-up. Outcome scores and range of motion measurements were compiled. Complication and revision rates due to failure of the humeral or glenoid components were summarized.ResultsNineteen TSA and HA studies with a total of 1115 patients were identified, with 4 studies and 162 patients with a mean follow-up between 60 and 120 months. Six RTSA studies with a total of 346 patients were identified, all with a mean follow-up between 18 and 60 months. There was a reliable improvement in outcomes compared with preoperative scores across studies. A cumulative 0.7% (8 of 1115) humeral component complication rate was found for TSA and HA components. There was a cumulative 1.7% (6 of 346) humeral complication rate for RTSA prostheses.ConclusionsIn the studies reporting similar outcome measures, there were reliable improvements on par with stemmed counterparts. Aggregate complication rates appear similar to those published in the literature for stemmed components. Evidence supporting the utility and safety of stemless designs would be strengthened by longer-term follow-up and additional prospective comparative studies.

Revision of a Stemless Anatomic Implant into a Stemless Reverse Implant

“…With very good clinical results, the clinical outcome of our patient is comparable to the outcome of primary reverse arthroplasty or revision surgery [ 2 – 9 , 14 – 17 ]. The radiological results show a good short-term follow-up; the long-term survivorship has to be waited for.…”

“…All actually published studies on stemless reverse shoulder arthroplasty are showing the results of the Biomet TESS implant. According to Upfill-Brown et al [ 17 ], all those studies show good results in the clinical scores and radiological outcome. For the LIMA SMR stemless implant, no clinical results are published up to now.…”

Glenoid Component Loosening in Anatomic Total Shoulder Arthroplasty: Association between Radiological Predictors and Clinical Parameters—An Observational Study

“…Both the constant score and a patient-reported outcome (SSV) in our population decreased between two and five years follow-up after showing continuously improving scores for the first two years postoperatively. Looking at the current literature, most studies on mid-term stemless aTSA outline a comparison between preoperative and postoperative status, without describing performance over time at several follow-up points [ 41 ]. One explanation for worsening outcome scores after two years in our population may be that, in a relevant number of cases, a high grade of loosening caused functional deterioration and pain.…”

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

“…There is also a lower risk of periprosthetic bone fractures as stemless designs do not require broaching and they also reduce stress shielding by the implant. 2 Moreover, stemless implants allow for flexibility with respect to alignment particularly when the humeral diaphysis is altered or in cases of fracture sequalae and malunion. 1 While there are numerous advantages associated with stemless implants, there are potential risks due to the constrained nature of the implant and increased forces on the humeral component.…”