Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy

Abstract

Background: It is unclear whether stemless shoulder prosthesis lead to better clinical outcomes than conventional stemmed shoulder prosthesis. The purpose is to compare clinical outcomes and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis. Method: All studies comparing the constant score (CS), range of motion (ROM), and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis were included. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through March 31, 2019. No restrictions were placed on language of publication. Results: A total of 6 studies met the inclusion criteria and were analyzed in detail. Overall postoperative ROM (95% CI: 3.27 to 11.92; P < .01) was significantly greater for stemless prosthesis compared to conventional stemmed prosthesis. However, postoperative CS (95% CI: −2.98 to 7.13; P = .42) and complication rates (OR 1.22, 95% CI: 0.48–3.08; P = .68) were did not differ significantly between the 2 groups. Conclusion: This meta-analysis revealed that postoperative CS and complication rates did not differ significantly between the 2 treatment methods, stemless shoulder prosthesis and conventional stemmed shoulder prosthesis, for shoulder arthropathy. However, stemless shoulder prosthesis resulted in better outcomes than conventional stemmed shoulder prosthesis in terms of postoperative ROM. Level of evidence: Level III, Therapeutic study.

Recent Advances in the Design and Application of Shoulder Arthroplasty Implant Systems and Their Impact on Clinical Outcomes: A Comprehensive Review

“…They reported that while postoperative constant scores (Mean difference, (MD):2.07, p=0.42) and complication rates (Odds ratio (OR) 1.22, p=0.68) did not significantly differ between stemmed and stemless shoulder arthroplasty, stemless implants demonstrated better forward elevation (MD:9.39, p=0.04) and external rotation (MD:4.63, p=0.04) post-operation. 41 However, the study was unable to determine if there was a significant difference in pre-operative range of motion as well, which could contribute to the difference found post-operatively. In contrast, Dasari et al 12 found no significant difference in forward flexion (MD=0,24, p=0.92) or external rotation (MD=3.31, p=0.05) between stemmed and stemless implants in their meta-analysis of 5 clinical studies with a total of 584 patients.…”

“…Short-stem implants were designed to compress the cancellous bone of the proximal metaphysis with the advantage of preserving bone stock and reducing risk of stress shielding and periprosthetic fractures. 41 However, concerns have been raised regarding potential malalignment and adverse bone reactions associated with short-stem implants. Short stems that fail to engage the cylindrical portion of the endosteal canal can potentially become misaligned and alter humeral head positioning.…”

“…However, a disadvantage of stemless implants in both TSA and RSA is that they require good bone quality, making them less suitable for elderly patients and those with osteoporotic bone. 41 A meta-analysis conducted by Shin et al included 122 subjects with stemless implants and 122 patients with stemmed implants. They reported that while postoperative constant scores (Mean difference, (MD):2.07, p=0.42) and complication rates (Odds ratio (OR) 1.22, p=0.68) did not significantly differ between stemmed and stemless shoulder arthroplasty, stemless implants demonstrated better forward elevation (MD:9.39, p=0.04) and external rotation (MD:4.63, p=0.04) post-operation.…”

Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature

“…Though less common, traditional stemmed aTSA has been associated with stress shielding resulting from proximal humeral bone resorption, implant loosening, and intraoperative humeral periprosthetic fractures. 28 , 35 Due to recent advancements, stemless aTSA has become a promising option for the treatment of degenerative shoulder disease in patients with an intact rotator cuff and sufficient humeral bone stock. At the present moment, current investigations propose significant improvement in functional outcomes with similar complication and revision rates when compared with stemmed-implants.…”