Are there differences between stemless and conventional stemmed shoulder prostheses in the treatment of glenohumeral osteoarthritis?

Abstract

BackgroundConventional stemmed anatomical shoulder prostheses are widely used in the treatment of glenohumeral osteoarthritis. The stemless shoulder prosthesis, in contrast, is a new concept, and fewer outcome studies are available. Therefore, the purpose of the study was to investigate the early functional outcome and postoperative proprioception of a stemless prosthesis in comparison with a standard stemmed anatomic shoulder prosthesis.MethodsTwelve patients (mean age 68.3 years [SD ± 5.4]; 5 female, 7 male) with primary glenohumeral osteoarthritis of the shoulder were enrolled, who underwent total shoulder arthroplasty (TSA) with a stemless total shoulder prosthesis, Total Evolution Shoulder System (TESS®; Biomed, France). The control group consisted of twelve (age and gender matched) patients (mean age 67.8 years; [SD ± 7.1]; 9 female, 3 male), getting a TSA with a standard anatomic stemmed prosthesis, Aequalis® Shoulder (Tournier, Lyon, France). Patients were examined the day before and six months after surgery. The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.ResultsComparing the postoperative CS, there was no significant difference between the groups treated with the TESS® prosthesis (48.0 ± 13.8 points) and the Aequalis® prosthesis (49.3 ± 8.6 points; p = 0.792). There was no significant difference in postoperative proprioception between the TESS® group (7.2° [SD ± 2.8]) and the Aequalis® group(8.7° [SD ± 2.7]; p = 0.196), either. Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.DiscussionIn patients with glenohumeral osteoarthritis, treated with TSA, the functional and the proprioceptive outcome is comparable between a stemless and a standard stemmed anatomic shoulder prosthesis at early followup.ConclusionFurther follow-up is necessary regarding the long-term performance of this prosthesis.Trial registrationCurrent Controlled Trials DRKS 00007528. Registered 17 November 2014

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%).…”

Cementless humeral head resurfacing for degenerative glenohumeral osteoarthritis fails at a high rate

“…In our practice, we found similar results to Churchill et al with a metaphyseal fixed humeral prosthesis. 26 Therefore, we decided in our practice, that we prefer a metaphyseal fixed anatomical shoulder prosthesis to the CUP-Prosthesis, especially for young patients, considering the dramatic results of the CUP in patients under 55 years.…”

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

“…As the anatomical TSA has shown quite successful results in reducing pain and improving function when performed in patients with glenohumeral osteoarthritis (OA) and an intact rotator cuff it is the golden standard in surgical treatment. [ 1 , 2 ]. However, stem-related complications, which include such as bone stock loss, stress shielding, intraoperative and postoperative periprosthetic fractures, mal-positioning of the humeral head component relative to the metaphysis, and in situations of infection difficulty with stem and cement extraction [ 3 – 6 ], have been described in several studies.…”

“…Therefore, stemless shoulder prostheses, such as the Total Evolution Shoulder System (TESS®; Biomed, France) have been developed to reduce these stem-related complications [ 3 ]. Today, different models of stemless TSA are available and increasingly used, but studies about their clinical results are rare [ 2 , 7 – 11 ]. The aim of this study is to investigate the clinical midterm outcome of stemless TSA in comparison with a standard anatomical TSA.…”