Mid-term results of Eclipse total shoulder arthroplasty

Abstract

Aims The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. Methods Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the Oxford Shoulder Score (OSS) at a minimum of five years. Secondary outcomes were ranges of motion and radiological analysis of humeral radiolucency, rotator cuff failure, and glenoid loosening. Results Mean OSS at mean follow-up of 6.67 years (5.0 to 10.74) was 40.12 (9 to 48), with no statistically significant difference between those implanted for a non-OA indication and those for OA (p = 0.056) or time-dependent deterioration between two years and five years (p = 0.206). Ranges of motion significantly improved compared with preoperative findings and were maintained between two and five years with a mean external rotation of 38° (SD 18.1, 0 to 100) and forward elevation of 152° (SD 29.9, 90 to 180). Of those components with radiographs suitable for analysis (n = 83), 23 (28%) were found to have a least one humeral radiolucent line, which were predominantly incomplete, less than 2 mm, and in a single anatomical zone. No humeral components were loose. A radiolucent line was present around 22 (15%) of glenoid components, and 15 (10%) of components had failed. Rotator cuff failure was found in 21 (15%) components. The mean time to either glenoid or rotator cuff failure was greater than three years following implantation. Survivorship was 96.4% (95% CI 91.6 to 98.5, number at risk 128) at five years, and 94.3% (95% CI 88.2 to 97.3, number at risk 76) at seven years, both of which compare favourably with best results taken from available registries. Conclusion Functional and radiological outcomes of the Eclipse stemless TSA are excellent, with no loose humeral components at minimum five-year follow-up. The presence of radiolucent lines is of interest and requires long-term observation but does not impact on the clinical results. Of the eight revisions required, this was predominantly for glenoid and rotator cuff failure. Cite this article: Bone Joint J 2022;104-B(1):83–90.

Short-term survival and patient-reported outcome of total stemless shoulder arthroplasty for osteoarthritis are similar to that of stemmed total shoulder arthroplasty: a study from the Danish Shoulder Arthroplasty Registry

“… 15 Batten et al included 143 stemless TSA and reported a 5-year implant survival rate of 0.96. 1 Loosening was a rare indication for revision, and the cementless metaphyseal fixation does not seem to have a negative effect on the short-term arthroplasty survival.…”

Mid-Term to Long-Term Follow-Up of Stemless Anatomic Total Shoulder Arthroplasty

“… 1 Conventional anatomic TSA aims to reproduce glenohumeral kinematics with a stemmed humeral component and pegged and/or keeled glenoid components that restore anatomy and centre-of-rotation. Stemmed humeral components remain the gold standard, 2 though over the past decades, manufacturers have shortened stems to reduce risks of malpositioning, loosening and periprosthetic fractures. 3 This led to development of stemless humeral components that restore proximal humeral anatomy without reaming the humeral diaphysis.…”

“…3,4,[6][7][8] There are few studies and registries that report mid-term to long-term outcomes after stemless TSA, and information on functional outcomes and implant longevity are therefore lacking. 2,4 The purpose of this study was to report mid-term to long-term clinical outcomes in a multicentre series of patients who received stemless TSA. The hypothesis was that stemless TSA would be a safe and effective treatment with satisfactory mid-term to long-term clinical outcomes.…”

“…3 This led to development of stemless humeral components that restore proximal humeral anatomy without reaming the humeral diaphysis. 1 Since their introduction in 2004, stemless humeral components gained increasing popularity, 2 as theoretical advantages over their stemmed counterparts include improved accuracy of anatomic reconstruction and bone preservation, with reduced rates of periprosthetic humeral shaft fractures, stress shielding, surgical time, and blood loss. [3][4][5][6] Moreover, stemless components are easier to revise because they preserve the humeral canal.…”

Mid- to long-term clinical outcomes after press-fit short stem reverse shoulder arthroplasty

“…Stemmed humeral components remain the gold standard in total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). 4 Compared to first-generation implants, manufacturers have short stems in subsequent generations, 2 , 13 with the aim to reduce risks of malpositioning, loosening, and periprosthetic fractures. 14 Recent years have seen a rise in the use of uncemented, press-fit short stems, <10 cm long, 9 as their potential benefits include shorter surgery times, better bone stock preservation in cases of revision, and easier access in shoulders with substantial humeral deformity.…”