A Comparison of Operative Time and Intraoperative Blood Volume Loss Between Stemless and Short‐stem Anatomic Total Shoulder Arthroplasty: A Single Institution's Experience

Abstract

Introduction: There has been increasing interest in the use of stemless humeral implants for total shoulder arthroplasty when compared with both short-stem (SS) and standard-length implants. Although evidence for decreased surgical time and blood loss exists for stemless versus standard-length stems, far less literature exists comparing these clinical parameters for stemless versus SS implants. Methods: A retrospective review of consecutive anatomic total shoulder arthroplasty (aTSA) cases conducted by a single, fellowshiptrained shoulder surgeon was undertaken from January 2016 through January 2022 with the exception of March 2020 through January 2021 secondary to the COVID-19 pandemic. Demographic patient and surgical data, including age, sex, body mass index, American Society of Anesthesiologists score, age-adjusted Charlson Comorbidity Index, prior ipsilateral shoulder arthroscopy, surgical time, use of a Hemovac drain and/or tranexamic acid, hospital length of stay (LOS), and both postoperative day #1 (POD 1) and discharge visual analog scores. The use of a stemless or SS implant was recorded. Intraoperative total blood volume loss (TBVL) was calculated, in addition to the need for either intraoperative or postoperative transfusions. Nonparametric analysis of covariance was used to examine effects of stemless versus SS aTSA on surgical time and intraoperative TBVL adjusted for demographic, clinical, and surgical variables. Results: There were 47 SS and 83 stemless anatomic implants included, of which 74 patients (57%) overall were women. The median surgical time for the stemless cohort was 111 minutes (IQR 96-130) versus 137 minutes (IQR 113-169) for the SS cohort (P , 0.00001). The median intraoperative TBVL for the stemless cohort was 298.3 mL ) versus 359.7 mL (IQR 253.9-415.0) for the SS cohort (P = 0.05). After multivariable regression analysis, use of

The Relationship Between Preoperative International Normalized Ratio and Postoperative Major Bleeding in Total Shoulder Arthroplasty

“…Previous studies have demonstrated an average intraoperative blood loss of approximately 350 mL in TSA procedures. 20 , 21 When accounting for postoperative blood loss, the overall blood loss after TSA is approximately 850 mL. 21 Blood transfusions carry associated risks of allergic reaction, infection, cardiovascular dysfunction, and disease transmission.…”

Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain

“…Gruson et al showed reduced pain at the time of discharge after stemless with a VAS of 0 in 83 patients compared to 4 in the short stem cohort of 47 patient which was associated with a reduced length of stay in the hospital. 4 In a study of 203 stemless aTSAs, 354 short stem aTSAs and 1159 traditional length stem aTSAs, Labrum et al stratified postoperative pain scores by stem type. 11 The authors found no differences in postoperative pain between any cohort across all pain metrics recorded during the first 3 months postoperatively.…”

“…Compared to stemmed implants, stemless anatomic implants have similar implant longevity and PRO’s. 1 , 14 , 15 , 22 , 24 , 26 However, stemless implants have been shown to result in less intraoperative blood loss, 4 reduced surgical time, 4 , 5 a lower rate of intraoperative fractures, 28 and improved center of rotation restoration. 21 …”

Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis

“…Unlike lower extremity surgery, tourniquets cannot be used for shoulder arthroscopic surgery. In comparison, the methods of reducing intraoperative bleeding mainly rely on controlled blood pressure reduction and plasma radiofrequency hemostasis, and a large amount of normal saline irrigation is required during the operation [ 3 , 4 ]. Swelling of the shoulder joint, more wound exudation, and subcutaneous blood stasis often occur after surgery.…”